Opinions

D.C. residents’ health care isn’t a political prize

D.C. Mayor Vincent Gray should know better. It was his legislation that created the D.C. Department of Health Care Finance (DHCF) in 2007, because he recognized the importance of improving the administration of health-care services for the District’s most vulnerable residents. But his recent actions including questionable hires show a disturbing disregard for an agency that spends over $2.3 billion a year to ensure access and delivery of health care for 225,000 D.C. residents — a third of the city.

To be sure, I am not an unbiased critic. I started on day one in the city administrator’s office with Mayor Adrian M. Fenty and went on to become the first DHCF director. I have dedicated most of my career to health-care issues for vulnerable populations, and I am proud of the successes we achieved at DHCF. Not only did we spare these low-income residents reductions in coverage during tough budget times (unlike nearly every state in the country), but under our leadership the District had the second-lowest percentage of uninsured residents in the country. We brought in new federal dollars, improved our payment systems, tripled the number of fraud and abuse referrals (including the recoupment of more than $17 million from fraudulent providers) and created the first consumer outreach office.

But you don’t have to take my word for our success. Independent auditors for the District-wide Comprehensive Annual Financial Report (CAFR) found that after the first year of operations, we significantly improved management of the Medicaid program for the first time in five years. After our second year, Medicaid was removed altogether from the list of weak areas — a remarkable turnaround that will have a significant positive bearing on the city’s financial standing.

Fenty’s instructions were to turn around the agency while protecting its beneficiaries. To implement this vision, we made tough decisions — most of which were related to personnel. We conducted a major realignment and brought in new staff, many of whom had never before worked in District government but who were drawn to the opportunity to make a ground-level difference in their own backyard. Our success stemmed from building a team of the best and brightest — no “have to” hires, no political payoffs and no preference for certain populations, special interests or other groups. When Fenty lost the mayoral primary, many of those new arrivals, including myself, decided to leave. My former staffers are now in senior positions in the federal government, leading think tanks, industry associations and consulting organizations. My deputy was tapped by the Ohio governor as the state’s Medicaid director.

During the transition after the November election, many of us were concerned that we would receive conflicting directions from our boss and from the incoming leadership. The reality was worse: Though I reached out, not once did the Gray transition team contact me. I left District government on Dec. 31 without having spoken to anyone in the incoming administration and deeply concerned about the fate of the agency and, more important, the residents it serves.

As feared, after the inauguration the Gray administration started filling the many vacant senior positions with people who lack the technical knowledge or experience needed at a critical juncture of implementing reforms for this agency. Sharon Baskerville, executive director of the D.C. Primary Care Association, said at a recent D.C. Council hearing, “I am warning, this is not the department to dump people.”

While the allegations about improper hiring practices by Gray and his team are very serious, the potential implications of their actions are far more important — affecting the 225,000 District residents who count on DHCF to deliver access to high-quality care, and the sustainability of the hospitals, community health centers and other providers that serve these populations.

D.C. Council member Marion Barry said recently, “To the victor go the spoils.” He is right. And from my experience in the Fenty administration, those spoils were both the mandate and the independence to transform our city agencies into high-performing, responsive agencies. I hope Mayor Gray realizes soon that this should be his mandate, too. The health and welfare of hundreds of thousands of D.C. residents depend on it.

The writer was director of the D.C. Department of Health Care Finance from 2008 to 2010.

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