Other counties in Florida- Polk, Hillsborough, Alachua, and Gulf- and in other states have successfully developed and implemented similar models for the delivery of health services to the uninsured and medically poor.
Looking at these other counties, it does appear that the Polk HealthCare Plan and Hillsborough HealthCare have been successful in reducing healthcare costs and providing needed care to the working poor. However, the Alachua County plan, known as CHOICES, has been criticized for collecting too much money for too few beneficiaries. In fact, only about 700-800 people have enrolled in CHOICES, while the program has received in excess of $20 million in sales tax revenues.
Why is this important? Because, of these counties, Alachua County is the most similar to Escambia County. Polk County has a population of nearly 600,000, while Hillsborough County has over 1.1 million residents. By contrast, Escambia County and Alachua County both have less than 300,000 people. Alachua County and Escambia County report very similar median household incomes ($34,696 and $36,743, respectively, in 2004), as well as similar retail sales per capita ($10,720 and $11,255, respectively, in 2002). Hillsborough County, by way of comparison, shows a median household income in 2004 of $44,850, and per capita retail sales in 2002 of $13,231.
The problems that Alachua County has faced with its CHOICES program makes me even more hesitant to support the Access Escambia plan.
8 comments:
Patrick, go back and check now and I think you'll find higher enrollment numbers in Alachua.
But, more to your point, we've spoken with them and we can learn.
Hey, cool blog!! I'm a bit of a wonk myself.
There are a couple of things that you ought to consider here as well that I think might make a difference in your outlook.
First of all, even back in 2004, Escambia County had about 16,000 more uninsured than Alachua. We are now up to 66,000 and my guess is that Alachua is probably still in the 30,000s.
Second, the number of people in Alachua who rate their heath as fair or poor is only about 13 percent. Escambia is over 20 percent.
I think Alachua made the mistake of thinking that people would naturally flock to the program and didn't do a good job of marketing it. We will.
In one of your earlier posts, you said that something needed to be done. In Escambia, that something is on the table. Please don't give up on it.
Jim, thanks for the comments. You're right, I did say that something needed to be done about healthcare, and I really believe that. The AccessEscambia plan still makes me nervous, though.
Maybe if we weren't already tied for the highest sales tax rate in the state.
Maybe if this were a 6-year plan instead of a 10-year plan.
Maybe if CHOICES had had better success in Alachua County.
I don't know, I'm still on the fence. But I think you can see which way I'm leaning. I'm still looking for more information, though, because I think this is a VERY important issue.
Patrick, unlike some of the other posters (on Rick's blog), you have a genuine interest in this and I appreciate all your comments and perspectives.
The 10-year timeframe is necessary to allow us to see two reports from the Partnership for a Healthy Community (the CATCH reports.) That time frame also is important to give us a realistic chance to start to see the benefits to public health. After all, the real purpose of this is to make our people healthier.
I do think we will have a ramp up period before we get enrollment up to where it needs to be, but I don't think that it will be as long or as lame as Alachua's.
Unlike Escambia County, Alachua already had a pretty good public health program in place before they launched this effort.
Wherever you end up on this, please know that I appreciate the fact that you've studied the issue and really dug deeply into it. If more people did that, we would be much better off.
Keep on bloggin'!
It's also important to note, that the "CHOICES" program was championed by a county commissioner who was employed by the Shands Healthcare System at the time. Conflict of interest? Perhaps...perhaps not...but the tax is nothing short of a subsidy for the Shands Healthcare System
Alachua County Choices program enrollment was at about 1000 in mid 2007.
This is from a very very reliable source.
RE: "It's also important to note, that the "CHOICES" program was championed by a county commissioner who was employed by the Shands Healthcare System at the time. Conflict of interest? Perhaps...perhaps not...but the tax is nothing short of a subsidy for the Shands Healthcare System"
Thats absolutely not true. Only 2 of the many service providers (~10) are connected with the Shands Healthcare system. The other 8 or so are entirely separate entities!
Do the research before making such bold statements.
BTW, CHOICES enrollment was 1000 in mid 2007. Thats from internal source.
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