Cuts to Housing Programs, No New Investment

Anyone who thinks that the affordable housing crisis in the District of Columbia is over is wrong.

One only has to spend a day chatting with Bread for the City clients to realize that the crisis is real. The vast majority of clients identify housing as an issue in their lives. Take for example the woman I recently encountered during an intake. She is disabled, and is living on monthly disability benefits of $674 from SSI. She pays $555 of that income in rent. She is not alone.

Nearly 1 in 5 DC residents are spending more than 50% of their incomes on housing. (The standard for “affordability” is 30%.) Perhaps this explains why there are approximately 38,500 households on the waiting lists for subsidized housing through the D.C. Housing Authority.

There are a variety of tools the DC government uses to assist in providing affordable housing options to residents. They include a wide spectrum from homeless shelters to home ownership programs. Three of these vital programs are at risk in the proposed city budget (as per DCFPI’s analysis).

  • The Housing Production Trust Fund finances the construction and renovation of affordable housing, and also provides financial support to tenants who want to purchase their buildings.
  • The Local Rent Supplement Program (LRSP) provides a rental subsidy to help low-income residents — those making less than $30,000 a year — afford their rent. Since 2006, it’s funded housing for 1,700 families.
  • The Permanent Supportive Housing Program (PSH) provides supportive housing for chronically homeless individuals and families, in the Housing First model.
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While Mayor Vince Gray declares that they are not cutting funding for any of these programs, the budget put forth essentially does just that. First, the budget raids $18 million from the Housing Production Trust Fund by using money intended for the creation of new affordable housing to pay existing LRSP rental subsidy costs. Without the Housing Production Trust Fund, the disparity between creation of affordable housing and luxury housing will continue. Since 2000 the number of low cost rental housing units has shrunk by more than ⅓ while production of luxury units has nearly doubled. We need the trust fund to continue at full funding levels in order to have any chance at reducing the number of tenants who need affordable housing.

Second, the budget ends the LRSP voucher program through attrition, both in policy language and through reduced funding. Phasing out the LRSP tenant based vouchers will result in the loss of an important affordable housing tool. We cannot abandon this program. In the last several years it is the only program that has resulted in households moving off of the DCHA waiting list. In addition, it is the only program that serves the lowest income residents – folks at or below 30% of area median income.

The need for additional vouchers is clear. It is evidenced by the wait list. It is evidenced by the large number of tenants paying more than 50% of their income toward their housing costs. It is evidenced by the number of people coming through the doors of Bread for the City each day.

Finally, the budget moves PSH participants (and their funding) in two ways that may or may not even be possible — by transferring them to federal vouchers and commandeering newly available units opening at project-based sites. The Housing First model is an innovative way to serve chronically homeless individuals. PSH serves those most difficult to house, including individuals with drug addiction, mental illness, criminal records, poor credit history, poor rental history and a host of other issues. However, transitioning these individuals to federal vouchers or project-based local programs may prove impossible. Criminal records, poor credit history, substance abuse, family size, and poor rental history are all considered in the screening process for the federal voucher program. Many folks, if not the majority, will simply not qualify.

We cannot afford to reduce the number of people served through these very important housing programs. We need to make progress in serving the 38,500 families on the waiting list. Reducing this funding only adds to the wait list.

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Don’t cut IDA, but do make it better

Interim Disability Assistance (IDA) is a vital program to our clients here at Bread for the City. It can take years for some clients to get approved for Social Security disability benefits and with our clients unable to work during that time period, this cash assistance program gives these clients $270 dollars per month to make ends meet. When clients are approved, Social Security pays back IDA for payments to the client. IDA in the District of Columbia has a recoupment rate of 40% of the funds it gives out – roughly equal to rates in other states. In the upcoming budget vote on May 25, IDA is in danger of being completely eliminated.

