Byline: James Amos
Jan. 29--It would be the Holy Grail of health-care coverage -- a health benefits plan for the working poor that they can actually afford -- and Pueblo officials said they think they can bring it here. The plan is based on a successful Michigan program in which employees, business owners and the community each pay one-third of the cost for coverage for each employee. The cost has been less than $50 a year for employees, and the entire community chooses which services are covered and to what extent. The community's share was paid with federal funds that come to area hospitals when they provide uncompensated care. Philanthropic foundations also contributed to start the program.
The program could easily be used here in Pueblo, and there are thousands of working adults with no health-care coverage who need it, according to Len Gregory of St. Mary-Corwin Medical Center. Both St. Mary-Corwin and Parkview medical centers support creating a similar plan in Pueblo, Gregory said, with backing from the Greater Pueblo Chamber of Commerce, United Way of Pueblo County, Pueblo Medical Society and several other local groups. Pueblo has at least 13,000 working residents who have no health insurance, Gregory said. The Michigan plan, first started in Muskegon, Mich., in 1994, is designed to provide coverage to those who work in businesses that can't afford to provide health insurance, typically companies with 25 or fewer workers. Pueblo business and medical leaders started talking about the plan last year after being approached by members of a statewide task force of Centura Health, St. Mary-Corwin's parent company. The task force had heard about the success of the Michigan program and, hoping to start a pilot program here in Colorado, was told that Pueblo would be a good candidate. Muskegon, like Pueblo, is an industrial city of about 100,000 people that suffered when the steel and auto-making industries collapsed in the 1980s, Gregory said. The two cities each are home to a high number of uninsured working residents with a desire to do something about it. Muskegon officials put the program together with the help of the W. K. Kellogg Foundation and chose a board-game style format for choosing which benefits the program would provide with its limited funds. The exercise, available under the 'try a demo' function at http://healthmedia.umich.edu/cgi-bin/WebObjects/chat.woa/wa/login, shows people how they must budget their health-care resources when choosing plan benefits. The benefits selected in the Michigan program were chosen by everyone who participated and do not vary by person.
Cindy Lau of the Pueblo Step-Up agency has been conducting the benefits exercise with groups of employees at Pueblo businesses in order to help decide what Pueblo's plan would look like. Participants in the exercise use a fixed number of stickers to chose which levels of coverage will be in the plan. Workers can get more stickers, and therefore more coverage, if they agree to several health-maintenance and improvements programs, like taking classes to quit smoking or better manage chronic diseases. Lau said she has made the presentation and conducted benefits-choice exercise to a small number of Pueblo businesses and their workers. The reaction from initial business owners and their employees has been overwhelmingly positive, she said.
'They all wanted to sign up today.' Pueblo's plan isn't finished and won't be for about a year, according to Lau and Gregory. The Pueblo group trying to start the plan must make sure there aren't legal problems, work out the benefits package with workers and the community and set up contractual agreements with health-care providers. Gregory said the group has met with a number of Pueblo doctors, and nearly all of them said they'd be interested in participating. The Michigan plan pays doctors and other health-care providers the amount they would get from Medicare plus 10 percent, so providers don't have to discount their services more than that. The Michigan plan also uses case managers to spot usage and efficiency problems, such as workers using the emergency room for common colds. They then talk with workers to steer them to the correct type of care. The plans doesn't cover families, since the children of many of the people who qualify for the plan already qualify for government programs. It also steers workers to other health and wellness programs that can help them. Rod Slyhoff, president of the Greater Pueblo Chamber of Commerce, said the business community has liked what it has seen of the plan so far. 'We're excited about it,' he said. 'The chamber's number one legislative priority has been trying to get a handle on the cost of health care in Pueblo County. And while we've not had a lot of luck on that, this is an opportunity to at least put a Band-Aid on that and help some folks.' He said employers stand to benefit from the plan by having healthier workers, and workers who are not worried about large medical costs taking away their finances and even their homes. 'People with financial problems aren't good employees,' he said. 'Their minds are on other things.'
The Michigan program can provide a decent basic level of coverage, with other benefits, because it costs much less than private health-care insurance. The Michigan program is run by a community nonprofit agency and has low overhead. Gregory said the community share of premiums for the Pueblo plan could come from grants, federal matching funds for the hospitals and even the hospitals. Leaders at both Pueblo hospitals have said they think Pueblo needs the plan and have pledged to help, he said. The Michigan program is not the same as health insurance, a fact everyone involved has taken great pains to emphasize.
'This is not an insurance product,' Gregory said. 'And this is not competition for insurance products. We don't want to threaten the insurance industry.' Chris Adams, a consultant helping the Pueblo group bring the plan to fruition, said Michigan's experience has shown that the plan doesn't keep people from buying regular health insurance.
Instead, because most poor workers has never had private insurance before, the plan actually trains them to use and pay for it, Adams said. Later, when they move on to better-paying work, they are accustomed to buying health insurance and using it wisely. The Pueblo plan would not provide benefits outside of Pueblo or Pueblo County, depending on how it is configured, Gregory said. But the Pueblo pilot plan could become an example for the entire state, its backers said. 'The whole reason that this will work is that there is this whole community behind it,' Lau said. 'People have really been excited by the idea.' For more information, or to schedule a presentation of the plan and its benefits-decision exercise, call 560-5886. ------ HEALTH COVERAGE CHOICES EXCERCISE Inspired by a health care plan for the working poor in Michigan, Pueblo business and medical leaders are working to craft a low-cost health benefits plan for working people who cannot afford private health insurance. Participating employers and their workers will decide what benefits the system will offer, using the circle graph below and a certain number of 'dots' to determine how much of each service to buy in the coverage plan. Rings farther inside the circle provide more services, but cost more. A working demonstration of the Michigan program's exercise is available at: http://healthmedia.umich.edu/cgi-bin/WebObjects/chat.woa/wa/login
Copyright (c) 2007, The Pueblo Chieftain, Colo.
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