Anthony
Williams for Mayor

Anthony Williams Vision for Health Care in the District

As Mayor I will ensure access to high quality health care services for all District residents. My plan for improving health care delivery includes the following five key components:

1. Expanding insurance coverage
2. Maintaining a health care safety net for those without insurance
3. Developing better health care infrastructure, including a viable Public Benefits Corporation delivering high quality health care services to our community
4. Ensuring quality health care delivery, with patient protections and appropriate regulation of HMO's
5. Providing access to and availability of critical services such as community mental health programs, substance abuse prevention and treatment, and services for individuals living with HIV/AIDS

All of these goals can be accomplished without being fiscally irresponsible. My administration will work to improve health care delivery through better management, maximizing federal resources, and reallocating resources to meet our priorities.

The health care environment is changing quickly in the District and across the country due to recent changes in federal legislation, health care markets, and health care insurance. If properly coordinated and managed, this is an opportunity to increase the quality and availability of health care in the District while taking steps to assure a stable long term funding structure for those changes.

Background

The District currently spends about one-third of its budget on health care related services. Despite this spending, the current health care system in the District fails to meet the needs of many residents. The health care status of the District is poor by a number of measures. The District has higher than national average rates of infant mortality, homicide, and communicable diseases including HIV/AIDS. Some of these health care indicators reflect the high rates of poverty, crime, and substance abuse in the city. As Mayor, I am committed to doing better. We must improve these unacceptable statistics. We can do this by focusing on policies directly related to health care as well as improving the overall health of the city (reducing crime and poverty while increasing focus on education).

Expand Access to Health Care Services by Increasing Health Care Insurance Coverage

Insurance coverage is one of the primary ways that individuals have or can gain access to health care services. Currently 17 percent of all District residents lack health insurance. Through Medicaid expansions and policies to encourage employers to retain employee coverage the number of residents without coverage can be dramatically reduced.

Children Health Insurance

I am excited about the new Children's Health Insurance Program (CHIP) that will be implemented by Medicaid starting in October. This program will increase Medicaid coverage to more than 8,000 children in the District living in families with incomes below 200 percent of the federal poverty level. As Mayor, I will work with the Department of Health to expand coverage to the parents of these children and other low income single adults. These expansions could increase coverage to another 14,000 individuals. Some of these initiatives will be implemented this year. As Mayor, I guarantee successful implementation of these expansions.

These expansions could increase coverage to pregnant women. Medicaid coverage would ensure access to prenatal care services which will ultimately help reduce the high rates of infant mortality in DC.

These expansions can succeed if individuals sign up for the program. This requires intensive and coordinated outreach efforts to inform District residents that they may be eligible. In fact, there are many individuals who are currently eligible for services but who are not enrolled in the program. Outreach efforts need to be targeted to all ethnic and racial groups through community organizations and schools. These efforts should include outreach in other languages such as Spanish.

These Medicaid expansions would allow the District to reduce the number of uninsured individuals and increase access to health care services. In addition, these proposals are fiscally prudent because they allow the District to maximize federal Medicaid funds.

Policies to encourage employers to maintain coverage

Across the country the number of uninsured is increasing because employers are dropping employee coverage and health insurance is extremely expensive to purchase. As Mayor, I will explore options to encourage employers to maintain insurance coverage for employees. I will also investigate opportunities that would allow employers or groups of individuals to work together to use group purchasing cooperatives so the uninsured can purchase more affordable health insurance.

Maintain a Safety Net of Services for Those Without Insurance

I recognize and support the Public Benefits Corporation (PBC) as one of the primary providers of services of comprehensive, high quality and community-based services for the under-served residents of the District. We must maintain a viable safety net for those without insurance. The PBC is composed of DC General Hospital and several community-based clinics. The mission of the PBC is to provide health care services regardless of an individual's insurance status or ability to pay for care.

As Mayor I will work with the PBC to develop and implement a contract with the District for funding uncompensated care delivery. In addition, I will continue to work with the administration of the PBC to help it improve service delivery to their customers and improve operations.

Develop Appropriate Health Care Infrastructure to Address Primary Care Needs

The health care infrastructure in the District is currently focused on hospital based care. However, in the District and across the country hospital days and beds are declining. In place of intensive hospital care, the District needs to devote attention to the development, repair, and expansion of community based services and clinics. A 1996 General Accounting Office report surveyed health facilities in the District and provided estimates and recommendations for repairs to existing clinics. These recommendations should be reevaluated and prioritized for capital funding. Community clinics are vital for access to health care services because they can best provide immediate primary and preventive care services to individuals in targeted neighborhoods.

In addition to community clinics, access to health care can be dramatically increased by establishing school based health clinics. More so than ever before, urban schools are becoming the cornerstone for the network of programs for children. As such, it makes sense to integrate access and availability of health care services info targeted schools. As Mayor, I will support the creation of several school based health clinics following the lead of demonstrations already successfully implemented in other states.

Ensure Duality Delivery Systems with Patient Protections

Health care markets are changing rapidly both in the District and across the country. Health care is increasingly being delivered through managed care arrangements and Health Maintenance Organizations (HMOs). While individuals can benefit from these delivery systems through greater access and attention to primary care services, we must ensure patient protections in this changing environment. Too often managed care entities are denying care recommended by physicians. I support the Congressional proposal to give consumers access to the doctors of their choice, the procedures these doctors recommend, and the right to promptly appeal improper decisions of HMO bureaucrats denying them the care that they need. To the extent the federal government fails to properly address this national problem, the District should step in with appropriate legislation to control managed care organizations.

As Mayor, I will advocate for greater patient protections and then ensure that these protections are implemented successfully. As a proven manager I will establish a governing coalition with physicians, other health care professionals, and health care consumers to ensure that the right laws are not only passed, but also fully implemented.

Critical Services

As mentioned above, the District has higher than national average rates of infant mortality, communicable diseases (including HIV/AIDS), homicide, and substance abuse problems. As Mayor, I will provide resources to address these critical issues. Substance abuse is linked to violence, crime and poverty so particular efforts need to be made to prevent substance abuse from beginning and continuing.

Finally, as Mayor, I will work with the Commission on Mental Health Services to expand of community mental health programs. The establishment of these programs has been ordered by the courts and must be addressed.

As with other issues, these services can be provided while maintaining fiscal integrity. We must maximize federal funding for these services and provide services in the most efficient way possible.