STATEMENT OF COUNCIL CHAIRMAN
LINDA W. CROPP
This afternoon, I have called an additional
legislative meeting to disapprove the contract with Greater Southeast
Community Hospital to provide health care services to the District's
uninsured, and to override two Mayoral vetoes of the Fiscal dear 2001
Supplemental Budget Request Act of 2001. Both actions are designed to
determine once and for all the future of our public hospital.
on Council Action to Disapprove the Contract with Greater
Southeast Community Hospital and to Override the Mayor's
Veto of Funding for the Public Benefit Corporation
April 27, 2001
As I have said before, this is not a fight
between the Council and the Mayor, nor the Financial Authority and the
Council. We agree:
- that every District resident should have
access to quality health care services with an emphasis on
community-based primary care;
- that health insurance coverage should be
- that efforts must be directed toward improving
the health status of District residents; and
- that the structure of the Public Benefit
Corporation must change from its management system to its financial
We also agree that our health care system could
benefit from public-private partnerships, and that contracting is a means
to bring about much needed reform. However, we differ on using a private
hospital as the core or anchor of the health care system.
Over the last two months, the Council has raised
a number of concerns about the potential contract. To an extent, many of
those issues were addressed during negotiations with Greater Southeast
Community Hospital. Still, this contract between the Financial Authority
and Greater Southeast Community Hospital to establish the D.C. Healthcare
Alliance Program is not in the best interest of the District or its
The reason we are here today, is because of the
financial pressures placed on the District by D.C. General Hospital. Yes,
the hospital exceeded its budget, but it was also under-funded. This total
operating cost of this contract is approximately $90 million for the first
year. The cost of the Public Benefit Corporation is projected at
approximately $100 million in local funds for next year, not including
savings resulting from the implementation of reforms. Therefore, this
contract raises the similar concerns about cost.
Overall, the structure of this contract is such
that a profit is unlikely if the budgeted amounts are adhered to,-some
services are under-funded, and significant cost over-runs will trigger a
limitation on services or renegotiation of the contract. With no
alternative, the safety net would be threatened without an infusion of
additional funds. The costs are tremendous. This contract has the
potential to devastate the District's newfound financial stability.
With regard to service delivery, the contract is
limited in some respects and quite ambitious in others. For example, the
school health program includes 20 hours per week of nursing services. This
does not recognize the school nurse services in excess of the minimum
provided in some schools. Without additional funding these schools will
receive reduced services. The primary care practitioner has numerous
duties related to managing and coordinating patient care. This is a
time-consuming endeavor, as is patient education. It is questionable
whether any provider would assume this responsibility without additional
compensation. Care management and follow-up are key in truly effecting
better patient outcomes. Without it, the D.C. Healthcare Alliance Program
will not reach its goal of improving the health status of District
As a final example, there is the issue of trauma
services. Under the contract, Greater Southeast Community Hospital has no
obligation to maintain trauma services at D.C. General Hospital until it
has established comparable on-sight trauma capacity. This leaves the
possibility of a gap in
services. Greater Southeast Community Hospital must, however, ensure the
availability of trauma services through agreements with other providers if
it is unable to provide those services on-site by August 31, 2001. This
raises questions about the ability of other hospitals to fill the void and
the Emergency Medical Service's ability to transport patients from the
eastern-most section of the city to Northwest.
Given the cost implications
and remaining concerns about the level of services to be provided,
disapproval of the contract with Greater Southeast Community Hospital to
provide health care services to the District's uninsured is warranted.
In a related matter, the
Council will vote on overriding the Mayor's veto of two provisions in the
Fiscal Year 2001 Supplemental Budget Request Act which would provide
additional funding to the Public Benefit Corporation. This action will
increase funding for the hospital by an additional $21.5 million. With
already implemented reforms and monitoring by the Chief Financial Officer,
this amount will sustain the hospital through the remainder of this fiscal
year. If this funding is approved by Congress, District officials will
have an opportunity to consider further the options available to reach
their collective goal of meeting the health needs of the District's
The District has made great
strides in improving its financial condition so that it can better serve
its residents. Today's vote by the Council is in keeping with its
responsibility to act in the best interest of the District of Columbia,
its citizens, and particularly the least fortunate among us.
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FREQUENTLY ASKED QUESTIONS ABOUT
THE COUNCIL'S POSITION ON CONTRACTING FOR HEALTH CARE SERVICES
FOR THE DISTRICT'S UNINSURED
1. IS THE COUNCIL SUPPORTING
THE STATUS QUO BY FUNDING D.C. GENERAL HOSPITAL?