This program should not be cut. The people who receive IDA have no other options for income and this monthly assistance makes a huge difference for being able to ultimately get approved for SSI. One client, Ms. J, makes a compelling case for IDA. She worked for many years, but suffers from serious and worsening physical and mental illnesses and had to leave her job. She received IDA for the two years it took for the Social Security Administration to find her disabled. Ms. J put almost all of the $270 a month she received each month towards rent; although she was almost evicted on several occasions, those funds, with the help of relatives and non-profits, kept her from homelessness. IDA also paid for things that food stamps and other programs do not: bus rides to her doctor, over-the-counter medication, toothpaste. Our attorneys were more effective representatives for Ms. J because she had a phone where they could call her, a stable address where Social Security could send her notices, and funds to travel to medical appointments or her Social Security hearing. As a result, Ms. J qualified for disability benefits and recovered a large back award, of which part was sent to the District.

Instead of using costly emergency services, the money she got from IDA – and the SSI she receives now – is generated additional economic activity.

Instead of cutting the program, I have some ideas for making it more efficient, based on the SSI application assistance we provide here at Bread. Here in our social services program at Bread for the City, we help clients apply for disability benefits. During the Initial and Reconsideration level applications, we request medical records and have regular contact with the client’s Disability Determination Services examiner to make sure they have everything needed to make a decision on their disability. We help streamline the process and make each submission as effective as possible. This helps the DDS examiner not to have to wait months for records and hopefully means our clients receive a fast, favorable decision.

DC’s IDA program could include applications assistance. The District is already working with SOAR (SSI/SSDI Outreach, Access, and Recovery) to improve access to application assistance for homeless and recently incarcerated residents. Bread for the City has been involved with this organization for years. We believe they have developed a great model in which case workers help disabled clients submit complete and detailed applications that clearly present any medical evidence of the claimant’s disability. This allows for the applications to be processed quickly and efficiently and increases the number of first-time approvals, thus saving the time and expense involved in lengthy appeals. We have incorporated many of the SOAR best practices into our own applications assistance work.

By improving the process to get applicants approved for SSI, more money would ultimately be recouped from Social Security. Elements from Washington state’s IDA program, called Disability Lifeline, could also be used to assist with the SSI application process, such as having an initial assessment by a member of a trained assistance team to help determine the level and duration of the disability. This worker can assist with the initial application and improve the quality of the application submitted, in turn increasing the likelihood of approval in the early stages.

When clients fail to get approved for SSI in the initial or reconsideration stage, they advance to the hearing stage. It can take over a year for a hearing to be scheduled, during which time they continue to receive IDA even though no progress is being made on their application. Helping clients get approved before the hearing stage would allow others off the waitlist to receive IDA benefits, thus needing less money overall to run the program and helping more people.

If the District is not satisfied with the recoupment rate, it should modify the program, not eliminate it. Recipients of IDA truly have no other means of support; taking this program out from under them will result in homelessness and more costly emergency services. Especially considering the possible closure of homeless shelters due to budget pressures, our neighbors are likely to experience increased rates of mental illness, substance use, domestic violence, and even death. Please take a few minutes to call your Councilmembers now to ask them to fully fund safety net programs:

Kwame Brown (Chairman) 724-8032 or kbrown@dccouncil.us
Vincent Orange (at-large) 724-8174 or vorange@dccouncil.us
David Catania (at-large) 724-7772 or dcatania@dccouncil.us
Phil Mendelson (at-large) 724-8064 or pmendelson@dccouncil.us
Michael Brown (at-large) 724-8105 or mbrown@dccouncil.us
Jim Graham (Ward 1) 724-8181 or jgraham@dccouncil.us
Jack Evans (Ward 2) 724-8058 or Jackevans@dccouncil.us
Mary Cheh (Ward 3) 724-8062 or mcheh@dccouncil.us
Muriel Bowser (Ward 4) 724-8052 or mbowser@dccouncil.us
Harry Thomas, Jr. (Ward 5) 724-8028 or hthomas@dccouncil.us
Tommy Wells (Ward 6) 724-8072 or twells@dccouncil.us
Yvette Alexander (Ward 7) 724-8068 or yalexander@dccouncil.us
Marion Barry (Ward 8) 724-8045 or mbarry@dccouncil.us
Jen Budoff, Council Budget Director 724-8139 or jbudoff@dccouncil.us

You can also email them all at once here.

