Increasing Primary Care Coverage
When it comes to health and health care delivery, 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 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. Additionally, DCPCA supports the Medicaid Expansion and Eligibility Subcommittee of the Mayor’s Health Reform Implementation Committee in its work to develop a single-point of entry for District public benefits, as well as examine impact of the transition to Modified Adjusted Gross Income or “MAGI” for determining Medicaid income eligibility.
• Preserving the DC HealthCare Alliance: As the District continues to move Medicaid-eligible District residents over from the Alliance, few Alliance beneficiaries remain. Moreover, many Alliance beneficiaries have lost their insurance cover as recent changes require Alliance enrollees to recertify twice a year by having a face-to-face interview with an Economic Security Administration (ESA) [formerly Income Maintenance Administration (IMA)] employee. Together, these changes present 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 highest in the country. Therefore, DCPCA is devoted to making sure that no District resident loses insurance coverage as a result of health reform implementation.
• Health Insurance Exchange: Currently, the District is exploring the opportunity for developing a Health Insurance Exchange (HIE). In preparation for putting into effect the Affordable Care Act, the Council of the District of Columbia passed legislation creating an exchange on December 20, 2011. Exchanges are the central mechanisms created by the federal health reform bill to help individuals and small businesses purchase health insurance coverage. Beginning in 2014, an exchange will be established in each state to help consumers make valid comparisons between plans that are certified to have met benchmarks for quality and affordability. The exchanges will also administer the new health insurance subsidies and facilitate enrollment in private health insurance, Medicaid, and the Children’s Health Insurance Program. Nobody will be required to purchase health insurance through the exchange, though subsidies will only be available for plans sold through the 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 in 2011 were reduced to 80 percent of the Medicare rate for primary care and 90 percent of the Medicare rate for dental care. The federal health reform law increases Medicaid reimbursement rates for certain evaluation and management services provided by primary care physicians to 100 percent of Medicare rates in 2013 and 2014. The impact of the reimbursement increase likely will be limited because of its temporary nature and exclusion of other services provided by primary care providers and any services provided by medical and surgical specialists. DCPCA continues to advocate for reimbursement at the true cost of care.
• Workforce: DCPCA actively works with the State Primary Care Office in the Community Health Administration at the DC Department of Health 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. For more information, please visit our page on the SLRP, or Health Professional Loan Repayment Program.
• Malpractice Coverage: DCPCA has been working with the DC Council 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 2012 Policy and Advocacy Goals Remain Focused on:
(1) Efforts to Achieve 100% Health Insurance Coverage Among District Residents;
(2) Efforts to Develop Public-Private Partnerships in Prevention and Health Service Delivery;
(3) Efforts to Facilitate the Development of a Fully Integrated Health System; and
(4) Continue to Build and Strengthen Relationships with Media to Ensure Maximum Coverage.
For additional information about health reform in the District of Columbia, contact Howard Liebers, MPH, DCPCA’s Director of Policy, at (202) 552-2316.