No, the Council is not supporting the status quo.
The Council is clear in stating that it supports an efficient,
cost-effective health care system. To that end, the Council has invested
considerable time and effort in -collaboration with other government
officials, health care experts, and paid consultants to look at the
problem and to provide direction for corrective actions. D.C. General
Hospital was, and remains, in the process of implementing the mandated
reforms. In the long run, it is more reasonable and more cost-effective to
continue reforming the existing system than to create a new system. The
Council, further, believes this system can and should be public so that
access to health care for all District residents is assured.
2. D.C. GENERAL HAS HAD FINANCIAL AND MANAGEMENT
PROBLEMS FOR YEARS. HOW HAS THE COUNCIL ADDRESSED THOSE PROBLEMS?
D.C. General Hospital, like every other public
and private hospital in the District and across the country, has
experienced financial and management challenges. Many of those challenges
arise from the way health care is delivered and financed in this country.
Therefore, the problems of D.C. General Hospital are not unique.
In 1996, the Council enacted legislation to
address concerns facing D.C. General Hospital. The "Health and
Hospitals Public Benefit Corporation Act" established a nonprofit
corporation, the Public Benefit Corporation, to provide comprehensive
community-based health care to District residents. It removed D.C. General
Hospital from the bureaucracy of the District government, provided the
needed flexibility for it to change with the evolving health care
environment, and ensured access to health care services to all District
residents regardless of their ability to pay. It also incorporated the
public health clinics and the school health program formerly under the
Commission of Public Health, creating an integrated health care system
providing a full spectrum of services from primary care through tertiary
Unfortunately, neither this law nor the public
health system has ever received the adequate funding or resources. As a
result, the Public Benefit Corporation never attained the level of success
initially envisioned by the Council.
3. DOES THE COUNCIL SUPPORT EXPANDING HEALTH
INSURANCE COVERAGE TO CURRENTLY UNINSURED PERSONS?
Yes, the Council supports expanding health
insurance coverage. Over the last several years, legislation on this
matter has been introduced and considered. As recently as last year, the
Council passed legislation to expand Medicaid eligibility to a greater
number of uninsured residents. The "Health Care Expansion Act of
2000," however, was never enacted due to concerns raised by the
Financial Authority regarding the fiscal impact of the expansion. Efforts
are currently underway to revisit this legislation to maximize the use of
both federal and District funds in serving low-income uninsured residents.
The cost of an insurance program is a valid
concern. The Council must be assured that any such program is financially
viable and sustainable over the long term. Therefore, the Council is
taking a phased-in approach to increase the number of insured persons in
4. WHY SHOULDN'T THE COUNCIL SUPPORT A CONTRACT
TO PROVIDE AT LEAST THE SAME LEVEL OF SERVICES AT LESS MONEY?
The Council does not object to any contract that
would provide at a minimum the same level of services provided by the
Public Benefit Corporation but at a lower cost. However, the contract
undertaken does not appear to meet this goal. In fact, the contract calls
for payments in excess of those previously paid to the Public Benefit
Corporation and D.C. General Hospital.
5. WHY DID THE COUNCIL WAIT SO LONG TO DEVELOP A
PLAN TO REFORM THE HEALTH CARE SYSTEM?
The Council's plan has existed since 1996 and is
embodied in the Public Benefit Corporation. It centers on an integrated
public health care system with the ability to partner or contract with
other health care providers to care for all District residents.
With respect to the Mayor's proposal to contract
with the private sector for services, the Council has requested specific
details since last summer. However, those details were not received until
this month. Therefore, the Council had no other concrete plan to which to
6. SO, WHAT IS THE COUNCIL'S PLAN?
The Council's plan is to contract with the Public
Benefits Corporation for the provision of services to the District's
uninsured population. The Public Benefits Corporation could subcontract
with health care providers throughout the city to meet that population's
health needs. This is exactly the arrangement proposed with a private
entity, although at a higher cost than it could be accomplished through
the Public Benefit Corporation. This type of contractual arrangement was
considered when the Public Benefit Corporation was established.
7. HAS D.C. GENERAL HOSPITAL RESTRUCTURED TO
RECEIVED THUS FAR AND THE ADDITIONAL PROPOSED BY THE COUNCIL WILL SUPPORT ITS
THIS FISCAL YEAR?
Yes. The Chief Financial Officer has indicated
that current spending is within budget and an additional $21 million will
sustain the hospital through September 30, 2001.