By Brooke Postlewaite

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The Budget Countdown Begins

The city budget season is just around the corner. The release of the our newest Mayor’s proposed budget happens April 1st, and the advocacy community is gearing up for big cuts. There have been more than $120 million in reductions to safety net programs in the last three years. With another $400-600 million city revenue shortfall — the most yet — we’re anticipating whole programs on the chopping block.

Do you want to know how best to take action to save city services? Are you curious about the process? Come to one of the many budget trainings taking place at Bread for the City and around the city. These trainings are appropriate for staff of non-profits, curious citizens, volunteers, etc.

SOS Rally Signs

Here’s our roundup:

Fair Budget Coalition Breakfast Briefing on Tax and Revenue
9:30 – 11:00 am, Friday February 25th
Wilson Building, 1350 Pennsylvania Ave NW, Room 120
Our friends at the DC Fiscal Policy Institute will talk about how tax works and the importance of a balanced approach to the budget, including progressive revenue.

Fair Budget Coalition Meeting
9:00 – 11:00 am, Wednesday March 2nd
True Reformer Building, 1200 U St NW
Guests Eric Goulet (Budget Director for the Mayor) and Jennifer Budoff (Budget Director for the Council) will brief the coalition on the upcoming budget, followed by Q&A.

Bread Budget Training #1
5:30 – 7:30 pm, Monday March 7th
1640 Good Hope Rd SE
Kristi Matthews (Fair Budget Coalition) will lead this training geared toward Bread for the City clients and open to the public. We will talk about the budget process and tools for advocacy.

Bread Budget Training #2
11:30 – 1:30, Tuesday March 8th
1525 7th St NW
Susie Cambria (Consultant Extraordinaire) is leading this training geared toward Bread for the City staff and open to the public. We will learn about the budget process and the roles of various agencies, and discuss strategies for effective campaigns and advocacy.

What’s in Store for FY 2012?
9:30 – 11:30 am, Wednesday March 9th
Goethe Institute, 812 7th St NW
A forum on the latest information and perspectives on the D.C. budget outlook, including panelists Jennifer Budoff, Eric Goulet, Fitzroy Lee (Office of the Chief Financial Officer), Jenny Reed (DC Fiscal Policy Institute).

Bread Budget Training #3
5:30 – 7:30 pm, Monday March 14th
1525 7th St NW
Kristi Matthews will lead this training geared toward Bread for the City clients and open to the public. We will talk about the budget process and tools for advocacy.

Contact me at jpodschun(at)breadforthecity.org or 202-587-0524 to RSVP or learn more about any of these meetings.

Dishing on the District: Food Agencies 101

In past weeks we explored the scale and scope of food insecurity in the District as well as the role of the federal nutrition programs in fighting hunger. I found myself asking, “Where do we begin, if we want to make it better?” Let’s start with how DC Government might contribute to building a more food secure DC.

As it turns out, understanding how the DC government shapes the city’s food system is no easy task. Local policy and administration have a role in everything from the location of supermarkets, to nutrition education in schools, to feeding programs for seniors, to food safety standards. These food-related functions, and more, are addressed by at least thirteen different city agencies, which in turn are overseen by seven different DC City Council Committees. DC has no “Department of Food” – no central agency or governing body tasked with ensuring quality affordable food for DC residents. This makes it very tricky to understand and track whether and how well our government is contributing to a more food secure DC.

Fortunately, we have some tools. Each government agency has its own web-page as part of the DC government website, with information on programs and initiatives. Agency budgets and activities are measured and shared through Track DC. The Office of the City Administrator also compiles performance plans and reports for all agencies.

Each agency reports to the mayor, but also operates with the oversight and influence of the City Council. Specific committees conduct regular public oversight hearings, where they receive public testimony and reports from the agencies. Anyone can testify by contacting the committee ahead of time. (Here are some tips.) The schedule for these hearings and information about how to get your name on the witness list can be found online. Resources and documentation from prior hearings are also available on the Council’s website.

While it is helpful to provide feedback on individual programs within each agency, there’s no mandate or mechanism for addressing the big picture. Some cities have established bodies or working groups, commonly referred to as food policy councils, as a way to bring some combination of government, non-governmental organizations, citizens, advocates, and others together, an idea I hope to explore further in my next post.

