Health Care Giant Holds Out On Low-Income D.C. Residents

Walter Smith, Executive Director - DC Appleseed

Walter Smith, Executive Director - DC Appleseed

Residents of Washington, D.C., like Ebony Price in Ward 8, are asking why the nonprofit arm of CareFirst BlueCross BlueShield, the largest health insurance company in the Mid-Atlantic, is holding onto a surplus of nearly $1 billion. 

In December 2014, the Commissioner of the D.C. Department of Insurance, Securities and Banking determined that under D.C. law, this surplus is excessive by $268 million, and $56 million of that excess is owed to the District and must be reinvested in community health.

DC Appleseed, a nonprofit organization dedicated to solving problems affecting people like Ebony, is arguing that close to $300 million of that surplus should, by law, be invested in community health.

Ebony Price: "Some people out there don’t have Medicare, Medicaid or insurance of any kind.

Ebony Price: "Some people out there don’t have Medicare, Medicaid or insurance of any kind.

Ebony is an active participant in the local life of her community, which is how she became first a client and then a volunteer at Bread for the City, serving the wellness needs of D.C.’s residents like her, struggling to make ends meet on low-income. “I decided I needed to get out and meet people going through the same things I’m going through,” says Ebony, adding; “I needed counseling services to connect the day-to-day life issues. Now, I volunteer on and off for mental health issues, helping others to cope with their issues. This results in good things for people, but not everyone, there’s still a lot of folks that need help.”

That kind of help would be easier to give if CareFirst lived up to its obligations. “We have spent more than a decade trying to hold them accountable to their obligation to invest in the community in ways that promote health in the District,” said Walter Smith, DC Appleseed Executive Director.

Recently, a Washington think tank prepared a report suggesting many positive ways the surplus could be used to benefit D.C. residents via school-based mental health services, community-based programs to reduce chronic disease, and increased access to care in underserved areas.

Bread for the City, for example, would be able to increase healthcare services substantially and build a new medical clinic if they were given access to even a small portion of that surplus.

“People shouldn’t have to be ashamed of their situation, but are in a hard place – especially for their kids,” says Ebony: “Some people out there don’t have Medicare, Medicaid or insurance of any kind. These are kids some of whom eat and some don’t. It messes with their nutrition and when they get sick even simple over the counter medicine – simple ointments and creams – are hard to afford.”

George A. Jones, Chief Executive Officer - Bread for the City

George A. Jones, Chief Executive Officer - Bread for the City

“People won’t have to beat the odds if we change the odds,” said George A. Jones, CEO of Bread for the City. “Ebony isn’t an isolated case, More than 100,000 D.C. residents live at or below the poverty line. While we have some measure of success providing primary medical care, there is a gap between what we have the capacity to offer now and what we could offer [with access to the surplus].”

Through various legal maneuverings, the company has managed to avoid spending a dime. But the community is hopeful that tens of millions of dollars—and potentially hundreds of millions—will soon be reinvested back into the community in ways that will promote and safeguard public health. 

After the company failed to file a plan for reinvesting the District’s share of the excess, in August 2016 the Commissioner ordered CareFirst to rebate $51 million to subscribers.

And after nearly a year of negotiations, on September 1, 2017, CareFirst rejected the Commissioner’s Proposed Consent Order that would have required the company to spend $9.5 million a year for 10 years on community reinvestment. The Commissioner has not yet acted, but DC Appleseed has asked him to promptly order the company to dedicate at least $51 million to grants for nonprofit health providers.

The wealth gap is painfully obvious in Ward 8 of Washington D.C.

The wealth gap is painfully obvious in Ward 8 of Washington D.C.

“The Commissioner’s Proposed Consent Order was too small, but it was a step in the right direction. But now that CareFirst has turned it down, it’s time to issue a final order that returns the first $51 million to the community and allows our appeal to increase this amount to proceed,” said Smith.

DC Appleseed vows to continue the fight for Ebony and her community. They plan on seeking an expedited review of the order in the D.C. Court of Appeals—where there’s a potential for up to $300 million—and will seek prompt enforcement of the $51 million payment contemplated by the August 2016 order.

“My hope,” said Jones, “is that these excess CareFirst funds at long last come back to the communities that helped generate them, and help us to better address the medical and other socioeconomic disparities that so many D.C. residents experience.”

Impact Fund agrees and is with Ebony and the residents of D.C., who are getting shortchanged by CareFirst.