The Island Health Plan, which seeks to provide affordable health insurance for many of the estimated 3,000 Islanders now living without it, is poised to win legislative approval that will enable the nonprofit group to begin work this spring.

The plan is one item on a list of programs expected to win a vote in the state legislature, overriding an earlier veto by Gov. Mitt Romney. Cape and Islands Rep. Eric T. Turkington said yesterday: "Once it's taken up, I'm confident [the veto] will be overridden."

The news comes as the fledgling group that organized the plan held its first annual board meeting and charted an ambitious course for the year ahead.

Until now, the Island Health Plan has been largely conceptual. But within 60 to 90 days of a legislative override, a first batch of uninsured Islanders will be provided with health insurance cards. By year's end, program leaders say, nearly 700 Islanders will be signed on to the program. Enrollment is expected to climb through the coming years, said Cynthia Mitchell, director of the plan.

The plan is designed for Island small businesses that cannot afford to offer health insurance to their employees, and for the self-employed. The plan also will serve patients enrolled in MassHealth, the state's Medicaid program.

Island Health Plan leaders have been lobbying for more than a year to access millions of dollars in state funding needed to establish the program.

"We've been at this constantly for a year. We've been making specific plans. It's well developed; it just needs to be implemented," said Mrs. Mitchell in a conversation with the Gazette.

The Island Health Plan is partnering with Neighborhood Health Plan, a private, Boston-based insurance company already serving many of the state's low-income residents. Neighborhood Health Plan, which carries the contract for 90,000 of the state's Medicaid patients, is offering market-rate insurance, Mrs. Mitchell said. Direct state subsidies reduce premium costs for both employers and their modest-income employees. Self-employed Islanders would receive reimbursements on both sides of the equation. Island doctors have preliminarily agreed to accept sliding-scale co-payments from Island Health Plan customers.

State-funded subsidies already exist for very low-income citizens, but the Island Health Plan would grant eligibility to those earning up to $55,000 for a family of four.

The plan's ultimate success will depend upon a complicated web of state and federal grants, as well as collaboration with Island health care providers.

"It's very complex. But all people need to know is it's affordable and exactly how much they'll pay. The headache of the details is ours to deal with," said Mrs. Mitchell.

The Island Health Plan was spun off from the Dukes County Health Council in 2001, after the council found that nearly 20 per cent of Islanders lack health insurance, twice the rate of uninsured across the state. The idea was to band together the Island's uninsured population under a single, private health insurance company, leveraging their group's volume to secure competitive rates.

Since 2002, the Island Health Plan has received more than $850,000 in funding - the bulk of which came last summer through a federal grant enabling the Island Health Plan, Vineyard Nursing Association and Vineyard Affordable Health Care Access Program to open a rural health clinic. Over the next three years, the group will receive $462,000 in federal funds to operate this clinic, the first such in the state.

Mrs. Mitchell's salary, benefits and travel expenses are currently paid through a $103,000 grant from the Lighthouse Alliance, a regional collaborative formed four years ago to address access barriers faced by the uninsured population on the Cape and Islands. But that grant ends in September, and Mrs. Mitchell's salary will then partially be funded by the rural health clinic startup grant.

The Island Health Plan has yet to begin fund-raising, though Mrs. Mitchell said she anticipates doing so in the coming year.

The rural health clinic, which will receive cost-based reimbursement from state and federally subsidized insurance users, brings the equivalent of another full-time primary care provider into the Island's mix. An estimated 3,000 year-round Islanders, in addition to thousands of seasonal residents, do not have a primary care provider, Mrs. Mitchell said. The clinic, which at full capacity could serve as many as 3,500 patients, is expected to be self-sustaining after three years. The clinic, housed at the Triangle in Edgartown, will open late this spring.

Mrs. Mitchell said the rural health clinic is a natural extension of the nonprofit's mission: "The insurance program formed to help access issues. The rural health clinic is just another way of addressing the access."

Noting their expanding mission, this week the board of Island Health Plan voted to restructure itself. An umbrella organization, Island Health Inc., will operate both the health insurance program (to be called the Island Health Plan) and the rural health clinic (to be called Island Health Care).

"The restructuring recognizes that our organization is doing more than just insurance," Mrs. Mitchell said.

In the coming year, Island Health Inc. will be tackling a number of other projects aimed at linking uninsured Islanders with affordable medical care.

Island Health Inc., Mrs. Mitchell said, will be training at least one class of medical interpreters to assist non-English speaking residents of the Island. These interpreters would be available to doctors and the hospital to help translate the health concerns of the foreign-born population.

Island Health also hopes to roll the insurance plan out to Nantucket and Cape residents by year's end. Mrs. Mitchell is currently coordinating the specifics with officials and medical providers on both Nantucket and the Cape. She expects to enlist uninsured residents of those communities four to six months after the program gets off the ground on the Vineyard