Copyright 1999 Federal Document Clearing House, Inc.
Federal Document Clearing House Congressional Testimony
June 16, 1999
SECTION: CAPITOL HILL HEARING TESTIMONY
LENGTH: 1255 words
HEADLINE:
TESTIMONY June 16, 1999 GREGORY MCCARTHY DIRECTOR, OFFICE OF POLICY AND
EVALUATION HOUSE APPROPRIATIONS DISTRICT OF COLUMBIA FISCAL
2000 DC APPROPRIATIONS
BODY:
Statement of Gregory
McCarthy Director, Office of Policy and Evaluation Executive Office of the Mayor
District of Columbia Health Care Priorities for Washington, DC
Subcommittee on the District of Columbia Committee on Appropriations U.S. House
of Representatives June 16,1999 Chairman Istook, Representative Moran, Committee
members, thank you for the opportunity to speak today about Mayor Williams'
vision for health care in the District of Columbia. The Mayor's
initial budget submission to the City Council earlier this year launched a
spirited citywide debate on the future of health care in the
District. Today I will briefly outline the Mayor's vision; summarize some
critical events since the original submission; and relay to you plans to forge a
citywide consensus on how to proceed. The administration has three broad goals:
dramatically reduce the number of uninsured District residents
build primary care capacity in currently undeserved areas strengthen the
health care delivery system Obviously, these are broad and
ambitious goals, but they do translate into more specific accomplishments around
which the Mayor hopes to develop a citywide consensus, including: +increased
access to insurance coverage for District residents expanded access to primary
and critical health care services such as substance abuse
treatment, medications for persons living with HIVAIDS, and trauma services
improved quality of care with strengthened oversight of managed care plans
revitalization of the health care safety net for those who
remain uninsured or underinsured reduced burden of
uncompensated care costs on providers and employers redirection of grant funds
currently being spent on direct service delivery to finance
health prevention, promotion, and intervention activities
increased competitiveness of the District-based health care
sector, supporting the effort to maintain and increase one of the District's
largest employment sectors The Mayor remains firmly committed to a strong safety
net system and to refocusing the system on patients rather than institutions -
while ensuring equitable access to health care for all
geographic and economic sectors of the city. Of course, this will mean allowing
institutions to maneuver in a market that is increasingly becoming more
competitive. It also means having health care institutions that
are strong and viable, particularly those that serve the
uninsured and lower income populations. Despite the fact that
we spend one-fifth of the District's budget on health care,
there are still 80,000 uninsured people. Ample resources exist
in our public health care system to cover more people, and we
must not lose sight of this reality. As you know, the Mayor's original budget
proposal was bold and far-reaching. He proposed a significant expansion of
health insurance coverage for as many as 35,000 people up to
200% of the federal poverty level as well as reform of how the city manages some
substance abuse and prevention programs. The latter program will contract out
more substance abuse programs, transforming the government's role from primary
service provider to regulator, monitor, policyrnaker, and evaluator. The
health insurance expansion proposal provoked a vigorous
dialogue in the city among government officials, health care
providers, patient advocates, and health experts. Almost all
agreed that the goal of universal coverage was laudable, but there were
divergent opinions about how we reach that goal and the likely impact of the
proposal on healthcare institutions. The Mayor proposed that the expansion be
funded by reallocating Disproportionate Share Hospital (DSH) payments and local
funds to pay for health insurance coverage. Under this plan,
all hospitals would have been held harmless in FY 2000 through a combination of
residual DSH payments and increased income from newly insured patients. What
emerged from the process was a much smaller pilot program for 2400 people funded
by reallocation of $6 million in DSH payments. In FY 2000 the administration
will focus on implementing this smaller program while not losing sight of the
humane goal of coverage for considerably more uninsured
residents. Ultimately, this should not be a debate about institutions. At issue
is the best way to use our resources to increase the efficiency of the delivery
system, especially for our most vulnerable populations. At the same time, the
Mayor recognizes that reasonable, informed people can have differing views on
how to achieve better health care. To this end, the Mayor is
pleased to have joined with the City Council and Financial Authority in
establishing a high-level commission that will examine the current system with a
view toward making practical, action- oriented recommendations on the following
subjects: inpatient bed overcapacity distribution of health
care services and providers role and needs of the Public Benefit Corporation
maintenance of safety net providers impediments to accessing care beyond the
lack of health care insurance fiscal impact of expanding
health insurance coverage implementation schedule for
redeveloping the health care system The 11 -member commission
will consist of mayoral and Council appointees. During its work, the commission
will engage the full spectrum of health care parties to develop
recommendations with broad support. Authorization for the commission is
contained in the Budget Support Act of 1999. Final recommendations are due with
180-days of the effectiveness of the act. The Mayor is eager to discuss fiscally
prudent options that address the systemic problems in our system. He has,
however, eliminated one option: the status quo. There is no going back to a
system that is fragmented, unfocused on primary care, and, ultimately, results
in troubling health status indicators. All while consuming
considerable public funds. It is incumbent on all parties to prepare for and
implement change in a way that honors important principles, protects the
vulnerable, and causes minimal disruption and turbulence for individuals and
institutions. The Commission's work could not be more timely. As you know, under
an agreement with the city, last month Greater Southeast Hospital sought and
received Chapter 11 reorganization protection. The city is committed to loans,
loan guarantees, and/or payment advances to allow the hospital to meet immediate
payrolls and provide vital services for up to 90-days -- during which it should
develop a plan for financial health and competitiveness. In the
meantime, the Mayor, the Council, and the Financial Authority have convened a
working group of other hospitals with a safety net mission to outline short- and
medium- term options for uninsured and underinsured residents,
especially those east of the Anacostia River. Fully aware of the vital and
urgent needs that Greater Southeast fulfills for the community, the Mayor has
committed time and resources to ensure that residents in Southeast have access
to quality health care. The working group's findings will
contribute to the work of the broader health care commission.
Mr. Chairman, quality heath care is an absolutely essential element of the
Mayor's vision to improve city services and the quality of life for District
residents. Economic development plans, hopes for our young people, and
neighborhood stabilization efforts cannot succeed if larger
health issues are not addressed. Thank you for your time and
attention to the issue of health care in the District of
Columbia.
LOAD-DATE: June 18, 1999