In the meantime, here’s an alphabetical list of some of the agencies and initiatives that oversee or regulate or serve food, based on a document prepared by the Fair Budget Coalition for their annual issue briefing on food held last month:

This post is the third in a series from Bread for the City intern Allison Burket exploring the basics of food, hunger, and politics in the District.

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Hope for the Holidays

This holiday message comes from Patty Anne, a member of Bread for the City’s Client Advisory Board. You can see Patty Anne fighting for her rights in this video from Empower DC.

It’s the holiday season and although again this year I don’t have a lot, I’m grateful to have a roof over my head and my daughter Kerryn, who has been by my side through all the tough times. She’s the reason I’m here today.

I was in an abusive relationship, and I got out of it because I knew I was pregnant. I know some people will stick with a person and take what they can get. My husband had money, he had nice cars, but underneath he was abusive – I didn’t want that for my daughter. So I chose to walk away.

Even after all the troubles with my crazy landlords, having to be homeless for a little while, getting sick from mold in the places we were living, having to move from house to house, I don’t regret my decision. But sometimes it’s hard, knowing that Kerryn doesn’t have what other kids have, knowing she deserves better. I wish I were a millionaire so I could give her it all, but I have what I have, and I am trying to make it work.

Last year when we moved, I had no money to buy her gifts, and Kerryn had no Christmas. There was no tree, there were no lights. She came down the stairs and I know she was looking for something. I just said “Kerryn, I am so sorry,” and she said, “It’s ok Mommy, it’ll be better next year.” Even though things were that way, she never complained. Some kids would get mad. Instead, when I cry, Kerryn will hug and kiss me and tell me it’s alright.

Now here we are at Christmastime again, and I get just $118 a month in Food Stamps, even though Kerryn has food allergies and needs more expensive foods. I’m disabled and on a fixed income, so I’m not sure I can even get her the basics, let alone a special holiday meal. And even as I struggle to put food on the table, the City Council is cutting the budget for programs like Interim Disability Assistance and Temporary Assistance for Needy Families.

Some people in my situation would give up. Because I have Kerryn, I find hope when so many people are trying to take our hope away. She is on the Principal’s Honor Roll, and she was just voted Vice President of the student government. I am so proud of her, and I want so much to be a mother she can be proud of. I want to take care of her the way I know she deserves. She gives me joy and peace, and the strength to fight for my rights and make sure my voice is heard.

City Council votes today. Here's what we're saying.

Today is the vote on the city’s budget. We blogged about it here at Beyond Bread, and the budget cuts and their impact have been covered by news outlets and the blogosphere. If you still need to email your Councilmembers about this, don’t worry — there’s still time. Take action now.

Here are a few letters from people close to Bread for the City, to inspire you as you share your thoughts with our elected officials.

From Leonard Edwards, Bread for the City client:

Dear City Council,

My name is Leonard J. Edwards, and I have been a resident of Washington, D.C., for over thirty years. I have a disability, and at the present time I am working towards my Associates Degree, in Health Care Administration.

I used to work construction, but I cannot do that work any longer because of my disability. I take on-line classes, and I depend on the disability services and other parts of the safety net to help with just about everything. This is where I am in my life right now, and if it was not for places like Bread for the City I can truly say that I do not know where I would be right now.

How am I supposed to complete my education if my utilities are disrupted? How can I keep my strength and health to study if I do not have a place to live, or food in my refrigerator? How am I supposed to improve my situation if I cannot even get back and forth to school?

I am not asking for hand outs, just a hand. These few services help me to keep some dignity. These few services are the only thing, at the present time, that are keeping me from being homeless and helping me to complete my studies. When I complete my education, I will get that job in the health care industry, so I can get back on my feet and help others.

I have always worked, and I enjoy working, and I have always been a good employee, with many letters of recommendation. With my disability, I had to re-tool my skills for the 21st century. If the cuts are as bad as I hear, I am afraid that I will become a statistic.

Sincerely,
Leonard J. Edwards

From Burke Stansbury, Ward 1 Resident and Save Our Safety Net volunteer:

Hi Councilmember Graham,

I live in Mt. Pleasant and have been active in advocating against safety net budget cuts over the last year. I’m also likely among those who would pay more taxes if rates for high-income earning DC residents were raised. And I want to say that I fully support such new tax proposals.

