Access to Health Care

I have seen firsthand the problems that result from people staying in shelters and not receiving the medical care they need. In my own experience as a diabetic living in the Federal City shelter known as Second and D, it was very difficult for me to receive the medical help I needed. If people are not near death, they are ignored. – Carl S., SOME Client

Inadequate access to essential health care is a major problem in D.C., as it is nationwide. The problem is particularly acute for homeless and low-income residents. Lacking access to regular medical and dental care, they are more likely to develop urgent health problems that require emergency treatment. They are also more likely to die from conditions that could have been treated if caught at an early stage.

• The infant mortality rate in the District is twice the national average.
• D.C. mortality rates for many forms of cancer are the highest in the nation—including cancers that are often treatable if detected in time.
• Hospital admissions that could have been averted are higher in D.C. than almost anywhere else in the country.

D.C. Government Response

The D.C. Government has taken some important steps to meet the essential medical and dental care needs of its homeless and low-income citizens. It has created a program—the DC Healthcare Alliance—to provide health insurance to low-income residents who are not eligible for Medicaid. It has also expanded its Medicaid program to cover more low-income children and dental care for adults.
 
SOME advocates continued full funding for the DC Healthcare Alliance. The District's Fiscal Year 2008 budget took an important step toward universal healthcare insurance coverage by providing the DC Healthcare Alliance with sufficient funds to cover the estimated number of residents who are eligible to participate. The Mayor and City Council must ensure that the Alliance remains able to cover their healthcare needs and the needs of additional residents who may enroll.

Continuing Access Problems

Low-income residents still have less access to medical and dental care than the rest of the population. There are two major reasons for this. One is that relatively few healthcare practitioners—particularly, specialists—will treat low-income patients because the reimbursement rates under Medicaid and the DC Healthcare Alliance do not cover the actual costs of care. Reimbursement rates under the Alliance are the same as when the program was established seven years ago, despite escalating costs.
 
SOME advocates increased funding to increase reimbursement rates under the DC Healthcare Alliance. Reimbursement rates under the DC Healthcare Alliance have not been increased since the program was established in 2001. Costs of providing medical care are much higher now. In fact, the current reimbursement rate for a primary care visit covers only about one-third of providers' costs. The District relies on nonprofit community health centers to serve residents enrolled in the Alliance. Centers cannot expand—indeed, may need to severely cut back on services unless the District closes the gap between reimbursements and operating costs.

The other major problem is that there are so few sources of health care in areas where most low-income residents live. The District has the highest ratio of physicians to residents of any U.S. city. Yet more than 50% of D.C. residents live in areas officially designated as medically underserved.

On an ongoing basis, SOME provides health services, including primary medical, eye, and dental care, to homeless and other low-income residents in the District. Our clinics are located in a low-income neighborhood near a bus stop.

SOME advocates federal legislation to give the District a match on its funding for the Health Professional Loan Repayment Program. The Health Professional Loan Repayment Program gives physicians an incentive to provide services through organizations that are located in high-need areas and accept patients regardless of ability to pay. Under the Federal Health Services Act, all states receive a match on their funding for the program. The law should be amended to give the District equal treatment.

Resources

Facts & Figures

• Health and the Underserved
• Health Insurance
• Oral Health Matters

Research Summary

• Oral Health Needs Assessment of Homeless Adults in the District of Columbia

Issue Papers

• Oral Healthcare in Washington, DC
• Access to Medical Care in Washington, DC

Recent SOME Testimony

• Regarding the Renewal of SOME's Oral Heatlh Grant (April 23, 2008)
• Regarding Budget Oversight for the Medical Assistance & Health Care Safety Net Administrations (April 10, 2008)
• Regarding the DC Medical Liability Captive Insurance Company (March 11, 2008)
• Regarding Medical Assistance Administration and DC HealthCare Alliance Oversight (February 28, 2008)
• Regarding the Public Oversight Roundtable Regarding Poverty Issues (January 16, 2008)

Additional Resources