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Health campaign seeks aid for poor

(Published September 20, 1999)

By REBECCA CHARRY

Staff Writer

When a construction worker recently showed up at a Mount Pleasant health clinic with a gashed eye, the injury was already a month old. The man, who didnít speak English and was being paid "under the table," had no health insurance.

The clinic called the eye center of a well-known city hospital. The doctor there was sympathetic but could not get authorization for operating room time for an uninsured patient.

The man is now blind in one eye.

Dr. Andrew Shamess, director of La Clinica del Pueblo, says this story about one of his patients is typical of what happens to more than 80,000 Washington residents without health insurance. Unable to pay for routine and preventative care, they seek medical attention only in an emergency, he said. Even then, hospital emergency rooms help stabilize dangerous conditions but generally donít provide surgery or follow-up care for patients who canít pay, he said.

"Thereís a big difference in the way insured and uninsured patients are treated," Shamess said. "Of the 10 private hospitals in this city, none are particularly keen on taking uninsured patients."

Government leaders and health care professionals have long acknowledged that the cityís health care delivery system suffers from serious problems ó from inadequate services for the poor to too many unused hospital beds. Mayor Anthony A. Williams recently created the D.C. Health Care System Development Commission to try to find some solutions. Shamess will sit on the commission along with representatives from the private sector and public hospitals.

Big hospitals, bound by federal law to treat emergency conditions regardless of the patientís ability to pay, do provide stop-gap measures to the uninsured and write off the costs as bad debt, said Joan Lewis, vice president of the D.C. Hospital Association. But that cannot take the place of ongoing routine care, she said.

"The issue is where do people find routine primary care if they are uninsured," Lewis said. "Episodic care in a hospital emergency room is not the answer."

Shamess and leaders of about 20 other nonprofit city clinics are lobbying the D.C. City Council to extend Medicaid coverage to all D.C. residents with incomes under 200 percent of the poverty level, or $16,480 for a single adult. The effort, dubbed "Campaign for Health Care 2001," aims to give clinics that serve the poor a voice in shaping the cityís fiscal 2001 budget. Organizers have planned a rally at 11 a.m. Sept. 22 in front of One Judiciary Square to kick off their campaign.

Overall, the city needs more and better neighborhood clinics and fewer big hospitals, said Robert Cosby, executive director of the Non-Profit Clinic Consortium, which backs the lobbying campaign.

"We have patients with multiple problems who havenít had care in a long time," he said. "They are generally viewed as undesirable because itís unlikely that you are going to be able to get reimbursed for the care you give them and they are unlikely to be able to pay."

A charity "bank" of donated services run by the Roman Catholic Archdiocese of Washington does provide some relief, but still falls far short of filling the demand, Cosby said.

About 20 percent of D.C. residents are uninsured, about twice the national average, Shamess said. Most are immigrants, single adults, people working part-time jobs with no benefits, or people who donít qualify for public assistance, he said.

When uninsured patients leave the emergency room, itís often with a prescription but no money to pay for it, Shamess said. They canít afford non-emergency follow up appointments to monitor conditions such as diabetes and high blood pressure. Their medical records are scattered and incomplete. They have additional problems with transportation and language barriers.

Most city leaders and health care professionals agree that extending coverage is a good idea. The problem, they say, is how to pay for it.

A proposal from Mayor Williams to extend Medicaid coverage to 39,000 uninsured residents was rejected by the D.C. City Council. The insurance was to be paid for by cutting government subsidies to hospitals that provide most of the care to the cityís poor ó D.C. General, Howard University and Greater Southeast hospitals, all in some degree of financial trouble.

Hospital executives said they would go broke if they lost the subsidies. Lewis, of the D.C. Hospital Association, contends that extending Medicaid is not enough. She and others worry that patients will have trouble adjusting to the new system, finding care in unfamiliar places, or making and keeping appointments when they are accustomed to just showing up at an emergency room for any medical care.

Members of the cityís new Health Care Development Commission have 180 days after the commission is formally seated to draft a set of recommendations for improving the cityís health care delivery system. Funding for the commission is included in the cityís budget for fiscal 2000, which begins Oct. 1.

In addition to Shamess, mayoral appointees to the commission are Dr. Marsha Lillie-Blanton, vice president of the Kaiser Family Foundation; Martis James Davis, a public relations executive; Gilbert Hahn, a lawyer who is former chairman of D.C. City Council and former chairman of the board of D.C. General Hospital; and Loretta Tate, acting president of the Marshall Heights Community Development Organization.

Commission members appointed by the city council are Sister Carol Keehan, president and chief executive officer of Providence Hospital; Larry Gage, an attorney and president of the National Association of Public Hospitals and Health Systems; and Henry J. Werronen, a health care consultant and former managed care executive.

Mayor Williams, City Council Chairman Linda Cropp and Ward 8 Councilwoman Sandra Allen, who chairs the human services committee, also are ex-officio members of the commission.

Copyright 1999, The Common Denominator