Mod 7 Final Assignment I decided to report about an unacceptably high number of District of Columbia residents that lack health insurance. About 74,000 District residents under age 65 did not have health insurance coverage at some time during the year. Many do not qualify for public health insurance or, if they qualify, do not enroll. The Health Care Coverage Advisory Panel has issued eight recommendations for expanding health insurance in the District. Several of them urge the District to do better at enrolling eligible public program participants and a couple target the working poor who do not qualify. An Urban Institute study found that hospitals serving both District and the suburban Virginia and Maryland residents compete in an environment marked by both rich health resources and a high rate of uninsured citizens. The District keeps more hospital beds, physicians, and registered nurses relative to its population than does the nation as a whole. Yet, nearly one out of five District residents is uninsured.
Many uninsured residents wind up in emergency rooms for treatment, further stretching the District hospitals that are already hit by strong market pressures. Both private and public insurers, such as Medicaid and Medicare, seek to cut costs by reducing payments to hospitals. For insured patients, this market discipline can lead to more efficient services; but such pressures are also forcing some hospitals, such as D.C. General, which was forced to close. As a result, economically depressed sections of the city are now underserved. The nation's capital is home to 570,000 people, 70 percent of who are African Americans and 24 percent of who are non-Hispanic whites (table 1). Measured against the composition of the entire country, Washington's population consists of smaller proportions of children, elderly, and noncitizen immigrants. While the country had a 5.0 percent gain in its census from 2007 to 2012, while the District of Columbia lost 9.5 percent of its population, a decline similar to those experienced in the other large northeastern cities.
As in many of the areas of the country, the low-income people in Washington, D.C., face a number of challenges in obtaining health services delivered in a timely manner, in an appropriate setting, and with attention to continuity and quality of care. One barrier is clearly financial. Nearly 30 percent of nonelderly DC residents are below 200 percent of the federal poverty level (FPL) are uninsured. Another obstacle is availability. Numerous economically depressed sections of the city are underserved by health care providers. Hospitals and clinics that serve the poor are experiencing some financial pressure as competition among hospitals for paying patients continues to increase and Medicaid payments are held in check. The District's Medicaid program has for many years paid facilities relatively large rates. In an effort to control what many recognize as a bloated program budget, the city has adopted new fee-for-service payment procedures and instituted managed care reforms. From a fiscal perspective, the effect of these changes and others on the budget appears favorable; however, the outcome for safety net providers and Medicaid recipients remains to be seen. Some observers are optimistic that access to providers, whether traditional safety net providers or providers who mainly serve a commercially insured population and continuity of care for the Medicaid population will be improved. Additionally, increases in Medicaid coverage under the Children's Health Insurance Program (CHIP) as well as other proposed coverage initiatives promise to lessen some of the financial barriers to care faced by low-income population in the District who are not currently enrolled in Medicaid. Simultaneously, safety net providers could witness a decline in the amount of uncompensated care they provide. The information in this report was taken from written reports on District policies and