On December 10, 2010, Brookings Greater Washington Research released a report, funded by the Rockefeller Foundation, on the expansion of health coverage in the District of Columbia. The report is a case study on the District of Columbia's reforms over the past 10 years (1999-2009), which made positive strides in moving toward Universal Coverage, while also shifting its role to a purchaser of health care services rather than an operator of a public provider system. Gina Lagomarsino, Results for Development Institute (R4D) Managing Director was one of the report co-authors.
Expanding Health Coverage in the District of Columbia
To fix a health system in crisis, in which the public hospital and associated clinics were offering poor quality care at high cost per patient, the District initiated a series of reforms to expand access to health care and improve residents’ health. The city closed the public hospital’s inpatient facility, transferred control of the hospital’s emergency department and affiliated clinics to a nonprofit health care provider, and created the DC HealthCare Alliance to pay for health services for uninsured low- income District residents who were not eligible for Medicaid. The District government shifted from directly providing health care to purchasing health care services from private providers.
Despite the political unpopularity of many of these reforms, the District encountered a number of successes. Enrollment in the Alliance program exceeded 50,000 in 2009 and as a result of the Alliance and a generous Medicaid program, the District currently has one of the lowest uninsured rates in the country. The Alliance also helped stabilize and strengthen community health centers—both the former public clinics and nonprofit community health centers—since it attached a revenue stream to patients the centers had been serving without reimbursement.
The District’s experience in redesigning the health care system for low-income residents provide important lessons for other states and localities. To be sure, some of the District’s circumstances were unique. Nevertheless, the city’s experiences in shifting its role to a purchaser of health care services rather than an operator of a public provider system highlight common opportunities and pitfalls.
For more information visit the Brookings website: www.brookings.edu/washington
