The Washington Post

Mistrust of government may be D.C.’s biggest hurdle with new health-care law

The biggest hurdle facing D.C. officials as the city begins to roll out the first phase of President Obama’s Affordable Care Act might not be finding the District’s uninsured people and convincing them to sign up for health insurance. The stiffest test might be convincing residents that its city government can implement and manage the program.

The District and states across the country are in what they call the “awareness” stage of the implementation of the new health-care law, which has come to be known as Obamacare. In the District, this stage includes 11 town hall meetings in the city’s wards.

To get an idea of what residents are thinking about the new law, I attended four of the meetings — one each in Wards 1, 4, 5 and 8. A common theme I heard, in questions asked by those in attendance and in speaking to many of them after the meetings, is skepticism about the District government’s ability to successfully launch its version of Obamacare.

A sampling of the questions that imply a lack of confidence in D.C. government:

— Is there a backup plan if the computer system that houses the D.C. health insurance crashes? (Yes.)

— What if I don’t know how to use a computer or don’t have one? (There will be community-based assistance throughout the city and a 24-hour hotline.)

— Will assistance and instructions be available in languages other than English? (Yes.)

— Will there be details of the different plans on the health insurance marketplace’s Web site? (Yes, plan details will be available by Oct. 1.)

Ebony Washington, 32, a D.C. native with two children, is a self-employed occupational therapist with experience in dealing with D.C. government. She said she was impressed by what she heard at the town hall meeting at the Columbia Heights Recreation Center but has reservations about how the city will handle the new program.

“I think it’s great that the application process will be streamlined,” Washington said. “But the history of the D.C. government for keeping records in order, keeping documents and not losing them has not been good.”

For years, problems have plagued the city’s foster care and other child welfare programs, group homes for youth offenders, and mental health and housing programs. At one point, seven class-action lawsuits had led to court oversight over various social service agencies. Since Mayor Vincent C. Gray (D) took office, two cases have been dismissed.

In some ways, the District is better off than other jurisdictions when it comes to health insurance statistics. That is part of why getting the uninsured covered might not be the city’s toughest task. The District has about 42,000 people without insurance, officials say, about 7.2 percent of the population. If it were a state, that would rank it second behind only Massachusetts.

A majority of the uninsured are black — about 58 percent — and between the ages of 18 and 35. About 66 percent are men. The uninsured live mostly in Ward 1 (22.7 percent), Ward 4 (18.7 percent) and Ward 7 (18.1 percent), based on 2009 estimates.

Mila Kofman, executive director of the D.C. Health Benefit Exchange Authority, said she understands concerns. But she says the exchange will be ready to go Oct. 1, the date that individuals can begin using the D.C. marketplace to purchase insurance. Coverage purchased between Oct. 1 and late December would begin Jan. 1.

“I’m very confident in where we are,” Kofman said. “By Oct. 1, when everything goes live, what is within our control, every glitch that we can find will be patched.”

The authority, a quasi-government agency, has 23 full-time employees. One thing that District residents should feel good about is the people who are working at the authority. Some had a hand in crafting the law in Congress. All that I talked with are enthusiastic supporters of the benefits that the health-care law will offer and believe the new system will succeed.

“Failure,” says one authority employee, “is not an option.”

Washington got that impression after sitting through the two-hour town hall presentation. But she still had questions. “You pay premiums through the marketplace through D.C. government. If I get behind in payments, will I still be able to renew my professional license? In the past, if I owed D.C. government any money, the city would not renew my license.

“You know,” she said. “It’s still D.C. government.”

Keith Harriston lives in Prince George’s County and teaches journalism at Howard University, where he edits


number of people without insurance in the District

58 percent

majority of the uninsured who are black and between the ages of 18 and 65

23 percent

of uninsured in Ward 1, the highest in the District



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