The DC HealthCare Alliance Cut: A Q&A
The biggest cut in Mayor Gray’s proposed budget is a $23 million reduction in DC’s HealthCare Alliance, which would eliminate hospital coverage for those enrolled in the locally-funded health insurance program. DCFPI is working on understanding the impact of this cut, but here’s a quick question and answer on some Alliance basics:
- What is the DC HealthCare Alliance? The DC HealthCare Alliance is the District’s locally-funded public health insurance program. It was started by Mayor Anthony Williams to promote primary and preventative care by offering health insurance to residents who could not afford coverage in the retail market and did not have insurance through an employer or through a public program such as Medicaid. Before the Alliance, many residents used the city’s hospital emergency rooms as their primary access to medical care, which was costly for the hospitals and for the city. Plus, it did not provide a good medical home for residents to address non-emergency health issues.
- How many residents does it serve? According to recent statistics, the program serves approximately 23,000 District residents. In its initial years, the program served more residents, but many became eligible for coverage under the federal Medicaid program after adoption of federal health reform in 2010.
- What would be cut under Mayor Gray’s proposal? The cut would eliminate coverage for hospital visits, including both in-patient and out-patient.
- Why would the Gray administration propose this? In public briefings, the mayor and his staff have explained that they feel the hospital benefit for the Alliance ends up as a “double-payment” to hospitals because a majority of the city’s hospitals receive a DSH payment or “Disproportionate Share Hospital” payment under the Medicaid program. This payment covers the uncompensated care these hospitals give because by law hospitals must provide treatment to those in need even if the patient is unable to pay. Eight of the city’s hospitals receive DSH payments, but several with emergency rooms do not, such as George Washington University Hospital.
- How will the cut impact DC residents? DCFPI along with other health-care groups are unpacking this issue. One concern is that Alliance patients may feel discouraged from going to the hospital when they truly need to do so. Another is that residents that show up at the emergency room and do not have the ability to pay for care will still get billed. And even though the care would get covered under DSH and the hospitals would receive payment, the patient might get billed, and, when the bill went unpaid, be sent to bill collectors and have other actions taken that might be detrimental to their finances. Some clinic providers also have expressed concern about limited access to services that they refer patients to hospitals to receive, such as having an MRI.