I also want to thank you for introducing new brackets at $350,000 in the spring. I’m writing because I believe we need even lower brackets for meaningful, new revenue to fund safety net programs. I support two possible solutions: a 1% increase on income over $200,000 a year or Tommy Wells’ plan for comprehensive tax reform.

Please do the right thing and take a stand this week in favor of increased income taxes.

Thank you,
Burke Stansbury

Take a moment to send your own email now.

We Need City Council to Take Action, Make the Better Choice

Mayor Fenty has proposed another round of cuts as part of this year’s city budget. Utility assistance, child care, TANF, job training, disability assistance, affordable housing, legal services, and more are on the chopping block. I’ve been through my share of hard times: an abusive relationship, losing my home, getting harassed by landlords, and health issues. I want to speak out and share my story to help prevent other people from having to go through what I did.

I’ve already blogged about being on the TANF program to provide for my daughter during the seven years that I was unable to work and waiting to get approved for Social Security Income. I know that they don’t give you the skills you need to get a job that pays the bills, and now they’re taking away more of what people need to survive.

It’s hard to make ends meet on a fixed income, even though I’m careful with my budget. My daughter hasn’t had a new coat for three years, and right now we’re wearing our coats in the house because I can’t turn the heat on. I don’t want to run the bills up and then have my utilities cut off. That’s grounds to lose my housing voucher, and I can’t take that chance. My utility assistance appointment isn’t until April, so I know I’m not the only one who’s cold. Now they’re making more cuts to utility assistance!

It’s clear that they give you the help that they want to give you, not what you need to pick yourself up. It’s not like I’ve been asking for a million dollars, or for people to move mountains or part seas. I just want a stable home for me and my daughter. I want somebody to step up and help me do better for myself, so I can do better for her. I don’t want her to live in a constant state of trial and tribulation. If I had the tools that I needed, I would be able to make it.

But they just keep taking, until they take away your hope. When you take away someone’s hope, you take away their way of taking care of themselves, to push forward and survive. Councilmembers don’t see it, because it doesn’t affect them. We need action, and all we’re getting is talk. Talk doesn’t help you when you’re hurting.

I have a saying, though – it’s the squeaky wheel that gets the grease. If I had sat silent through all of this, I wouldn’t be here now. My daughter wouldn’t be here now. You have to know your rights and fight for them. That’s why I’ll be speaking at the People’s Hearing on Tuesday, December 7 at 9:00 am in front of the Wilson Building, 1350 Pennsylvania Ave NW (Federal Triangle, Metro Center, 30 buses). I want others in this situation to have hope that they can make it, but I also want city leaders to learn from our experiences and make the better choice.

I say to Mayor-Elect Vince Gray – give to me what I need to help myself. Don’t keep stripping things away until you break me. Let him know what you think he should do now.

DC needs smart solutions to close the budget gap.

This post is adapted from testimony delivered today by Bread for the City’s Advocacy Coordinator, Joni Podschun, to City Council’s Committee of the Whole. (You can follow a live discussion of the budget hearing on Twitter under the #gapclosing tag; follow Bread for the City’s tweets here.)

The health and prosperity of our city depend on public investments that expand economic opportunity and support families. In these difficult economic times, careful planning is needed to make sure we can continue to meet these goals.

Last week Mayor Adrian Fenty released his long-awaited FY2011 Budget Gap-Closing Proposal. Yesterday, the DC Fiscal Policy Institute published analysis of the proposal, listing cuts to programs like affordable housing, TANF, job training, Access to Justice, Interim Disability Assistance (IDA), mental health services, and LIHEAP utility assistance.

We’ve blogged about the critical importance of these programs many times.

One of the proposals is to reduce TANF benefits by 20% for households that have been in the program over five years. When I read that proposal, I thought about Tameka, who I first met three years ago when she was receiving training through the Center for Employment Training. At the time, she was just barely making ends meet on $428 a month provided by the TANF program for her and her two boys, even though she was among the 1/3 of TANF recipients fortunate enough to live in subsidized housing. She now has a good job with a career path, after graduating from the program, but she has received TANF for over five years. But what happens if she has an emergency and needs to quit her job? What if her position is eliminated due to the recession? If she needed TANF again, her benefit would be cut by $85. For her and other women like her, 20% of their already meager household income would be gone.

