As states across the country scramble to meet the requirements for national health reform, the nation's capital is "way ahead," according to Dr. Julie Hudman, director of the Department of Health Care Finance and a member of the city's Health Reform Implementation Committee. Mayor Adrian M. Fenty created the panel last May to explore how best to implement federal health reform.
At a recent public meeting, officials eagerly highlighted some of the city's accomplishments. They noted that the District's uninsured rate of 6.2 percent of residents is the second lowest in the country, only behind Massachusetts, a state that voted for near-universal health insurance almost four years ago.
They pointed out that Washington has already expanded Medicaid coverage, a key component of the new health care reform law that will be required in four years.
The city embraced an invitation by federal administrators to make people eligible for the program at up to 133 percent of federal poverty guidelines. As a result, D.C. officials successfully converted 32,000 residents from the D.C. HealthCare Alliance, a city program that covers low-income residents who don't qualify for Medicaid, into the program on July 1. Now, 188,220 residents are covered by Medicaid while 29,280 are covered by the Alliance, according to the Kaiser Family Foundation. (KHN is a program of the foundation.)
The D.C. government also sought federal permission to transfer an additional 4,000 residents who fall between 133 and 200 percent of the poverty level into Medicaid, an expansion Hudman said was a "win-win" scenario.
This step makes the city and Connecticut the only two jurisdictions to have expanded Medicaid coverage early. Both previously covered people under their own low-income health programs, which were more generous than pre-reform Medicaid requirements.
But such comparisons involving the District and states are often problematic because the former has a smaller population than most states and is an entirely urban area. The District heavily relies on public programs to provide insurance to poor and disadvantaged residents. More D.C. residents receive public coverage -- including through Medicare, Medicaid and the Alliance -- than other areas in the country and the city government picks up a large portion of that cost, according to the Urban Institute. Approximately 32.8 percent of D.C. residents receive public coverage. Another 55 percent receive employer coverage and 6 percent access it through individually purchased plans and military, veteran and student health programs, according to the Urban Institute's 2009 DC Health Insurance Survey.
While officials praised expanded coverage, they noted that some of the city's poorer residents still have difficulty getting access to doctors and health care facilities.
"We need to be pushing for greater access to care," said Department of Health (DOH) Director Pierre Vigilance. He emphasized the need for more access in emergency rooms, school based health programs and primary care clinics and doctors' practices.
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