8:00-8:30	Coffee and continental breakfast
8:30-8:40	Welcome and Opening Remarks Michael Rogers, Executive Director, Metropolitan Washington Council of Governments, Michael Daniels, Sector Vice President, SAIC and Co-Chair, Potomac Conference, and Bruce Katz, Director, Center on Urban and Metropolitan Policy, Brookings Institution
8:40-8:50	Overview of the District’s Recovery Linda Cropp, Chair of the Council of the District of Columbia
8:50-9:20	The District’s Economic Future and Its Implications for the Region Alice M. Rivlin, Senior Fellow, Brookings Institution, and Carol O’Cleireacain, Senior Fellow, Brookings Institution
9:20-9:50	The District’s Current Development Plans Andrew Altman, Director, D.C. Office of Planning, and Lloyd Smith, Chair, National Capital Revitalization Corporation
9:50-10:10	Audience Question & Answer Session
10:10-11:30	Revitalizing the Core through Regional Collaboration Anthony Williams, Mayor, Washington, D.C. Douglas Duncan, Montgomery County Executive Katherine Hanley, Chair, Fairfax County Board of Supervisors Moderator: John Tydings, President, Greater Washington Board of Trade
11:30-11:45	Audience Question & Answer Session
11:45-12:00	Closing Remarks John Tydings, President, Greater Washington Board of Trade

      

 

 

Audrey Singer presented the findings at this forum. She and panelists representing a broad spectrum of local and national interests discussed the broad implications of immigration growth in the region, both for the incoming residents and the communities in which they choose to live.

      

 

 

Agenda

8:00 a.m.
Breakfast

9:00 a.m. – 9:10 a.m.
Chuck Bean
Executive Director
The Nonprofit Roundtable of Greater Washington

9:10 a.m. – 9:30 a.m.
Martha Ross
Senior Research Analyst
Greater Washington Research Program

Joe Cordes
Professor
Department of Economics, The George Washington University

9:30 a.m. – 9:40 a.m.
Alice Rivlin
Director
Greater Washington Research Program

9:40 a.m. – 9:50 a.m.
A. Cornelius Baker
Executive Director
Whitman-Walker Clinic

Albert C. Eisenberg, (D-47)
Member
Virginia House of Delegates

9:50 a.m. – 10:30 a.m.
Q & A

      

 

 

On March 26, the Brookings Greater Washington Research Program released a new report introducing practical strategies for increasing the skills, earnings, and employment of the District’s low-income residents. Mayor Adrian Fenty’s office is considering these recommendations, which include improvement of housing assistance and other policies that support work (like the Earned Income Tax Credit and health insurance).

Brookings Senior Fellow Alice M. Rivlin, also director of the Brookings Greater Washington Research Program, joined a distinguished group of community leaders, service providers, and local government representatives to address a broad agenda focused on the economic well-being of low-income District residents.

      

 

 

To help inform the policy debate on transportation financing and traffic management, Greater Washington Research at Brookings hosted a roundtable bringing together experts from the policy, planning, advocacy, and development community. Roundtable participants included Ron Kirby, director of the Transportation Planning Board at the Metropolitan Washington Council of Governments; Stewart Schwartz, executive director of the Coalition for Smarter Growth; Bob Grow, senior director for Regional Government Relations at the Greater Washington Board of Trade; and Patrick DeCorla-Souza, program manager for the Federal Highway Administration.

Alice Rivlin, senior fellow and director of the Greater Washington Research Program at Brookings, and Benjamin Orr, research analyst for the Greater Washington Research Program at Brookings, facilitated the conversation.

      

 

 

On February 26, the Metropolitan Policy Program and Greater Washington Research at Brookings hosted a discussion focusing on a new report that examines the local, regional and national factors that led Prince William County, an outer suburb of the nation’s capital, to adopt tough measures against unauthorized immigrants. Additional case studies will be explored, with a focus on the ripening immigration debate and ideas for successfully addressing long-term demographic changes and challenges.

Brookings Senior Fellow Audrey Singer presented the report, and Marcela Sanchez of the New York Times Syndicate moderated a panel discussion.

