Urged on by D.C. Mayor Anthony A. Williams (D), about 150 demonstrators noisily demanded yesterday that the District's 80,000 uninsured residents be enrolled in Medicaid so they can obtain basic health care that would keep them out of emergency rooms.
The rally at the front door of One Judiciary Square was organized by officials of private, nonprofit clinics. They are frustrated that Williams's $70 million proposal to give Medicaid cards to 39,000 uninsured residents was squeezed out of next year's D.C. budget during negotiations with the D.C. Council and the D.C. financial control board.
Hospitals argued that funding the plan would cut their overall Medicaid revenue and threaten their financial stability, and council members agreed. The council and the financial control board instead approved a $6 million pilot plan to add 2,500 enrollees to Medicaid.
Uninsured residents told the crowd that they need coverage to cope with the biggest uncertainty in their hand-to-mouth existences. While some do not grasp the complexities of the health-care debate, everyone understands that health insurance is not affordable, said Maryce Hall, 47, an uninsured nursing assistant from Northeast Washington who cannot work because of disabling arthritis.
"You can't pay for health insurance if it means taking food off the table," Hall said.
She told the demonstrators that it is costlier than it may seem for the city to have so many uninsured residents. "We don't pay taxes if we're unhealthy," she said. "We want to contribute to the city, but we can only do that if you help us help the city."
The mayor said he had no role in organizing the rally but added that he hoped it would force politicians to focus on the city's health-care crisis when he proposes a similar plan next year.
"We hear what you're saying, and you're right," he told the crowd. "It's a crisis with real people. An uninsured worker becomes disabled or loses a job because of an illness that could have been prevented -- that's a crisis."
A severe illness can immediately bankrupt the families of low-income workers whose employers do not offer health insurance, Williams said.
Instead of catering to the financial needs of health-care institutions, Medicaid spending must follow D.C. residents into the types of health facilities that could help them the most, the mayor said.
Bob Cosby, head of the Nonprofit Clinic Consortium, said the mayor's support has created a "historic opportunity" to improve the District's dismal health status.
The District has long ranked poorly in many health indicators, including life expectancy, and top officials have been unable to adopt policies to change that.
"This is about getting rid of the fighting and bickering, and finding common solutions," Cosby said.
Yet even at the rally, the crosscurrents that make the issue so complex were apparent. After the mayor spoke, D.C. General Hospital chief John A. Fairman said that expanding Medicaid is a great idea -- as long as none of the money for it comes from his public hospital's budget.
And Deairich Hunter, an aide to D.C. Council member Sandy Allen (D-Ward 8), told the crowd that D.C. General's budget must be protected. "We're talking about dividing up resources," he said.
Cosby promised to step up the political pressure, and D.C. Medicaid chief Paul Offner urged the demonstrators not to be deterred.
"Everywhere in the country, this is a desperately difficult fight," he said. "We are talking about millions and millions of dollars. Stay focused."