Increasing Primary Care Coverage
When it comes to health and health care, no one should be left behind because of their inability to pay for the care they need. DCPCA’s earliest work focused on advocacy for increased health care coverage for the poorest, most underserved people in the District of Columbia. Through those early efforts, DCPCA has emerged as a local health reform leader and voice for health care financing and coverage. DCPCA’s recent and ongoing policy work underscores an ability to galvanize political and community support, and to unite in action towards the common cause of strengthening primary care.
HEALTH INSURANCE COVERAGE — Coverage for all is the first step on the road to health equity.
• Medicaid Expansion: DCPCA Chief Executive Officer Sharon Baskerville continues to chair the Medical Care Advisory Committee (MCAC), and partners with other community advocates in oversight of the DC Department of Health Care Finance (DHCF) and with implementation of Medicaid for the District. The District has been quite progressive in moving residents who are eligible for Medicaid over from the DC HealthCare Alliance, and by doing so the District saves money and improves the benefits package for DC residents.
• Preserving the DC HealthCare Alliance: As the District continues to move Medicaid-eligible District residents over from the Alliance, few patients remain. This presents a unique challenge for the District, which pays for the Alliance with local dollars. The District has made a commitment to all DC residents by offering them health insurance coverage, and celebrates the 6.2 percent uninsured rate as being one of the best in the country. Therefore, DCPCA is devoted to making sure that no District resident loses insurance coverage as a result of health reform implementation. The FY12 DC Budget will require Alliance enrollees recertify twice a year by having a face-to-face interview with an Income Maintenance Administration (IMA) employee and DCPCA is actively exploring the potential implications for this new process.
• Health Insurance Exchange: Currently, the District is exploring the opportunity for developing a Health Insurance Exchange (HIE). The DHCF has been awarded a $1,000,000 State Planning and Establishment grant to look at the feasibility of developing: (1) A District-only health insurance exchange; (2) A regional HIE with Maryland and Virginia; or (3) Participating in a federal Health Insurance Exchange.
PRIMARY CARE INFRASTRUCTURE — Ensuring the provider community has the tools in place to provide quality, affordable health care.
• Provider Reimbursement: Ensuring that providers are reimbursed adequately for the care that they provide, compels more providers to be willing to accept Medicaid patients and allows historic safety net providers to meet their bottom lines. Last year, Medicaid reimbursement rates were increased to 100 percent of the Medicare rate. However, due to increasing budget pressure, reimbursement rates this year were reduced to 80 percent of the Medicare rate for primary care and 90 percent of the Medicare rate for dental care. DCPCA continues to advocate for reimbursement at the true cost of care. Additionally, there are new opportunities presented through health reform, such as an increased federal match on Medicaid for case management for patients with chronic diseases, as well as other prospects for payment reform around pay for performance.
• Workforce: DCPCA actively works with the State Primary Care Office in the Community Health Administration at the DC Department of Health (DOH) on primary care workforce issues. DCPCA previously advocated for the District’s ability to apply for federal funds to support the State Loan Repayment Program (SLRP); DCPCA continues to support community health centers who are interested in participating in both the SLRP program and the National Health Service Corps.
• Malpractice Coverage: DCPCA has been working with the Council of the District of Columbia and the DC Office of Risk Management in an effort to sustain the Medical Liability Captive Insurance Program. A captive insurance company was set up in 2008 to provide coverage for DC’s historic community-based primary care providers at a lower cost than available through the general insurance market. This program is essential for the continued operation of the District’s health centers, and an Advisory Council, as required by law, has been reconvened as of May 2011 to look at the program’s operations and long-term sustainability.
As the District implements health reform locally, through new opportunities presented by the American Recovery and Reinvestment Act (ARRA), Patient Protection and Affordable Care Act (PPACA), and others, the landscape changes every day. DCPCA has actively participated on each subcommittee of the Mayor’s Health Reform Implementation Committee, and engages with District agencies and the Council on a regular basis. These policy and advocacy efforts demonstrate DCPCA’s commitment to action and innovation for health equity.
DCPCA’s 2011 Policy Goals Remain Focused on:
(1) Preservation of, and strengthening, the primary care infrastructure;
(2) Federal health reform implementation in the District; and
(3) Data-driven analysis and advocacy.
For more information, read the one-pager about our Policy, Advocacy, and Health Reform efforts, visit Health Care Reform, our Health Equity Blog, or read our Testimony.
For additional information about health reform in the District of Columbia, contact Howard Liebers, MPH, DCPCA’s Director of Policy, at (202) 638-0252, extension 223.
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