Originally created 06/27/99

Florida plan cut care's total costs



Even having a choir behind her could not make Dorothy Wade sound more like a preacher.

"When I first come here to (the Center for Community Health), I was sick with high-blood pressure, I didn't have a job, I didn't know what I was going to do," said Ms. Wade, 50, as she sat on an exam table at the center. "I probably would be dead somewhere if I had to pay for all my medicine myself."

With only a part-time job as a nanny and no health insurance, the clinic has helped her control her diabetes and high-blood pressure and, more importantly, given her some security about her health. Her story is echoed across the country as an estimated 44 million people try to get by without health insurance.

Their communities, like voices in the dark, are trying to answer their call for help.

In Augusta, the CSRA Partnership for Community Health is seeking a Robert Wood Johnson Foundation grant that would allow leaders to create a comprehensive system to care for the more than 50,000 uninsured in Columbia and Richmond counties. Out of more than 100 applications, the partnership is one of 26 semi-finalist seeking one of 20 grants to be awarded in November.

But some communities have already taken on the uninsured problem. Back in 1991, Hillsborough County in Florida, which contains Tampa, got permission from the Florida Legislature to devote a half-cent of sales tax money to health care for the uninsured.

That provided an astonishing $67-68 million in funding a year, enough that Hillsborough HealthCare is now trying to spend down $150 million in reserves and has cut back to a quarter-cent a year, said plan administrator Cretta Johnson, director of health and social services for the county.

Hillsborough used the money to create the equivalent of a managed care plan for people who are above the federal poverty level, about $16,000 for a family of four.

The plan, which is divided into four geographic regions, has 12 community clinics and four hospitals and serves about 28,000 people a year, Ms. Johnson said. While 42 percent of those covered are working, 30 percent are unemployed, 18 percent because of health problems, Ms. Johnson said.

"Usually these are those people with chronic ailments or chronic illnesses that may not allow them to work full-time or work at all," she said. And while many may also be applying for Social Security disability, the program covers them during the long and sometimes drawn-out process.

Its success shows in the numbers -- before the plan, the uninsured were costing the county's hospitals and clinics an average of $600 per patient, usually because they came in with advanced problems, Ms. Johnson said.

"People just waited until they got so sick they couldn't stand it, and then they went to the emergency room," Ms. Johnson said. With regular care under the program, the cost has dropped to about $200 per patient per month, Ms. Johnson said.

"The cost of uncompensated care in general is lessened," she said.

A bill to allow Georgia communities to devote a local-option sales tax to the uninsured stalled in the last legislative session, though proponents like Augusta Commissioner Lee Beard still hope it can be passed. Others, like Augusta Mayor Bob Young, are looking to another, much larger, source.

Through a $206 billion settlement with the tobacco companies, Georgia will receive about $4.8 billion over 25 years. Advocates like the Access Project in Boston are pushing states to use that money to cover the growing uninsured population.

Using $71 million of the $178 million Georgia will receive each year in settlement money would cover an additional 39,000 adults and another 34,000 children.

But to get that kind of funding, states and local communities need to organize and lobby for what could be a unique opportunity to provide coverage, said Judy Meredith, a Boston-based consultant to the Access Project.

"It's a brand new funding stream," she said. "None of us have ever seen anything like it."

But already health care faces an uphill battle competing with other compelling needs like education.

South Carolina Gov. Jim Hodges wants to use the funds "for health care, for smoking cessation programs and also for the farm community impacted by the settlement," said spokeswoman Nina Brook.

There is already a bill to devote about half the funds to compensate tobacco farmers for their potential losses. Georgia Gov. Roy Barnes has said he would like the settlement money to go toward health care but has not offered any specifics.

Greg White of the American Lung Association's South Carolina chapter and an informal coalition of about 30 groups are trying to make sure at least 10 percent each year is devoted to tobacco use prevention and health care.

The settlement "was made for public health," he said. The coalition is planning a public education campaign and will begin lobbying legislators in September leading up to the legislative session in January, Mr. White said.

By that time, there may already be help coming from Congress. U.S. Rep. Charlie Norwood, R-Ga., had sponsored a bill that would have provided up to $3,600 in tax credits for families to buy insurance.

U.S. intervention in Kosovo, however, also interfered with that aid to the uninsured, said Norwood spokesman John Stone.

"The war in Kosovo has eaten up any kind of reserve we had to work with," said Mr. Stone. The relief could have potentially cost $50-60 billion a year, he said.

Instead, Mr. Norwood and some physicians in Congress are simultaneously working on a patient's rights bill and a more modest affordability bill, which would provide up to $84 per month per family for those purchasing their own insurance.

Both fights are important, Mr. Stone said.

"You can have the greatest health policy in the world but if it costs $5,000 a month, no one could afford it," he said.

Tom Corwin covers science and medicine for The Augusta Chronicle. He can be reached at (706) 823-3213 or tomc@augustachronicle.com