Health Care

THE PROBLEM

For too many District residents, reliable, quality health care remains out of reach:

• Substantial investment in health insurance programs for low-income residents has resulted in an uninsured rate in DC of just 9.8 percent — one of the lowest in the nation. Despite this investment in coverage, more than half of DC residents live in areas that lack access to care. Provider reimbursement rates offered by health insurance programs do not cover the full cost of patient care. As a result many practices face constant financial challenges as they struggle to meet patients’ needs and some refuse to accept these patients altogether.
• Health care services and resources are not distributed equitably throughout the District. The greatest gaps in access to primary care are in Wards 7 and 8, areas of the city that also suffer from the highest prevalence of chronic diseases. These diseases, including diabetes and HIV/AIDS, could be avoided or treated with better access to primary care.
• Thousands of District residents go without needed mental health and substance use treatment. Some residents can’t afford these services because they are not covered by the DC HealthCare Alliance. Those residents who have coverage through Medicaid lack access to quality, community-based services in their neighborhoods, particularly in Wards 7 and 8. Many residents who do have access to a primary care provider still cannot access mental health and substance use treatment because public financing for these services is not integrated with reimbursement for primary health care.

WHAT IS BEING DONE NOW

The District covers more than 30 percent of its residents, or over 213,000 people, through its health insurance programs. Nearly 159,000 residents are enrolled in Medicaid — one of the most comprehensive Medicaid programs in the country— and Medicare. An additional 55,000 residents have coverage provided by the DC HealthCare Alliance. Medicaid covers people with children up to 300 percent of poverty; the DC HealthCare Alliance, covers people up to 200 percent of poverty who may not otherwise qualify for health insurance; SCHIP, covers low-income families and their children; and, starting in 2010, Healthy DC covers those with incomes between 200 and 400 percent of poverty.

The city has also tried to correct for the low availability of providers by recently raising some Medicaid and Alliance reimbursement rates for primary and specialty providers. Alliance rates were increased from $65 to $95 a visit in FY 2009. However, the estimated cost of care for an Alliance patient visit— $179 — is still well above the reimbursement rates.

DC has a model public/private partnership underway called Medical Homes DC that seeks to improve access to quality primary care in the District’s medically underserved neighborhoods through capital funding, technical assistance, and programs to enhance the primary care infrastructure. The DC Primary Care Association is leading 13 capital improvement projects for health centers supported by more than $70 million in investment from the District government.

The District is working to address financial and administrative burdens that limit access to mental health and substance use treatment, but much more needs to be done to ensure that all residents have access to quality services in their community.

LEARN MORE

• The Uninsured: A Closer Look; Residents of DC Without Health Insurance, Families USA, March 2009.
• DCBA Issue Brief: Free-Standing Mental Health Clinics, DC Behavioral Health Association, October 2009.
• Toward a True System of Care: Improving Children’s Behavioral Health Services in the District of Columbia, Part 1, DC Behavioral Health Association, February 2009.
• Toward a True System of Care: Improving Children’s Behavioral Health Services in the District of Columbia, Part 2, DC Behavioral Health Association, February 2009.
• 
  Assessing Health and Health Care in the District of Columbia, RAND Corporation, 2008.
• Premiums versus Paychecks: A Growing Burden for the District of Columbia’s Workers, Families USA, October 2008.
• Who Has Insurance and Who Does Not in the District of Columbia, Urban Institute, December 2007.
• Slipping Through the Cracks: Closing the Gaps in the District’s Mental Health System, DC Primary Care Association, October 2007.
• Health Status and Access to Care among Low-Income Washington, DC Residents, Brookings Greater Washington Research Program/RAND, October 2006.
• Where We Are, Where We Need to Go: The Primary Care Safety Net in the District of Columbia, DC Primary Care Association, January 2005 update.