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Low-income families can get basic health care under plan
More than two years ago, Donald Goodrich tipped the scales at 300-plus pounds on his 6-foot frame. He felt like a physical wreck, miserable and rundown.
But as a seasonal worker for the Genesee County Parks and Recreation Department, he had no health insurance. And because money was tight, years went by without Goodrich getting a physical.
But in early 2004, he signed up for the Genesee Health Plan (GHP) after learning about it from friends. The locally managed program provides basic health-care coverage for low-income, uninsured adults who live in Genesee County, Michigan, and who aren’t eligible for Medicaid.
In March of that year, Goodrich visited a physician and was diagnosed with diabetes. The doctor continued his blood pressure medication and gave him another prescription to control his cholesterol. But Goodrich was convinced he could shed enough weight to avoid taking yet another pill to control his diabetes.
“I was so freaked out. I knew all the horror stories,” Goodrich, now 47, recalled of his initial reaction to the diabetes diagnosis. His fiancée and several family members have coped with the disease, so he knew there could be serious long- and short-term consequences.
Despite his physician’s skepticism, Goodrich lost more than 100 pounds over the next six months. He weaned himself off soda pop, which he had been drinking at the rate of more than two liters a day. He traded a diet of fast food and junk food for more fruits, vegetables and less fatty foods. And he started walking up to five miles daily. The result was he has controlled his diabetes without medication.
Besides what he describes as his “common-sense” approach to taking control of his health, the Flint father of two attended diabetes education classes through GHP’s disease-management and wellness program.
Michigan has 26 community-sponsored health plans covering 71 of the state’s 80 counties. The GHP is now the second largest. Its membership has almost doubled — to 21,000 low-income adults aged 19 to 64 — since last year. It paid more than $10.5 million in medical claims during 2005.
“We have absolutely phenomenal, remarkable, measurable results in this plan,” said Linda Hamacher, GHP’s executive director.
GHP’s goal is to make basic health care accessible by 2008 to all uninsured adults in Genesee County whose incomes are below 200 percent of the federal poverty level. There are now about 36,500 uninsured adults in the county. If the goal is achieved, Genesee would be among the first counties in the nation to make basic health care available to all of its uninsured low-income residents.
An initial $170,000 planning grant by the Mott Foundation to the Greater Flint Health Coalition supported the development and launch of the plan in late 2001. A $1.2-million grant in 2004 to the Genesee County Health Department supported expansion of the plan.
In 2005, Mott gave a $276,512 grant to Health Management Associates of Lansing to conduct an analysis of how providing basic health-care benefits to uninsured adults affects the community, especially its medical, education and economic systems. The first year-end progress report is due in October.
The Ruth Mott Foundation, located in Flint, provided early support for studies that led to the launch of the GHP. In addition, that foundation has made grants for plan-specific outreach, marketing and advocacy activities, and its formal evaluation.
“What is taking place in Flint through the Genesee Health Plan, like what is taking place in a number of other Michigan communities that have similar programs, is an unprecedented experiment in the United States,” said Jay Rosen, principal for Health Management Associates, a research and consulting firm.
“It’s very uncommon to find highly organized programs for low-income uninsured who aren’t eligible for a mainstream medical assistance program like Medicaid.”
The health plan provides outpatient services for those who have no health insurance and whose incomes are up to 175 percent of the federal poverty level, or $16,700 for an individual and $33,862 for a family of four.
Included in the coverage are office visits to primary-care physicians and specialists, prescription drugs, laboratory tests, radiology, and, as of February 2006, scheduled outpatient services. Members pay $3 to see a physician and $1 for prescriptions. The plan does not cover emergency-room care or hospitalizations.
In addition, the state pays the GHP to provide these services, and a few extras such as mental health and emergency room services, for childless adults who usually are unable to work.
Members can be seen by nurse practitioners for their primary-care needs at the new Urban Health and Wellness Center at the University of Michigan-Flint in downtown Flint, Hamacher said. The center also will provide physical therapy services, a new benefit for members.
The Wellness Center joins more than 180 physicians across the county as well as the Hamilton Health Care Network, a federally funded health system with three clinics, in providing primary medical and specialist care to GHP members.
About 36 percent of the members say their employers don’t offer health-care coverage. Others say they can’t afford the health insurance their employers offer, or they’ve just graduated from college and haven’t landed a job with health benefits yet, or they can’t get enough work hours to qualify for health insurance.
Josh White, a 27-year-old graduate of UM-Flint, is in just that situation.
White, a criminal justice major, graduated in 2001 and quickly landed a full-time job with health insurance as a corrections officer. However, after 18 months, White left to pursue law school or a job in politics.
He now manages a political campaign for a candidate for the state House of Representatives. He also works 30 hours a week for a private company that conducts drug-testing for people on probation or parole.
The Flint resident isn’t eligible for health insurance through work, so he signed up for the GHP in January 2006.
Although he has had only minor health complaints, White said being in the health plan “gives me peace of mind.”
“If I didn’t have this plan available to me,” he said, “I would just have to continue on without health care, and I probably wouldn’t see a doctor because I wouldn’t be able to afford it at the present time.”
The GHP has drawn state and national attention for its disease-management program, which works with its network of physicians to help educate members who have diabetes, heart disease, asthma or chronic pain — the four most prevalent medical diagnoses.
There are 1,119 members enrolled in the disease-management program, up from just 300 in 2005. Trissa Torres, M.D. oversees the program.
“We’ve figured out a way to reach low-income people to get them information on how to self-manage their own chronic disease and how to prevent disease,” she said.
Those with diabetes, for example, are given free glucometers and test strips to check blood sugar levels daily. And there are no co-pays on diabetes medications. In a survey of 357 members with diabetes who have been in the program at least six months, there were significant improvements reported in diets and exercise habits as well as an increase in education about their disease and how to manage it.
That work has not gone unnoticed. The Michigan Legislature in March paid tribute to the disease-management program as a model for focusing on diabetes.
Local, state and federal funds support the health plan, which has an annual operating budget of $16 million for 2006. It costs about $600 a year to cover each member.
“Sustainability is critical,” Hamacher said. “We realize that in the long term that we need to be able to have a steady funding source.”
So in November, Genesee County voters will be asked to vote on a tax millage to support the health plan.
“We’re at a moment right now with the plan where we’ll test, in the most basic way, whether the people of Genesee County want to support medical coverage for themselves as a backstop,” said Robert Pestronk, director of the county health department and vice president of GHP’s 12-member board.
“We want to ensure that, regardless of what happens at the state or the federal level, care will be available for them here.”
Besides the health department, area hospitals, physicians, local medical groups, lawmakers, UM-Flint and the foundation community have helped nurture the GHP.
“I think this has become a model in that the breadth of support among the institutions and agencies in Genesee County is unusually deep and strong,” Rosen said. “It’s really a case where you had all of the key institutions working in concert.”
For Goodrich, there is no disputing the plan’s impact on his life.
“I was a heart attack or stroke waiting to happen,” he said.