Health care crisis target of program: The pilot plan is geared toward certain small-business employees.
(Pueblo Chieftain, The (CO) (KRT) Via Thomson Dialog NewsEdge) Apr. 30--Within a year, a pilot project called Health Access Pueblo should begin providing low-cost health care coverage to people working in small businesses.
A board has been selected, two-thirds of the start-up funding has been pledged by the two private hospitals in Pueblo, and potential customers are being interviewed to determine what are Pueblo's priorities for types of care to be covered.
Planners stress that it is not insurance, with all the actuarial data and huge money reserves that insurance companies must have, but a plan to provide basic health care to people who can't afford insurance coverage.
The plan is aimed at people earning in the range of $12 an hour, working for businesses that employ no more than 25 people and currently providing no health-care benefits.
In Pueblo, "that's probably an endless potential," said Len Gregory of St. Mary-Corwin Medical Center.
St. Mary-Corwin and Parkview Medical Center each have pledged $200,000 for the starting costs for Health Access Pueblo, and both hospitals are represented on the board overseeing the project, by Corwin's interim CEO Phil Shaw and Parkview's chief operating officer, Mike Baxter. Others on the board are Ralph Williams of Steel City Agencies, representing the insurance industry; Dr. Alethia (Lee) Morgan, a former head of the Colorado Medical Society, representing the county medical society; and Byron Geer of the Pueblo Community Health Center.
The project will be working on incorporation as a nonprofit agency. To make the distinction between this project and insurance clear, State Rep. Dorothy Butcher has included the plan in a rural health care plan going through the Legislature.
Her bill would exempt the plan from the state insurance commission's oversight "because it is not insurance but pre-paid health care," Gregory said.
The planning process has been aided by Chris Adams, a health care policy consultant whose participation has been funded by the A.J. Kauvar Foundation. He also is a member of the commission Gov. Ritter has established to revamp health care in Colorado.
The plan is also limited to treatment within Pueblo County. So if a person covered by the plan was injured in an accident somewhere else, his care there would not be covered.
It is modeled after a pilot project in Muskegon, Mich., which has been operating since 1994.
"It's a three-share concept, with the employer, the employee and the community each putting in one-third," Gregory said. "In Michigan, the community share comes from what they call 'dish' dollars," the Disproportionate Share for Hospitals funding from the federal government for hospitals treating a high number of uninsured patients.
Once the funding is set up, the plan will contract with physicians, clinics and hospitals.
Cindy Lau of StepUp, an agency that has been working for several years with medically underserved people, has been working on the preliminary steps toward Health Access Pueblo. She expects that a high percentage of local doctors will participate in the plan, and anticipates that the fees they will receive will be slightly more than Medicare benefits.
For huge claims resulting from a devastating illness or injury, "the hospitals have said they will step in and waive payments -- just as they do today when they treat a person without insurance," Lau said.
In Muskegon, the monthly cost of the health care is about $150, split three ways -- and the cost of regular health insurance would be $450 a month, Lau said.
To determine health-care priorities, Lau has been inviting groups of small-business employees to "CHAT" -- for choosing health plans all together -- using a dart-board sort of a layout with three rings of priorities. People get stickers to place on their priorities, and they get extra stickers if they're willing to take a smoking-cessation class or exercise program, she said.
"For example, the first level for medicines might be a $5 co-pay for generic drugs and the second level might be a $25 co-pay for all drugs," she said. "Some of the young people who do extreme sports said they want speciality care if they break a hip on their mountain bikes, and they figure they'll pay for their care if they just get sick. Then they think about it a little more and they realize that wouldn't work for most people."
The plan will emphasize wellness and preventive care, to keep people healthier and keep them out of the hospital emergency rooms, she said.
Co-pays might be free for a regular checkup, $10 for an "acute visit," $100 for admission to a hospital, $75 for a CAT scan, Lau said.
Whether to offer family coverage will be up to the individual employer, she said, but she believes almost all children of families in the target group will be eligible for Colorado's Child Health Plan Plus.
The next key step will be setting up an office -- possibly in space donated by the Greater Pueblo Chamber of Commerce, Lau said. The county commissioners are expected to be the local-- government sponsor of the project, but there will be no infusion of county funds.
And soon, Gregory said, "they'll need to hire the guru who's going to run it all."
What kind of person will be needed? Lau said, "I think they're going to look for somebody who can think outside the box, because this is a new model."
Copyright (c) 2007, The Pueblo Chieftain, Colo.
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