Howard County, Md., officials on Tuesday at a news conference unveiled the Healthy Howard program, which aims to provide affordable and coordinated health care to uninsured state residents who are not eligible for state and federal programs, the Baltimore Sun reports (Carson, Baltimore Sun, 10/17).

To be eligible for the program, individuals must have lived in the county for at least one year and must have been uninsured for a year. Residents also cannot be eligible for state or federal health programs and must have incomes lower than 300% of the federal poverty level. Undocumented immigrants are not eligible for the program.

Residents with incomes at or below 200% of the poverty level will contribute $50 per month for coverage, and those with incomes up to 300% of the poverty level will contribute $115 per month. The program is expected to cost $2.8 million in its first year, and residents' contributions will cover about half of the expenses.

Program beneficiaries will be entitled to at least six physician visits per year at the Chase Brexton Health Services community health clinic, hospital care at Howard County General Hospital, and mental health, substance abuse and diagnostic services. The program also will offer prescription drugs at $10 per prescription, with drug costs not to exceed $20 per month (Otto, Washington Post, 10/17).

In addition, beneficiaries will be required to meet with a health coach who will design a wellness plan. Those who do not follow the plan could be put on probation after three months and lose their health benefits after six months (Baltimore Sun, 10/17). The county also will undertake efforts to enroll those eligible but not participating in state and federal health care programs (Washington Post, 10/17).

Comments
County health officer Peter Beilenson said that mandatory preventive care is a fundamental element of the program because, "We feel access to health care is a right, but it's also a responsibility" (Washington Post, 10/17). According to Beilenson, the national health care system is "broken," and the county "decided to step up and be a national model while developing a program to benefit the residents of Howard County." He added, "This is explicitly not insurance and not portable."

Georges Benjamin, executive director of the American Public Health Association, said, "We'll all be watching this experiment," noting, "It's much more comprehensive than what usually gets done anywhere. From that perspective, I think it's unique." Some experts doubt that the program will succeed given a lack of financial investment by the county. Ulder Tillman, health officer of neighboring Montgomery County, Md., said, "You've got to have an engine that can drive this."

Gerard Anderson, a Johns Hopkins University Bloomberg School of Public Health professor specializing in health care finance, said, "I just don't see how you cover people without any new money." Howard County Executive Ken Ulman said, "Much of this is new. To a certain extent, this is all a leap of faith" (DeFord/Otto, Washington Post, 10/16).