This is just one example of a larger trend to cut services that low-income and middle-income residents depend on. Low-income DC residents in particular face long lines at IMA service centers, harried staff at non-profits, reduced hours at libraries, a growing wait list for IDA (a program designed to tide people over while they are waiting for federal disability benefits), and limited capacity at TANF job readiness vendors, among other things.

According to DCFPI, 39% of the cuts in the gap-closing plan we consider today are to human services programs, even though they only make up 26% of the total budget. And there is just $1 in proposed revenue for every $40 in spending cuts.

The alternative is to ask more of households in the top 5%. These families have suffered the least in the recession, pay a smaller share of their income in combined taxes than middle-income households, and have continued to receive city services largely unchanged. By creating a new tax bracket of 9.5%, an individual earning $300,000 would contribute about $85 a month, only 0.3% of their income. This proposal would generate approximately $75 million in new revenue.

If we are going to ask District residents to take a hit, shouldn’t the $85 a month come from those for whom it will be only 0.3% of their income, not households barely making it on $428 a month, for whom it is one-fifth their total budget? After the new brackets, a household at $300,000 will still have income net of taxes at $24,915 each month.

It is the role of government to provide a basic level of support and to reinforce the positive steps that people are taking to meet their goals. That is more important during an economic downturn than ever. With a limited job market, we should invest in education and intensive hard skills, retooling District residents for the 21st century and ensuring they can compete for jobs. Housing costs are down, the perfect time for the preservation and creation of affordable housing. These are just two examples of costly programs that yield huge benefits down the road.

We need to make smart, targeted investments in the local economic infrastructure, to help our city rebound from the recession. Investments that keep families out of costly emergency and remedial services, that bring dollars into the local economy. Let’s have a conversation about priorities, about what we can build with progressive revenue. What kind of housing do we need to keep our workers in DC? What types of job training should we provide? How can we support entrepreneurship and small businesses that employ DC residents? When DC residents consider what their tax dollars can buy, they will be excited to contribute to a thriving, diverse, healthy city.

In the immediate, we need better choices and bold leadership. Tell the City Council to stop the trend of asking more of those with limited resources, struggling to survive. Create new tax brackets of 1% higher on income above $200,000, to invest in an economic recovery that includes everyone.

>Building a Human Safety Net

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Standing at the Wilson building today, chanting phrases like “Save Our Safety Net,” holding a net, and the hands of fellow advocates from across the city, I felt renewed in my commitment to serving my clients each day. I have journeyed this year with clients like Mr. S., Ms. N., and Mr. K. I have sat down with them, listened to their stories, and together, we have gone to their Social Security disability hearings hoping to win them Social Security benefits. Each day at Bread for the City, I meet with walk-ins and take calls from many people across the city calling because they have found themselves in need of an attorney. I have listened to their stories and have seen the effects of both personal choices and structural inequalities.

In the last month, the Wilson building has become quite familiar to me. Together with Eli and Legal Clinic for the Homeless attorney Scott McNeilly, we have gone door to door to Council Members, asking them to reconsider the proposed cuts to IDA, the program our SSI clients need to survive each month. I have helped the Fair Budget Coalition plan a budget briefing on housing, and have attended a previous rally urging City Council members to vote for progressive tax reform so that our social safety net services might be spared in the $500 million of proposed budget cuts this year.

Today felt different than those previous visits to the Wilson building. Today we stood, holding hands and nets, circling the entire building. This literal joining of hands, the literal act of building a human safety net, was a public testament of how important these services are to our clients. It is more than just about progressive tax increases or fighting for what I believe is right. It’s about making sure our clients can simply live.

Standing around the Wilson building, seeing familiar faces of the advocates I’ve met this year, holding hands and passionately chanting, my heart was flooded with emotions of connection, passion, dedication, and increased vigor. I felt a sense of renewal and recommitment. I am here for my clients, and for the ways we are growing together.

