Filling in The District's Gaps in Health Care

Sunday, May 4, 2008

The District, with all of its challenges, has one of the most progressive and comprehensive health-care systems in the nation. And yet uninsured people continue to seek free care from Bread for the City, such as the man who was referred to us a few months ago by a U.S. senator's Capitol Hill staff.

This gentleman, who worked at the senator's dry cleaners, was in severe pain and lacked health insurance. Our doctor saw the man immediately, diagnosed advanced rheumatoid arthritis and provided him with medication. Unfortunately, the man -- whose income is low by anyone's standards -- makes too much to qualify for public insurance programs.

D.C. Council member David A. Catania (I-At Large) is proposing what could be the next great component of the District's system in the Healthy DC Act of 2008, which would give access to affordable health care to the 45,000 people in the District who earn too much to qualify for D.C. Healthcare Alliance or Medicaid yet are unable to afford private insurance premiums. In short, the senator's dry-cleaning worker will have insurance.

Unlike the Cato Institute's Michael Tanner [Close to Home, April 20], we think this legislation is a great step forward for D.C. residents who lack affordable health care. Our organization's mission includes providing free primary health-care services to low-income D.C. residents. So we look forward to the great potential of Catania's plan. Yet there are some concerns:

· The proposal's $250 fine against people who don't buy into the plan is problematic. Rising food prices and energy costs, a lack of affordable housing, and stagnating wages increasingly affect the families that this act aims to benefit. In addition, fines do not work as an incentive; we have to look only as far as Massachusetts to learn that lesson.

· The obstacle of insufficient reimbursement rates is not adequately addressed. Providers such as Bread for the City subsidize as much as 75 percent of the cost of patient visits. Our service mission compels us to operate within this ineffective cost structure; however, few for-profit providers are able or willing to lose money on every patient visit. Consequently, many people who have coverage under Medicaid or the D.C. Healthcare Alliance lack a primary care provider.

· Finally, the plan presumes that there are enough primary care physicians in the District to care for an additional 45,000 patients. While the city has one of the highest physician-to-population ratios in the country, these doctors are concentrated in wealthier areas, and a majority are specialists, not primary care providers. Nearly 300,000 D.C. residents live in federally designated "medically underserved" areas. The D.C. government must use its leverage to significantly increase reimbursement rates, which would help sustain current clinics as well as attract more primary care providers to the District.

I believe that a national health plan is the best option for providing universal care. In the meantime, I applaud David Catania for working to ensure that, at least in the District, no one will go without access to care.

-- George A. Jones


The writer is executive director of Bread for the City.

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