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Health plan grows for working poor
By SHEILA BEACHUM BILBY
Felicia Skinner-Parker remembers first hearing about the Genesee Health Plan (GHP) several years ago while on the job as an interpreter for the deaf.
Then she started noticing billboards around Flint touting the plan, a health benefits program for low-income, uninsured adults in Genesee County.
Finally, curiosity prompted her to call the GHP offices to learn more. By the time she hung up, she vowed that she and her husband, David Parker, would enroll.
The couple signed up shortly after Skinner-Parker gave birth to their daughter, Victoria, in April 2005. What Skinner-Parker didn’t know at the time was that she was about to be dropped from Medicaid, which would have left her without medical coverage six weeks after the birth of their child. Thanks to the GHP, there was no gap.
“If you’re working hard and playing by the rules, you need to get a little help sometimes,” said Skinner-Parker, a Flint native with an associate’s degree in deaf studies and interpreting from Mott Community College.
Skinner-Parker and her husband are among the more than 26,000 uninsured adults who are enrolled in the GHP, supported in part by a voter-approved tax that will pump $11.3 million into the plan each year for the next seven years. That made Genesee the first county in Michigan to implement a tax dedicated to caring for the uninsured working poor.
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.
The GHP covers the cost of basic outpatient medical care for low-income adults ages 19 to 64 who earn up to 175 percent of the federal poverty level, which is $17,000 a year for a single adult or $36,000 a year for a family of four.
Meanwhile, an initial analysis of the plan by Lansing-based Health Management Associates (HMA), a health-care research and consulting firm, largely debunked the myth that it is too costly to provide coverage for the uninsured.
“I think one of the most important things that the analysis shows is that we can afford to cover the uninsured,” said Linda Hamacher, GHP’s executive director.
HMA, supported by grants from the C.S. Mott Foundation, the Ruth Mott Foundation and the Community Foundation of Greater Flint, will continue collecting data over the next two years as part of an ongoing analysis of the GHP and its impact on the local community. After that, the county will collect and analyze data.
The analysis found that while the number of physician visits per member climbed steadily in the first two years after enrollment began in 2002, visits per member declined markedly from 2004 to 2006, falling well below those of a comparable sample of insured county residents.
And people enrolled for two continuous years used fewer health services the second year, but their use of prescriptions increased.
“To us, it’s a clear-cut illustration of the adoption of common practices of using medical services,” said Donna Strugar-Fritsch, a principal with HMA.
“This is how everybody acts who has coverage. People have established a medical ‘home,’ and then their conditions are managed largely by prescriptions.”
In the four years from 2002 to 2006 covered in the analysis, there were 625,250 prescriptions written for members from a narrow list of critically important drugs for problems such as heart disease and diabetes.
From 2004 to 2006, the average cost per prescription decreased by more than $2, to $14.12. By comparison, in 2006 commercial insurance costs averaged around $78 per prescription, and the cost for a generic prescription averaged about $21.
“It’s an example of how people are getting the drugs they need,” Strugar-Fritsch said. “And it doesn’t cost a fortune.”
While the first members to sign up were more medically needy and cost more to treat, those enrolling more recently have fewer serious illnesses and haven’t been uninsured as long, costing fewer dollars. The expense per member per month is less than $44.
Strugar-Fritsch predicts the next wave of members will be even healthier and more like the insured population in how they use health services. That is, they are more likely to seek preventive care before they have a health-care crisis and make an emergency-room visit.
In fact, the analysis shows that emergency-room visits per hundred plan members dropped by more than half from 2003 to 2006, nearing the national average for the insured.
HMA has convened focus groups of GHP members to discuss what impact the plan is having on their lives.
“In the focus groups we held, almost everyone we talked to was employed, or seeking work, or was a student. And nearly all have been unable to work or go to school at some time in the past due to an illness or pain associated with a problem” Strugar-Fritsch said.
“We hear over and over, ‘I’m able to work because of this.’”
Although half of the plan members are employed, many times health benefits aren’t offered or aren’t affordable through their employers.
Such was the case with David Parker, who supports his family working full-time as a nurse’s aide in a Fenton nursing home while he attends MCC. He hopes to become either a nurse or a radiology technician.
“If I bought insurance through my employer, I couldn’t make it,” Parker said.
He said it would have cost him $300 a month for health coverage through his employer. With GHP, his family pays a small co-payment for office visits and $1 to $3 in co-pays for prescriptions. Their daughter is covered by Medicaid.
The plan proved its worth after Parker's wife developed chronic acid reflux, resulting in the removal of polyps, which tested benign. Skinner-Parker now is able to control the condition through her diet and is off medication.
She and her husband encouraged family and friends to support the 1-mill tax that voters approved in November 2006 by a margin of 54 to 46 percent.
“Everybody knew somebody without coverage -- a friend, a neighbor, a child -- and voters viewed it as a good value,” said Robert Pestronk, director of the Genesee County Health Department.
As GHP explores future options, such as how to provide some dental services to members, it was able to implement two new components this year.
The Tri-Share Program, which started April 1, targets employers in Genesee County with up to 20 employees. Coverage for employees earning up to $12 an hour is subsidized by GHP. Tri-Share offers more benefits, including hospitalization, with the employer, employee and GHP each paying $54 a month to cover the insurance premium.
And GHP received a local community mental health grant to contract with a small network of mental-health care providers to help its members who are dealing with depression and anxiety, but who don’t qualify for community mental health services.
“The goal here is to keep these patients with mild mental health disorders from turning into severe mental health disorders,” Hamacher said. “We think that early intervention can prevent that.”
Pestronk sees the health plan -- its goal to cover all 36,500 uninsured adults in the county by the end of 2009 -- as being a vehicle for beginning to solve some basic flaws in the U.S. health-care system.
“We would all benefit if people were able to receive appropriate and timely health care,” he said, “and that includes physical health care, mental health care and dental health care.”