JaxCare: High Hopes, Low Turnout; Stringent Eligibility Rules Have Hobbled the Program's Ability to Provide Health Insurance for the Working Poor

Article excerpt

Byline: URVAKSH KARKARIA

JaxCare's low cost health care plan geared toward the working poor was high on ambition when it began two years ago.

Executives projected the plan, which is marketed to small businesses, would attract 1,600 members by early 2006. But the optimism hasn't panned out -- enrollment stands at about 478.

"We had unrealistic enrollment expectations," CEO Rhonda Poirier said. "It simply didn't happen."

Poirier and her directors point to the program's restrictive eligibility requirements. Besides income requirements, enrollees could not have had insurance in the past six months or be eligible for other assistance programs. Members had to be residents of Duval County, excluding many poor people who work in Jacksonville, but live in surrounding counties.

"There are very strict regulatory guidelines that almost form a straitjacket on our ability to enroll people," said Hugh Greene, JaxCare's chairman and CEO of Baptist Health.

The JaxCare plan, supported by a coalition including hospitals and physicians, is one of four Health Flex plans approved by the state's Agency for Health Care Administration under a 2002 state statute. The local employer-based health plan offers primary care, prescription coverage and hospital stays through a network of 900 physicians and five hospitals. Unlike the other Health Flex plans -- which are in South Florida -- the local program is geared toward the low-income employed, and has considerable public-private financial support.

Member premiums are designed to pay for the health plan's administrative costs, while the cost of treating enrollees is financed through a city grant and in-kind services from participating hospitals.

JaxCare has given Tammy Font access to comprehensive medical care she didn't have before.

Font, who makes about $18,000 annually as an accounting manager at a music store on the Westside, makes too much to qualify for charity assistance and too little for private insurance.

With JaxCare, "I'm getting care that I've needed for a long time," Font said. "It was never available to me because I couldn't afford it."

Prior to becoming a JaxCare member, the 48-year-old received medical care at the Volunteers in Medicine, a clinic that provides free outpatient medical services to the working uninsured.

"But if you need a specialist [and there isn't one] on staff," she said, "you just have to go find yourself one and pay full price."

TOO RESTRICTIVE

The JaxCare health plan was initially limited to those who earned between 150 to 200 percent of the Federal Poverty level. But officials realized the 150 percent base left out many working poor.

"We found that people had second jobs" which raised their income levels and disqualified them from JaxCare, said Randy Kammer, a JaxCare director and an insurance executive.

JaxCare has raised the income requirement to include those who make no more than 200 percent of the poverty level, which amounts to $26,400, for a family of two.

"There are a large number of people who are uninsured," said Robert Nuss, a JaxCare director and senior associate dean at the Univeristy of Florida College of Medicine in Jacksonville. "But, by the time you go through all these eligibility requirements it reduces [the] potential [pool]."

Small business owners were leery of the program because they could not offer the benefit to all employees -- just those who qualified.

While 155 businesses have enrolled, Poirier said, at least as many have turned it down because it did not allow them to include all their workers.

An inability to extend the benefit to all employees was a deal breaker for Stanley Pools, a manufacturer and retailer of swimming pools.

About half the company's 30 employees didn't qualify.

"They are not eligible because they make too much money . …