November 23, 2002 Saturday

A Martha's Vineyard Care Package; Island Devises Novel Plan to Provide Health Insurance for Low-Income Residents

Pamela Ferdinand, Special to The Washington Post

BOSTON

Despite an international reputation as a summer playground for the affluent and influential, Martha's Vineyard's year-round population is of far more modest means: store clerks, contractors and a growing number of immigrant service workers -- many without health insurance.

In fact, about 20 percent of year-round residents lack insurance, which is more than double the 8 percent national average. Most island businesses have fewer than 10 employees and don't offer medical benefits.

Against that backdrop, doctors, hospital managers, government officials and other islanders banded together a while back to find coverage for those residents. They are on the verge of launching an affordable insurance plan, with federal backing, that health experts said could become a national model for community-based health care.

They hatched their mission in the community room of an agency for elderly housing in Vineyard Haven: Thirty-two doctors, patients, hospital and social services managers, public officials and others expressed their worries about local health care issues, including neighbors and friends who lacked health insurance.

Communities elsewhere in the country, including counties in Michigan and Florida, have relied on government bodies to coordinate health care and subsidize affordable health insurance through existing funds or special taxes. But on the Vineyard, where most people know each other at least by face if not by name, residents organized themselves in an unusual grass-roots effort to forge partnerships and find a solution. Unlike coverage plans offered by other communities, they say, their proposed Island Health Plan will offer standard, portable health insurance through an extensive statewide network of hospitals and providers.

"The fact that a cross section of a community came together makes it unique," said Phyllis Busansky, a senior fellow specializing in health care and welfare reform at the Hudson Institute. "They really focused on what they wanted to do, and they did it. They are one of the most interesting models around."

Ilene J. Klein, one of three private family practitioners on Martha's Vineyard, estimated that 15 percent of her patients are uninsured.

"The message that people are thinking about and trying to work out is that affordable health care really reflects a certain attitude of living on a small island community where one is concerned about one's neighbor," she said.

The brainstorming began in 1996, when residents from the island's six towns formed the Dukes County Health Council in response to concerns about island health care costs and access. Two years later, they had identified health insurance coverage as the one issue they could rally around.

The council found a partner in the nonprofit Neighborhood Health Plan, a Boston-based managed-care group known for serving low-income populations in mainly urban areas. It was willing to cross Vineyard Sound and negotiate lower fees with doctors and other providers.

What resulted was the Island Health Plan, which will be available to customers in the spring. It will offer a range of services include sliding-scale premium rates, subsidy payments to employees, low co-payments and, when possible, no deductibles. If successful, the plan will be expanded to Cape Cod and Nantucket, said Cynthia Mitchell, executive director of the Island Health Plan. The plan would be subsidized with state Medicaid money and federal funding.

According to preliminary estimates, monthly premiums of $ 240 (before subsidies) would be available for individuals and $ 678 for families of four who earn less than $ 72,000 a year, she said.

With the proposed sliding-scale subsidy, a single person making $ 13 an hour could pay as little as $ 48 per month, with the employer paying $ 87 per month. A two-income couple with two children earning a total of $ 63,000 per year would pay $ 169 per month. Their employers would pay a total of $ 256 per month.

"Ultimately, the providers and, in particular, the primary care physicians have to be on board. It has to work for them, and the fee structure that results has to be affordable for islanders," said Tad Crawford, a retiree who chairs the Dukes County Health Council.

The community will continue to look for other sources of revenue, Mitchell said, including raising property taxes -- a much-discussed notion given the island's valuable real estate.

"The funding will come from many sources, and that's by design," she said. "The theory being that there's enough money in the system, and it can be reapportioned and creatively assembled."

Few people know much yet about the details of the Island Health Plan, and it remains to be seen how many will sign up after it is advertised in coming months. Seasonal businesses may be hesitant to offer benefits to employees during the slow off-season, and some islanders shy away from traditional medicine altogether. But others may well leap at the opportunity.

The last time Rosemary Gambino, 51, offered benefits to her hair salon employees was 17 years ago, when she could still afford to pay for insurance and keep prices affordable for her clientele. That was also before a series of surgeries that have resulted in Gambino spending nearly $ 500 per month for health insurance, just for herself.

"My back is up against the wall, so I'm really excited [about the plan]," she said. "I'm hoping there will be something for me."