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Mayor Anthony A. Williams
Letter of Intent to Veto Appropriation to Support DC General Hospital
April 13, 2001




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April 13, 2001

The Honorable Linda W. Cropp 
Council of the District of Columbia 
441 4th Street, NW, Suite 704 
Washington, D.C. 20001

Dear Chairman Cropp:

I believe that the action taken yesterday by the Council, that would continue the current operation of the Public Benefits Corporation through the end of FY2OO1 by adding $21 million to the District's FY2OOl Budget Supplement request, poses a significant threat to the health and well-being of the District's most vulnerable citizens. The thrust of this amendment and actions taken by the Council with regard to FY 2002 Budget and Financial Plan would delay implementation of the DC Healthcare Alliance plan. This plan provides for an efficient and safe transition of inpatient and trauma services and a significant expansion of outpatient care. It also ensures that the District's residents will receive better care, and we cannot afford further delays. For these reasons yon have left me no choice but to veto this appropriation item. We must set aside our differences and move forward with the course of action agreed upon by the PBC Collaborative.

The Council's actions are particularly untimely. The District is truly at the twelfth hour in our mutually agreed upon efforts to design and implement a more comprehensive community-based and primary care focused health care system. It is particularly troubling to me that the Council has waited until now to present a "p1an" that lacks all the elements -- dollars, numbers, formal contracts and obligations, outcome measures and assurances that the Council has criticized previous plans for seemingly lacking. Now, at this late date, after I have presented a plan that responds to all of the issues that have been raised -- you are asking the administration to risk the well-being of our residents on something that is neither a "plan" or viable.

The Council has participated in various "consensus" dialogues over the last two years. In early 1999, the Council rejected my proposal to greatly expand Medicaid coverage, instead calling for a consensus building process. In response, we established the Health Care System Development Commission to advise the administration and the Council on effective strategies for transforming the District's ailing health care safety net. I complied with the Commission's recommendations for an independent evaluation of the PBC Consultant reports dramatized the need for drastic action, yet I agreed to join the Council in the PBC Collaborative to reach a consensus on how best to reform our system. Taskforces of experts and commnmty stakeholders presented the Collaborative with a list of key factors and financial figures to guide our decisionmaking. Once again this list identified the critical need for immediate and decisive action to finally improve the unacceptable health status of our residents. The Collaborative proposed turning to the private sector for help in developing a solution. So I agreed to an RFP process that would be evaluated by people chosen by the Council, the Authority, and me. These people unanimously recommended the proposal before us. Yet the Council now, after supporting the RFP process, is unwi1ling to implement its results,

The Council's delaying tactics will further bleed our safety net of tens of million of dollars that are desperately needed to provide health services and will perpetuate care that is inadequate. I believe that the Council's most recent actions, may be in conflict with the plan submitted to Congress to contract for health care services and, send a message to Congress that we are unable to work together -- in good faith -- to solve this crisis. It is ironic that as we focus on the importance of self-government at the end of the control period that the Council would now invite Congressional involvement in this purely local matter.

After cities across the country converted their public hospitals, their experiences have shown that health care access improves. An Urban Institute report that studied changes in Milwaukee, Tampa, San Diego, Boston, and Philadelphia says, "The new plans have improved efficiency of services for the indigent uninsured, as intended. Enrollees in the programs have better access through clinics and referral providers than they had at the prior public hospital alone. Quality is said to be as good as before or better. . . ." The report also says that these "localities created innovative and efficient new safety net programs, establishing health plans to supplant their public hospitals. This very promising development shows that localities can continue to play a vital role without running a hospital."

Given the very real and immediate health care crisis we are facing and the demonstrated health improvements of other communities that have privatized their public hospitals, I ask that you reconsider your April 12 action and approve my proposed FY 2002 funding for the Health Care Safety Net Administration and the Alliance contract. I call on the Council to fulfill its commitment to work with me in undertaking a transition of our health care safety net that will result in significant improvements in the health status of our residents and provide the District with a model health care delivery system for years to come.

The instances are rare when elected leaders can change the course of history by doing the rigbt thing - even when it is difficult This, I assert, is one of those occasions.


Anthony A. Williams


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