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Could a health co-op work?



WASHINGTON — Bob Redford of Fort Smith thinks he has experienced what could be the future of American health care, right in the Arkansas River Valley.

In 2002, Redford, with limited funding from foundations and intermittent, small government grants, led the way in setting up the Arkansas River Valley Health Cooperative in tiny Ratcliff.

It was a pilot program, bringing together doctors and hospitals in Franklin, Logan and Scott counties who agreed to help working-class Arkansans who lacked health insurance and didn't qualify for Medicaid, the federal-state program for the indigent.

It provided not only health care access but health education and “disease management,” as well as help with prescriptions and other assistance.

The beneficiaries didn't get it for free; they paid dues ranging from $80 to $200 a month depending on their income and whether they sought individual or family coverage. But if their per-person medical bills exceeded a $10,000 cap, area providers, mainly hospitals, agreed to eat the difference. All together, it was a far better deal than the working poor could get on the open insurance market. Over half of the population of the three-county area was under 200 percent of the federal poverty level

As for the providers, Redford, in a telephone interview, said they reasoned it was better to participate in the co-op and get some payment rather than have the same low-income patients come to emergency rooms for what would likely be uncompensated care.

But the cooperative went out of a business in 2007 after it ran out of grants and failed to attract ongoing federal subsidies — despite legislation advocated by Democratic Sen. Blanche Lincoln.

  Redford said it was also hurt by new initiatives in the legislature to extend health care coverage. He said he could never get state officials to adequately commit to his program.

Even though it didn't last the decade and served only 200 people, the ARVC attracted rave reviews from the Princeton, N.J.-based  Robert Wood Johnson Foundation and other centers of national health care expertise. The foundation studied it and provided grants of  $5,000 to $10,000 as part of its Southern Rural Access Program, an effort to advance health care availability in the rural South.

“We were ready to ramp up [the number of patients],” Redford said, had more money developed.

“They worked their tails off,” Michael Beachler of North Carolina, deputy director of the Southern Rural Access Program, said in a telephone interview. “It was pretty ambitious.”

He said he still considers it one of the best health cooperatives ever attempted. In a written analysis of the project, Beachler and other analysts called it a “unique contribution” to the array of health care networks available nationwide.

“It took a lot of momentum to keep up the funding,” Beachler said, adding that the cooperative was dealing with what tended to be very expensive or “high-resource” cases.

Now, the idea of using health-care cooperatives to help bridge the nationwide health-insurance coverage gap promises to be front and center when the Senate Finance Committee returns to working on its version of a health-care reform bill next week. Many see it as more politically palatable than the “public option” — a Medicare-like program directed from Washington for the working poor. The latter is called for by the main House bill.

Although co-op is a term that can be assigned to several slightly different business models, Redford said Congress should look at the ARVC as an example of what can work in rural areas, and possibly cities as well.

Beachler said co-ops lack the “philosophical baggage” of government-provided insurance, but if they are to work they must be much bigger than the Arkansas experiment.

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