In March 2010, President Obama signed into law federal health care legislation that will change dramatically the way health care services are delivered in this country.  The Patient Protection and Affordable Care Act (PPACA) will provide the District of Columbia and all states with the opportunity to make health care accessible and affordable for all of their residents.

On Monday, the Legal Aid Society of DC, a member of the District of Columbia Coalition on Health Care Reform, a coalition of organizations who represent consumers and providers participating in public and private health insurance programs in the District of Columbia, sent the attached letter to the Mayor, City Council and executive officials.  The letter presented our combined views regarding the opportunities presented with health care reform and the implementation of the new federal health care reform law. 

The District should be commended for making access to health care a major priority long before federal health care reform was enacted.  Instead of cutting back on Medicaid, as other states are doing, the District is expanding Medicaid income eligibility four years before it is required to do so, proposing higher income eligibility limits than are required under the PPACA and providing full Medicaid benefits to those who are newly eligible.  These efforts are laudable and have positioned the District as a national leader in ensuring that District residents have access to affordable health care.  This leadership is even more commendable given the tough budget pressures the District is facing. 

As the Mayor and Council have acknowledged, in implementing the PPACA, coordination, collaboration, and partnership across government agencies, and between agencies and the provider and consumer communities will be critical.  Health care reform need not increase the complexity of the health care system – though it could without careful planning.  Rather, it provides an unprecedented opportunity for development of a unified system encompassing all of the public payor options, i.e. Medicaid, safety net programs, expansions, and the soon to be created Health Exchange. 

The undersigned organizations urge the District to create a health care system that ensures that: (1) consumers can easily access benefits through a single point of entry system, and (2) providers can deliver high quality care assured of prompt and reasonable payments. 

To that end, we propose that the following principles guide the District as it moves forward in its implementation of the PPACA:

•  Principle 1:The District should have a coordinated policy development and implementation plan allowing for all affected District agencies and critical stakeholders to provide input.
   
•  Principle 2:The District should ensure that no one loses coverage as a result of health care reform implementation and that all individuals can access quality, affordable health care safely. 
   
•  Principle 3:The District should streamline its eligibility rules and processes for public insurance and the Exchange. 
   
• Principle 4:Any money saved through the implementation of the PPACA should be reinvested into the health care system.

We discuss each of these principles in greater detail in the attachment to this letter and offer initial recommendations designed to work toward that achievement.