Research by Author & Topic

Publications by Barbara A. Ormond on Uninsured/Uncompensated Care

The ongoing debate in California over two competing 2007 proposals for universal health coverage highlights both the strengths and weaknesses of the current insurance system in the District of Columbia as a platform for coverage expansion. The District's advantages include its relatively small uninsured population and existing mechanisms for administering a public coverage program tied to income. But its fiscal base is relatively small compared with California's, its largely unregulated insurance market could lead to severe adverse selection problems for new programs, and it is at much greater risk for border-crossing by both individuals and businesses in response to reform.

This testimony described DC populations lacking health coverage and issues that expansion proposals need to address. The biggest gaps in coverage lie within the District's generous Medicaid and Alliance programs. All residents with family incomes up to 200% of the Federal Poverty Level are eligible but many are not enrolled. Another, smaller group of uninsureds have incomes of 200-400% of FPL, but subsidizing them to buy coverage requires addressing potential crowd out among 80,000 similar-income already insured residents. Expansion also needs to address the potential for adverse selection as costs for the uninsured range widely by age and health status.

Urban Institute researchers, Randall Bovbjerg and Barbara Ormond, testify before the DC City Council, Committee on Human Services on the changing hospital sector in Washington, D.C. and what implications such changes have for the poor.