For more information about the Save Our Safety Net Campaign or for more pictures of this rally, please click here.

>Save DC Captive: Protect city-subsidized insurance for DC’s free medical clinics

>This is excerpted from testimony delivered by George A. Jones to City Council, regarding the proposed elimination of the Medical Liability Captive Insurance Agency, which provides malpractice insurance to community health centers like Bread for the City. Click here to hear Councilmember Mary Cheh discuss this issue with journalist Pete Tucker on “Spectrum Today,” WPFW 89.3 (6-7pm) last week.

Thank you for the opportunity to testify today in support of the continuation of the District of Columbia’s Medical Liability Captive Insurance Agency (The DC Captive).

The DC Captive was established in 2008 largely as a replacement for the DC Free Clinic Medical Assistance Act which, from 1986 to 2008, essentially provided malpractice coverage to the staff and volunteers of 4 DC nonprofit clinics: Bread for the City, La Clinica del Pueblo, Whitman Walker and Washington Free Clinic. This ensured that otherwise cost-prohibitive malpractice insurance would not prevent us from providing free primary care to tens of thousands of uninsured DC residents.

During the 20 years that the DC Free Clinic Act was in effect, not one time was a malpractice suit brought against any of the Clinic’s indemnified by the Free Clinic Act.

Still, some 3 or 4 years ago, the DC Government informed the clinics covered under the DC Free Clinic Act that it no longer wanted to have the unsecured risk associated with the Act. Instead, the DC government wanted to develop a special insurance product that would be funded by the government and would continue to provide DC’s nonprofit clinics with medical malpractice protection at little to no cost.

It was understood by the clinic community that the DC Government was making a firm commitment that this replacement, the DC Captive, would be sustained permanently.

Now, less than two years later, the DC Captive which we worked so hard with our government counterparts to establish, is threatened with no discussion or real notification given to the clinics or our patients. The DC Government seems prepared to renege on its promise to indemnify the community clinics, threatening the ability for tens of thousands of DC residents to receive free or affordable primary medical care.

I want to make it clear that the clinics are not here to beg for a public handout. When one considers the uncompensated care and private resources the community clinics bring to the DC healthcare system, it’s easy to see that it is in the District Government’s best interest to preserve our ability to provide healthcare to DC resident.

Please consider the following simple analysis of the return on the District’s investment:

Over the past 5 years, Bread for the City has provided an average of 8,000 medical visits to about 2,700 unique patients each year. Our average cost per patient visit was $122 in 2009 (when we provided 9,100 visits).

Of those 9100 visits, 51% were members of the DC Healthcare Alliance, which reimbursed us $95, or $27 less than it cost us to provide the care; 20% were Medicaid visits, which paid us on average $40 per visit, or $82 less than our actual cost; and 29% of our patient visits yielded no public or third party compensation, thus costing us the full $122 per visit. In short, BFC provided close to $600,000 of free care to District residents last year alone. That care is paid for with private funds that BFC raises at no cost to the District or our patients.

Patients like Ms. C who works in a liquor store and lives in the apartment above the store. She takes 7 different medications for her diabetes, hypertension and thyroid disease. She and her husband have a combined income that makes them ineligible for the DC Health Care Alliance. Without the free primary care provided by Bread for the City, this family would simply have no access to the medical care and medications they need to remain active, working adults.

Were it not for our primary care clinic, these patients might otherwise turn to local emergency rooms for matters like the flu, or a sprained wrist, or other non-emergency ailments. Compare our average cost of $122 with the emergency room’s estimated $1,000 average cost for non-emergency visit, i.e. those not requiring an overnight stay.

I feel confident the other nonprofit clinics included in the DC Captive could provide similar numbers and patient stories that expand on the level of value the District and its citizens receive through our efforts.

At the end of the day, our cost-effective model, our high quality of care for these patients, and the fact that not one claim has ever been made against the Free Clinic Act or DC Insurance, all represent ample reasons for the Council to restore the funding for the insurance that sustains our operation.

Again, thanks to the Council for allowing me to present this testimony this afternoon. I would be happy to address any questions the committee members might have.

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