Summary
• Access Health, in Muskegon, MI, is generally regarded as a successful community-based approach to expanding health care coverage to uninsured workers. While the program is located in a fairly typical Midwestern community with a faltering economy and a population with worse-than-average health outcomes, it was the stimulus for proposed legislation to federally fund related programs in all 50 states. Access Health is known as a “three-share plan”: Employers and employees each pay 30 percent of the cost of the program, and the community pays the remainder.
• Origins of Access Health: Access Health would not have evolved without the vision and financial support of the W. K. Kellogg Foundation of Battle Creek, MI. Following the demise of national health care reform in 1994, the Kellogg Foundation launched an initiative with the objective of increasing access to health care by encouraging community-based collaboration projects. The initiative led to the establishment of the Muskegon Community Health Project (MCHP), whose goal was to improve health care in the county by developing alternative, comprehensive, high-quality and affordable health services models. Access Health was the product of one of the initiatives at MCHP.
• Access Health Today: By the end of 2004, Access Health was serving more than 420 employers and 1,150 employees and dependents. In 1999, the employee share of Access Health coverage was $38 per month for adult coverage. By 2003, the employee share was $46 per month, an average annual increase of 5 percent since 1999. Employee and employer premiums have not increased since 2003. The community share was $46 per member per month in 1999, and reached $62 in 2003.
• Benefits Package: Access Health is a unique health plan that covers a comprehensive array of health care services, but with exclusions. Inpatient and outpatient services are covered, as are primary and preventive care services, emergency room care, and prescription drugs. Health care services are provided only within Muskegon County. Among the services not covered are routine dental, vision, and hearing exams; neonatal care outside of Muskegon County; injuries as a result of an automobile accident; work-place injuries; or treatment for organ transplants and certain treatments for burns.
• Lessons Learned: This detailed analysis of the emergence of Access Health and the program’s experience since it was formed paints neither a rosy nor a bleak picture, and certainly not a simple one. However, considering the big picture, it is remarkable that Access Health has prevailed when one considers the paucity of viable programs that help to cover the uninsured population.
• Sustainability: Today, Access Health’s greatest financial vulnerability rests on the uncertain continued availability of the monies it uses to subsidize the program. Increasingly, the federal government is scrutinizing mechanisms used by some states to obtain federal matching funds. As a result, the largest of the three shares—the community share that is subsidized by federal DSH funds—could be reduced or redirected in the future. In addition, state fiscal problems could result in fewer federal matching dollars, which has the potential of affecting Access Health sustainability.