District of Columbia City Council ‘Grills’ Top Health Official on Effectiveness of New Privatized Indigent Care System

It is "too early" to determine the success or failure of the D.C. Health Care Alliance, the city's new privatized indigent care system, Washington, D.C., Health Department Director Dr. Ivan Walks told the D.C. Council on Dec. 17, the Washington Times reports (Taylor, Washington Times, 12/18). In late April, the District's financial control board approved a plan that transferred management of the city's indigent health system from the "bankrupt" Public Benefit Corp. to a private company. The board also approved a plan to phase out inpatient and trauma services at D.C. General Hospital, the city's safety-net hospital. Under the new indigent care system, a private company manages a network of more than 20 clinics that contract with private physicians, and Greater Southeast Community Hospital treats patients requiring hospitalization or trauma care (Kaiser Daily Health Policy Report, 5/1). Thus far, 18,475 District residents are enrolled in the new system, which covers uninsured individuals with annual household incomes up to 200% of the federal poverty level. Health officials had expected about 25,000 District residents to enroll (Goldstein, Washington Post, 12/18).

Debating New Statistics
During a Dec. 17 D.C. Council public oversight hearing, "[s]parks flew" as council members questioned Walks on why the District has not yet seen "more health care at a cheaper price," as "promise[d]." Council member David Catania (R) said that District residents were "promised 34% more care at 25% less cost -- what we're getting instead is 18% less care than we were getting last year at no cost reduction." He added, "We've not built the infrastructure within our own health care system to absorb the closure of D.C. General." Catania had asked the health department to answer 28 questions about the success of the alliance. Council members recently received a 400-page binder filled with the answers to those questions (Washington Times, 12/18). Council members have interpreted the health department statistics and recent announcements by two alliance contractors that their costs are "virtually certain" to rise next year as "evidence that the program is destined to be a boondoggle," the Post reports (Washington Post, 12/18). Walks contended, however, that those statistics do not "accurately reflect the future of the city's new public health care approach because they are a 'snapshot' at the very infantile stages" of the new system (Washington Times, 12/18). Critics had predicted that the system privatization and closure of D.C. General would cause "doom and death," Walks said, adding, "Their predictions were wrong. They tried to paralyze us with fear. They failed." During his "upbeat assessment" of the new system, Walks charged that council members have "stoked so much public suspicion about the alliance that it has scared poor people away" from receiving care from system contractors (Washington Post, 12/18).