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Sun October 28, 2012
Election 2012: Millage to Deter Health "Doughnut Hole"
For the past 14 years, Ingham County has provided low-cost health care for qualifying residents. The Ingham Health Plan gives some 12,000 people who don’t qualify for Medicaid and can’t afford their own insurance access to medicine and regular doctor visits every year.
However, upcoming changes in federal health care policy mean the plan will need additional funding. Ingham County is asking its residents to approve a three-year millage to keep the Ingham Health Plan in operation.
Marvin Cato knows a little about irony. Two years ago, he had a well-paying job as a health promotion specialist with Michigan State University. But when the budget got tight, Cato got squeezed out. Like so many other casualties of recession, Cato found his ongoing job quest outlasted his COBRA insurance.
So when his coverage dried up, Cato – who’s diabetic – was forced to improvise.
“I was stretching my meds, taking them every other day,” Cato recalls. “And as someone that works in health promotion and chronic disease self-management, I knew that was a no-no. But I was trying to do the best I could with what I had.”
But Cato had an ace in the hole. He was a member of the Ingham County Community Health Center board, and he knew about the Ingham Health Plan.
“I had just never envisioned myself using the service, and decided, hey…it’s time now,” Cato says.
The Ingham Health Plan is a publicly funded safety net. Executive director Robin Reynolds says it’s designed for people living anywhere from zero to 250 percent of the federal poverty level.
“So, we cover the people who don’t have Medicaid and can’t afford to purchase insurance and don’t have employer-sponsored insurance,” says Reynolds. “And typically, about 60 percent of our population are working.”
Reynolds says when the Affordable Care Act takes effect in 2014, more than half her clients will be shifted onto Medicaid. The act also provides for the creation of health care exchanges where people will be able to enroll for the coverage they choose online.
But Reynolds says even then, there will still be a sizeable health care doughnut hole in Ingham County.
“The belief is that uncompensated care will go down, (and) so does our funding,” Reynolds notes. "So, we need the millage to keep going because we know 8,000 to 10,000 people is the estimate that will continue to be uninsured, and we want to be around to be able to serve them."
The proposed millage asks for a .52 mill over three years. That means the owner of a home with a taxable value of $100,000 will pay $52 per year. It’s expected to raise about $3 million for each of the three years.
It’s believed the millage will also help build the public health infrastructure. Reynolds says there aren’t enough primary care physicians to serve the population. Many uninsured patients wind up going to emergency rooms to treat routine ailments, which drives up premiums for those who do have coverage. Reynolds says the millage could help the county bring on more public health care doctors who would see patients on the county plan.
Reynolds says the county has been thinking about a millage for four years…and she concedes this may not be the best time to ask for one. She says the biggest challenge has been in overcoming the misconception that the Affordable Care Act will cover everyone. Still, Reynolds envisions a time when all the puzzle pieces might fit together.
“If we can have Medicaid expansion in this state and cover those people, and if we can have the Ingham Health Plan and then we can have the Affordable Care Act and the exchanges, we could potentially in Ingham County have everybody have access to some level of care,” she says. “Wouldn’t that be great?”
For his part, Marvin Cato is voting for the health services millage. He’s since found full-time work, and he does have insurance through his employer. But the health professional who once had to ration his pills against his better judgment remembers the day a doctor told him his diabetes was out of control. Cato says his subsequent treatment would never have happened had he not enrolled in the Ingham Health Plan.
“People think that somehow it’s somebody’s own fault that they’re in that position,” says Cato. “I’m someone that has a master’s degree that’s been working professionally since I was in my 20’s. But you can’t control the economy, so I found myself in need. It could be anybody.”
If the millage succeeds, county officials say they’ll be able to serve more people, improve service for existing patients and potentially add primary care doctors. But if it fails, they say they’ll be forced to cut many current enrollees from their ranks.