As spokesman for Health Access America in Saginaw County, Mike Nowlin doesn't have to look far to find an audience.
He recently was offering information on the Saginaw Health Plan's new Tri-Share project, which aims to help small business provide medical coverage, during a breakfast interview at a restaurant near Old Town.
The manager overheard him and inquired.
"I don't qualify for any medical help," she explained. "With my income, I'm described as overqualified. I'm what they call a spend-down. I can get coverage for my 14-year-old twin boys, but not for myself."
Her main concern is that she can't afford a prescription to combat her high blood pressure.
"Doctors always say they are accepting new patients, until you tell them you have no insurance. Then they're accepting none. My doctor will be whoever is on duty in the emergency room," she said.
Nowlin is familiar with the woman's spontaneous testimony. He notes that more than 30,000 Saginaw County residents are uninsured, about one in seven.
The statewide count is estimated at about 1 million, or one in nine
Nowlin started in March with a goal of helping at least 1,000 Saginaw County residents find insurance before the end of July. He already is about two-thirds of the way there.
Tri-Share is a nonprofit partnership geared t enterprises that employ fewer than 20 people. A worker earning $12 per hour or less can set aside $53 per month for personal coverage, or $100 to include a spouse. In turn, the employer and the Saginaw Health Plan each will contribute the same amount. Coverage is widespread with no co-pay deductibles.
Saginaw County is one of seven communities across the nation selected for Health Access America, created through a coalition of health care companies and an organization based in Washington and known as the Healthcare Leadership Council.
"We are taking our information meetings out to all sections of the community," said Nowlin, who has a session scheduled for 11 a.m. to 2 p.m. on June 5 at the East Side Soup Kitchen, on East Genesee near Cherry.
Few answers from government
Thirteen years have passed since the defeat of universal care plans proposed by former President Bill Clinton and spouse Hillary. The Clintons didn't try again after the 1994 debacle, which was fueled by fear tactics and disinformation from powerful insurance & health industry lobbies.
President George W. Bush's lone major reform is a prescription drug benefit, and critics say the provision favors the pharmaceutical companies more so than the people.
At the state level as Review Magazine went to press, legislators have decided against an immediate 6 percent rollback in Medicaid funding, but the issue will remain on the table with more budget cuts required down the road. More than 44 million Americans lack any health insurance, and millions more have only minimum coverage. Most of the uninsured have jobs. The lower the pay, the higher the odds that the employer doesn't provide insurance. The Michigan Department of Community Health reported that 84 percent of middle and upper-income families receive coverage from employers, in contrast to 34 percent among the so-called working poor, and the gap is growing.
Furthermore, employers at all levels are cutting back. Average income in Michigan is up 16 percent since 2000 and consumer prices are up 13 percent, but health insurance costs have skyrocketed in comparison by 73 percent.
Federal action seems unlikely. The national debt is $8.8 trillion, including more than $3 trillion accumulated during the first six years of George W. Bush's presidency. The debt is the equivalent of nearly $30,000 for each American.
The cost of the Iraq War alone has surpassed $430 billion, which is the equivalent of more than $1,400 per citizen. This same sum would allow an individual to enroll in Tri-Share for 26 months. Nowlin said he can't blame people for having a bleak outlook, based on what they have observed in politics.
At the same time, he said projects such as Tri-Share and MIChild (the state's children's health insurance program) offer options that can at least start to tackle the problem.
"Progress is not impossible," he said. "We can reduce the uninsured population by a meaningful number by doing a better job of linking individuals without coverage to resources that already exist."
State can't run debt
In contrast to federal spending, Michigan's potential $48 million Medicaid cut may seem like small potatoes. The sum equals the cost of fighting the Iraq War for about five hours. The difference is that state legislators, unlike the feds, must balance their budget.
Lansing lawmakers must tackle not only this year's shortfall, but also the annual loss of $1.9 billion from future elimination of the Single Business Tax.
"Medicaid funding is always at risk and we've been fighting against cuts for years," said Jacqueline Doig, a staff attorney at the Center for Civil Justice, a regional group based in Saginaw.
"We want to advocate for the strengthening Medicaid and MiChild, and coverage for the uninsured and the underinsured, but with the budget situation right now, we're busy just trying to convince the state legislature and the administration to maintain what's there."
Democrats say they will consider restoring the state income tax to 4.4 percent, the level that existed before a five-year string of cuts reduced the levy to the existing 3.9 percent. The Dems also are floating proposals to abandon the flat tax and set higher rates for higher-income people.
Doig said the potential Medicaid cutback is an example of a double impact.
"If we take $48 million from the state budget, then we lose another $65 million in federal matching funds, a total of $113 million in health care," she said.
"We need to have a revenue-based solution to the budget. We can't cut our way out of this, and cutting health care isn't going to help anyone. The costs of health care are still going to be there. They will just be shifted to the folks who have insurance."
Rhonda Miller, director of revenue cycle for St. Mary's of Michigan, said the hospital last year spent $19.3 million for uncompensated care of the poor and community benefits. The potential state Medicaid cut would drain another $1.3 million.
"We will not turn anyone away and we will not increase rates," Miller said. "Our main concern is our patients, and we are concerned that those with Medicaid as a primary means of insurance will have less benefits."
Partnerships show potential
Doig said that amid what is often described as a health care crisis, one bright spot is a growing emphasis on public-private partnerships.
"We had a state task force that completed its report last year, but many of the members are still meeting because they recognize that its in everyone's self-interest to address this problem, as the business community realizes the negative impact of an uninsured population on their bottom line," Doig said.
She referred to the Michigan State Planning Project for the Uninsured, coordinated through the Department of Community Health. One finding was that the impact of cost-shifting, to help pay for health care for the uninsured, added $730 to the annual cost of a typical family policy or $274 to an individual policy.
Donna Graham is an example of how partnerships can fill a void. She worked 30 years in Denver as a paralegal, and returned to her Saginaw hometown six years ago. Since then she has worked off and on, sometimes with health insurance but sometimes lacking coverage.
She learned about Tri-Share in April through local publicity. She didn't qualify for Tri-Share, but outreach workers helped her find a place in another Saginaw Health plan project. She received her card late in May.
"I don't have any major health issues, but these are things you worry about as you get older," Graham said. "I've avoided doing some things in terms of prevention. Now that I have coverage, I'm going to find a doctor and catch up on those things." Mary Buck runs a home-based child care center and has gone without coverage. She is hoping enrollment in the Saginaw Health Plan will help her pay for prescriptions to combat arthritis and high blood pressure. "I have two prescriptions right now that are sitting at the pharmacy because I can't afford to pay for them," Buck said.
St. Mary's is a partner in the Saginaw Health Plan along with Covenant Hospital, Health Delivery Inc., HealthPlus of Michigan, Healthy Futures CrxSP, the County Department of Public Health and other community organizations.
For information on Tri-Share, call toll-free, 1-888-874-7427. The Saginaw Health Plan website is countyhealthplans.org.