THE DISTRICT of Columbia is already ahead of much of the nation when it comes to health insurance for its residents. Eight percent of the population lacks insurance, compared with 16 percent nationally. Some D.C. Council members, though, are not content to rest on those laurels and are pushing a plan to achieve universal health care. The initiative holds promise, but city officials should be cautious as they scrutinize a plan that could contain hidden risks.
The brainchild of council member David A. Catania (I-At Large), the far-reaching program targets some 25,000 uninsured residents who are the intractable middle of the uninsured. They make too much money to qualify for government health care (Medicaid or the city's Health Care Alliance) but not enough to afford coverage on their own. Mr. Catania would mandate health-care coverage for everyone and offer a subsidized plan in which residents would pay as little as $20 a month. CareFirst BlueCross BlueShield, under pressure to better meet its charitable obligation under its federal charter, would kick in $5 million a year (some are already saying that's not nearly enough). Subscribers would be able to use the company's network of providers.
The plan resembles one adopted in Massachusetts, where implementing universal coverage has proved more difficult and costly than imagined. There's no question that the District would be dealing with a much smaller number of people and has a good foundation with the Health Care Alliance, but officials still would do well to study Massachusetts's work in progress. Of particular concern is how to guard against employers shifting the cost of health care onto government. Massachusetts is also dealing with a shortage of doctors who are able and willing to accept newly insured patients.
Another issue for D.C. officials is whether the financing plan -- $21 million in new taxes on health companies and cigarettes -- is the most prudent way to raise money in a worsening economy. Some question whether doubling the tobacco tax would produce the projected revenue or just cause smokers to buy elsewhere. Then, too, there are issues regarding whether the city is equipped to administer the program. Could it guard against freeloading by residents of Virginia or Maryland? Would the proposed $250 fine be enough to force everyone to obtain insurance? The proposed selection of CareFirst poses its own questions. No doubt CareFirst, with its proven network, offers advantages, but surely the District might want to invite others to bid on what promises to be a lucrative contract.
Mr. Catania should welcome a tough-minded review. As chairman of the council's Committee on Health, he knows better than anyone the importance of affordable, accessible and comprehensive health coverage. At the same time, he also knows the complexity of coming up with something that really works.