While small geographically, the District of Columbia is home to a racially diverse and entirely urban population of approximately 600,000 people. The District of Columbia’s unique governance structure gives local officials control over some functions, yet the U.S. Congress can overturn local laws and has ultimate jurisdiction in all matters.
See how the unique characteristics of the District of Columbia have influenced overall health and the implementation of the Affordable Care Act in the national capital.
District of Columbia health ratings
The District of Columbia ranks 21st nationally in the Commonwealth Fund’s 2014 Scorecard on State Health System Performance, up from 24th in 2009. The ranking gives each of the 50 states and the District of Columbia an overall score based on more than 40 health indicators. The indicators are grouped into five categories, with the District of Columbia scoring well in Access, Equity, and Prevention & Treatment. See the District of Columbia Scorecard for specific scores.
The District of Columbia is not given an overall ranking by America’s Health Rankings. However, you can how the District of Columbia is performing on a variety of health indicators. Positives include a low obesity rate, a low uninsured rate, and high immunization rates for children and adolescents. Health challenges in the District of Columbia include a low high-school graduation rate, a high percentage of children living in poverty, and a high rate of low birthweight babies.
Another source for public health information is the 2014 edition of Trust for America’s Health. This resource provides scores on individual health measures, but no overall rankings for the states or the District of Columbia. See Key Health Data About District of Columbia.
District of Columbia and the Affordable Care Act
While the District of Columbia is represented by a delegate in the U.S. House of Representative, that delegate does not vote on proposed bills. The District of Columbia is not represented in the U.S. Senate. Accordingly, the District of Columbia is not “on record” for the 2010 House and Senate votes establishing the Affordable Care Act.
The District of Columbia City Council established a state-run health insurance marketplace under the ACA. The legislation establishing the District of Columbia Health Benefit Exchange Authority was signed into law by Mayor Vincent Gray (D) in January 2012. The bill was also subject to review by the U.S. Congress. This is the typical process for legislation in the District of Columbia, and Congress rarely rejects laws passed by the District of Columbia. The District of Columbia’s marketplace is named DC Health Link.
The District of Columbia is also participating in Medicaid expansion through the ACA.
How did the ACA help District of Columbia?
According to the Kaiser Family Foundation, about 50,000 District of Columbia nonelderly residents are uninsured. About 27,500 of these residents will qualify for Medicaid or the Children’s Health Insurance Program, with many of them newly qualified under the ACA’s more generous eligibility criteria.
An additional 5,000 of uninsured, nonelderly residents qualify for the ACA’s premium tax subsidies to help them purchase medical insurance through the marketplace.
District of Columbia enrollment in QHPs
Approximately 10,700 individuals selected a qualified health plan through DC Health Link. This equates to 29.8 percent of the estimated eligible market in the District of Columbia. Nationally, 28 percent those deemed eligible signed up for QHPs during the 2014 open enrollment period.
In addition, about 13,000 District of Columbia residents enrolled through the SHOP marketplace. Most of those enrolling through the SHOP are members of Congress or staffers.
While the SHOP is generally intended for small businesses – the acronym stands for Small Business Health Options Program – the DC Health Link SHOP is an exception. Through an amendment to the ACA, members of Congress and their official office staff members are required to purchase their health insurance through the marketplace.
After much controversy, the Office of Personal Management, which oversees benefits for federal employees ruled that Congress and their staffers are eligible to continue receiving the federal employer contribution toward their coverage so long as they select a plan through DC Health Link.
The Medicaid program in the District of Columbia
The District of Columbia joined 28 states in expanding Medicaid under the ACA. The expansion extends Medicaid eligibility to most nonelderly adults at or below 138 percent of the federal poverty level.
During the ACA’s 2014 open enrollment period, 19,464 District of Columbia residents qualified for Medicaid or CHIP – some under existing criteria and some under the ACA expansion. Note that individuals can sign up for Medicaid or lose coverage if their eligibility changes anytime throughout the year, so enrollment totals fluctuate each month.
Learn about the District of Columbia’s Medicaid program, eligibility criteria and enrollment process.
Other ACA reform provisions
A provision of the ACA created a new type of health insurance plan called a Consumer Operated and Oriented Plan, or CO-OP. CO-OPs are nonprofit, consumer-run plans and are intended to increase market competition. Twenty-three CO-OPs have received $2.1 billion in loans to get up and running. Three of the initial 23 CO-OPs are expanding to nearby states in 2015.
No CO-OP plans were created in District of Columbia.
Reform bills in the District of Columbia
Here’s what’s happening legislatively with healthcare reform in the District of Columbia: