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May 21, 2021

Making the Politically Impossible the Politically Inevitable

At La Clínica del Pueblo we know we can change quickly. We have seen it. We have done it. So can the District.

By: Rodrigo Stein MSc, Director of Health Equity and Strategic Community Partnerships and Catalina Sol, Executive Director, La Clínica del Pueblo

Only a Crisis Produces Real Change


For many years, the D.C. Healthcare Alliance, a city-funded health insurance system for those who are not eligible for Medicaid or do not have private insurance, has been a lifeline. Many who rely on the program are immigrants and receive care at health centers like La Clínica Del Pueblo (LCDP). Unlike the usual yearly renewal of other assistance programs like Medicaid, recipients must recertify in person every six months at centers that may lack bilingual staff or on-site interpreters. Furthermore, due to long lines, some recipients lose valuable income from the hourly wages they earn or lose coverage entirely if they cannot take an entire day off from work.

A 42-year-old female patient at LCDP described her situation: "I have three kids; one has a disease and is unable to walk. I do not have anyone to take care of my children. I can't spend a whole day doing the recertification process every six months." These barriers contribute to both poor health outcomes and unnecessarily high program costs.

However, during the COVID-19 crisis, the District enacted the public health emergency, effectively amending the in-person recertification process to once per year and ensuring no one lost eligibility during the public health crisis. Now is the time to ask: What if D.C. made these transformations permanent?

We Know That We are Capable of Profound Transformation

"It turns out that during this time is when an immigrant is most in need. It was when we felt most discriminated; we felt isolated. We felt that they didn't even take us into consideration because...they gave that $1,200 to people who had a social [security number]. But what about those that don't have anything, who are mothers or fathers, who have young ones…people in need? Those are the things of the government I do not understand. How there is so much inhumanity...so much injustice." (Undocumented Female, living 16 years in the United States)

At LDCP, we have repeatedly heard these types of stories from our patients during the COVID-19 crisis. In Washington, D.C., Latinos had the highest COVID-19 infection rates and the second-highest death rates. This prompted a rapid transformation of all LCDP's systems.

Essential mental health and medical appointments continued as the clinic embraced telehealth. Our Community Health Action department transitioned in-person health education and outreach services to a virtual setting. We also created a food distribution service to address the widespread levels of food insecurity found among LCDP's patients.

A Force Capable of Announcing Justice

Milton Friedman, the late University of Chicago professor, laid out his theory of crisis: “Only a crisis—actual or perceived––produces real change. When that crisis occurs, the actions that are taken depend on the ideas that are lying around...Our basic function [is] to develop alternatives to existing policies, to keep them alive and available until the politically impossible becomes the politically inevitable.” But whose ideas matter? Friedman wanted to enact radical deregulation, privatize national industries and public-sector programs, and enact deep cuts to the welfare state—all of which has caused tremendous suffering worldwide.

Above all it is crisis that compels us to remember the words of Paulo Freire and not Friedman. He reminds us that “it is necessary that the weakness of the powerless is transformed into a force capable of announcing justice. For this to happen, a total denouncement of fatalism is necessary. We are transformative beings and not beings for accommodation.” It is on us to set the groundwork for the change we want. At La Clínica del Pueblo we know we can change quickly. We have seen it. We have done it. So can the District.

LCDP and our local partners have implemented ideas that are sensible, fair, and designed to keep as many people as possible safe, secure, and healthy. We are optimistic that the politically impossible will become the politically inevitable. It is time for the District to live up to these ideals and meet the moment, too. In the upcoming budget vote on May 27, we urge Mayor Bowser to use the COVID-19 crisis notto maintain the status quo or worse, but to invest in Alliance program by eliminating the six-month recertification for good.