Photo by Ruth Heide San Luis Valley Regional Medical Center CEO Russ Johnson makes a point during a meeting in Alamosa on Wednesday regarding the new initiative, SLV Health Access.

SLV Health

Access assists Valley’s

uninsured



By RUTH HEIDE

ALAMOSA — Frances Valdez may be an excellent example of the employees who will benefit the most from the San Luis Valley Health Access Program, a new initiative for the San Luis Valley’s uninsured population.

During a presentation and input-gathering session regarding the program in Alamosa on Wednesday, Valdez said she and coworkers at the South Central Colorado Seniors office do not have employee insurance but make too much money to qualify for other programs for the uninsured.

“I cannot afford insurance on my own,” Valdez said, “so I am uninsured. If I have a tooth that’s bad, unless it’s hurting, I am not going to go to the dentist.”

Valdez, who directs the senior program, added, “There are some of us who make too much to qualify [for other programs] but we do not work for somebody who can insure us.”

SLV Regional Medical Center CEO Russ Johnson said by far the majority of uninsured people are employed.

Gwen Heller, who has been involved in healthcare management for many years in the Valley, is serving as the unpaid interim executive director for SLV Health Access. She said the program would be fully operational sometime in January.

She and others explained the features of SLV Health Access, which is not insurance but is being described as a multi-share benefit plan that provides basic health care access for the working uninsured.

The plan would cost about $140 a month, split evenly three ways with the employer paying one third (about $47 a month), employee paying one third and federal grant funding available for the other third. (The program was awarded a $400,000 grant over five years to help with costs.) Plan developers said $50 a month was about the most those without insurance believed they could pay for it, so they are trying to develop a plan that stays within that price range.

One of the activities undertaken in the Wednesday session was discussion of what items could be included in a $140-a-month program and what might have to be left out. The approximately 20 participants on Wednesday voted through anonymous keypads on what options they believed were most important to be included in the SLV Health Access Program.

For example, 89 percent of the participants voted for primary care coverage that would allow folks to choose a primary care doctor locally and pay no co-pay for preventive care office visits, $10 co-pay for acute care office visits and $75 co-pay for emergency room visits.

On the other hand, 65 percent of the participants voted for no vision coverage.

The Health Access developers have held a number of meetings already and received public input at each of them. Taking that input up to this point, the group has developed benefit plan comparisons involving programs at the $150-per-month level, $147-per-monthlevel and $142-per-month level. In all options, the costs would be split three ways with the employee paying one third, or $50, $49 or $47.33, respectively.

The $142-per-month plan proposes: no care outside the Valley, no annual deductible; $25,000 annual benefit maximum, but that does not apply to all services; no co-pay for preventive care; $15 per visit co-pay for primary care physician office visit; $25 per visit co-pay for specialist physician office visit; $10 co-pay for routine lab and X-ray; $20 co-pay for mental health outpatient visits (limited to six); $20 for 30-day supply of diabetic supplies; 30 percent co-pay for durable medical equipment and oxygen ($500 limit); $15 for generic-only prescriptions ($2,000 maximum); $75 per day up to $450 per admission, inpatient hospital; $100 per procedure co-pay, outpatient surgeries/procedures; $100 per service, imaging (MRI, ultrasounds, etc.); $25 co-pay for non-routine lab and X-ray work; $75 per visit co-pay, emergency care; 30 percent co-pay, ambulance (ground only); $25 per visit, co-pay, physical/occupational and speech therapy (10 visits per episode); and $15 per visit co-pay, home health care.

Excluded would be dialysis, transplants, inpatient mental health and substance abuse and care outside of the San Luis Valley. The exclusion list could be longer.

Health Access organizers stressed that this program was not meant to replace or supersede any existing programs for which residents might qualify. If people could acquire health care coverage through another program, they would be expected to do so.

This program is targeted for low-income working people who do not qualify for other programs but cannot afford insurance on their own and do not have insurance through their employer.

Those developing SLV Health Access also stressed that this is not insurance, although some of its features might look like insurance benefits.

“It’s a very community specific program,” explained Chris Adams who facilitated the Wednesday session. He said unlike insurance, this is a specific agreement among providers such as the hospital, clinics, doctors, home healthcare agencies and others who provide care. Heller said the “community” enveloped in this program is the San Luis Valley.

Last year the legislature and governor authorized the SLV County Commissioners Association to create this program, Adams said.

SLV County Commissioners Association Chairman Crestina Martinez said those involved in this effort are trying to improve health care access to the community and although this may not be the perfect plan or a “Cadillac” plan, something is better than nothing.

Businesses that have not been able to offer insurance to employees for at least the past year and are interested in participating this plan may contact Gwen Heller, 589-8052 or Paul Roberts, 589-3696.