Research by Author & Topic

Publications by Barbara A. Ormond on Washington D.C. Region

DC fares better than the nation as a whole in the share of its population that is uninsured. Lower rates of employer-sponsored coverage are more than offset by higher rates of public coverage. The District's relatively generous Medicaid eligibility standards, and the DC HealthCare Alliance, a locally funded coverage program, contribute to the high share of publicly insured residents. Although all low-income individuals are eligible for either Medicaid or the Alliance, some 66,000 residents remain uninsured. These are among the findings of this data brief on insurance status in DC by age, employment, income, family status, and health status.

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 needs assessment, conducted for District of Columbia Department of Health (DC-DOH), presents findings from a literature review, analyses of Medicaid enrollment and hospital discharge data, interviews with key informants, a survey of school nurses, and findings from focus groups with young adults with epilepsy and caretakers of young adults with epilepsy in DC. It suggests changes within the health services delivery system for children and youth with epilepsy related to the following goals identified by DC-DOH: early detection, diagnosis, and treatment; improved access to medical homes; reduced stigma; reduced language and cultural barriers; and sustained systems change.

The uninsurance rate in the District is lower than the national average, but an unacceptably high number of residents remain uncovered. To help assess ways to improve coverage, the DC Department of Health convened the Health Care Coverage Advisory Panel under the District's State Planning Grant (SPG). This final report of the Panel, staffed by the authors, makes eight recommendations, including better outreach and enrollment in Medicaid and other existing public programs, allowing uninsured residents to buy in to such programs, better information on private options, and ongoing monitoring of coverage accomplishments and prevailing insurance market conditions.

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.

[Washington Post] After months of wrangling, a decision has been made: D.C. General Hospital will close. Its replacement, a private health care network of local clinics and hospitals led by Greater Southeast Hospital, promises to improve care while containing costs.

Institute researcher Barbara Ormond discusses the crisis facing emergenct room care in many urban areas—with Dr. Charles Cutler, chief medical officer for the American Association of Health Plans, Dr. Mohammad Akhter, executive director of the American Public Health Association, and Dr. Michelle Grant Ervin, chair of the department of emergency medicine at Howard University Hospital. Hosted by Kojo Nnamdi.

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.

The Washington, D.C. hospital sector has an excess of hospital beds and a concentration of services at the high end. Four community hospitals; three academic medical centers; a large, nonacademic tertiary care hospital; five specialty hospitals; and a public general hospital all compete to serve a city with a population of only 500,000. In addition, there are two military facilities. Forty percent of patients in this market are drawn from the adjacent Maryland and Virginia suburbs. The market is poised for change, driven by insurance market trends.