Read the report »
Download PowerPoint presentation » 

      

 

 

Starting in 1999, the District initiated a series of health reforms to expand access to health care and improve residents’ health. The city closed the public hospital’s inpatient facility, transferred control of the hospital’s emergency department and affiliated clinics to a nonprofit health care provider, and created the DC HealthCare Alliance to pay for health services for uninsured low-income District residents who were not eligible for Medicaid. The District government shifted from directly providing health care to purchasing health care services from private providers.

The closure of D.C. General Hospital was controversial and politically unpopular, but officials determined it was necessary based on the hospital’s out-of-control finances, serious quality problems and low utilization rates. By setting up the DC HealthCare Alliance, the city created an insurance-like program that allowed low-income residents to access primary and specialty services from participating private providers. Enrollment in the Alliance program exceeded 50,000 in 2009. As a result of the Alliance and a generous Medicaid program, the District currently has one of the lowest uninsured rates in the country. The Alliance helped stabilize and strengthen community health centers—both the former public clinics and nonprofit community health centers—since it attached a revenue stream to patients the centers had been serving without reimbursement.

The District’s successes and challenges in redesigning the health care system for low-income residents provide important lessons for other states and localities. To be sure, some of the District’s circumstances were unique: The political opposition to closing the public hospital and the public clinics was neutralized by Congressional pressure for cost containment. Moreover, the reforms were supported by a federally-appointed Control Board, which managed the city’s finances from the mid-1990s until 2001 as the city emerged from insolvency. But the city’s experiences in shifting its role to a purchaser of health care services rather than an operator of a public provider system highlight common opportunities and pitfalls. 

• Providing access to health services via insurance coverage is a viable option for governments, as an alternative to providing services through a public hospital and associated clinics. The shift to “buying” from “making” health services is a challenge, but a manageable one. Either approach can work well or poorly, depending on choices in design, financing, implementation, and ongoing management.
• However, key to the success in “buying” health care is the existence of a functioning health care delivery system—a network of providers (primary care, specialists, diagnosticians, and so on) willing and able to serve low-income patients, and able to communicate with each other and coordinate care. The Alliance had difficulty recruiting providers, especially physicians. Access to primary and specialty care is still inadequate, and the city is still struggling to create an integrated model of care.
• Health outcomes are still poor. The District’s health care system is still struggling to improve health outcomes by focusing on chronic diseases, increasing primary care usage and reducing reliance on emergency departments and other hospital-based care.
• Moreover, health system redesign does not address the social determinants of health, such as personal behavior, income, education and environmental factors.  Improving health outcomes will take not only reforms in health care delivery, but improved education, housing, and job opportunities, as well as changes in diet and exercise and reductions in smoking and substance abuse. Many of these factors are outside the control of the health care system and require major coordinated efforts across multiple agencies.

The key lessons for privatization and coverage expansion alike are that changes in health care financing cannot succeed to their fullest without supportive changes in delivery of care and complementary efforts in public health and other areas that greatly affect health status.

      

 

 

Despite perceptions that economic distress is primarily a central city phenomenon, suburbs are home to increasing numbers of low-income families. She highlighted the need to strengthen the social service infrastructure in suburban areas.

Full Presentation on Poverty in the Washington-Area Suburbs » (PDF)

      

 

 

It’s time to break the cycle. Summer jobs are not the only way to connect young people to jobs and training, and they shouldn’t be the sole policy focus. We also need to make our summer jobs program manageable and predictable. That means targeting enrollment for a specific number of young people, making quality — not size — the most important benchmark and putting improved management and financial systems in place. Then we can broaden the debate about youth employment to include year-round programs, internships, and career and technical education at the K-12 and post-secondary levels.

• That there are enough job sites for participants, and that each job site has a clear work plan vetted by DES. No one gets paid for doing nothing or gets make-work assignments, and all participants learn new skills.

• That youth are matched to their job sites based on an assessment of their hard and soft skills. Some sites want to provide basic skills enrichment and work-readiness training. Others, usually private-sector employers, want someone who is ready to go and needs less coaching.

• That there are clear standards for youth and job sites, and that both receive orientation, support and oversight throughout the summer.

• That managerial and financial systems are sufficient to handle registration, job site assignment, timekeeping, payroll and troubleshooting. Every summer, Employment Services has to dramatically ramp up its operations in a short time. This is not an insurmountable problem but appears to make it more likely that logistics swamp quality concerns.

Rather than building a program around unlimited enrollment, the city should deliver on its promise to provide meaningful work opportunities and help young people build skills — and stay within its budget.