As of Feb. 21, 18,465 individuals had enrolled in qualified health plans (QHPs) for 2015 coverage through DC Health Link. Twenty-six percent are new to the exchange for 2015, and just under 11 percent are receiving premium subsidies. This is dramatically lower than the rest of the country, but DC does not allow the sale of off-exchange plans, so everyone who needs to purchase individual insurance in DC must do so through the exchange, regardless of whether they qualify for premium subsidies. Vermont is the only that requires individuals to purchase coverage through the marketplace.
DC Health Link announced cumulative enrollment from Oct. 15, 2013, through Feb 13, 2015, of more than 80,500 people. The total includes 20,358 people who purchased coverage on the individual exchange, 15,763 people who purchased coverage through the small-business (SHOP) exchange, and 44,457 who qualified for Medicaid.
Special enrollment period for penalized
DC Health Link authorized a special enrollment period (SEP) for District residents who learned when they filed their 2014 federal tax returns that they are being penalized for not having health insurance. The SEP runs March 15 through April 30.
Funding plan again challenged
The District of Columbia’s health insurance marketplace, DC Health Link, was identified as the nation’s second most expensive on a per enrollee basis, and its long-term funding plan triggered a lawsuit.
DC Health Link’s funding plan was formed to meet requirement that all state-run exchanges be self-sufficient by 2015. A number of state-run exchanges have placed a tax on premiums sold through the exchange.
However, given the District’s small population, a premium tax would have to be very high to sustain DC Health Link — 17 percent according to a Washington Post article. Accordingly, the D.C. Council approved a one percent tax on premiums for all health-related insurance plans sold in the District — not just those sold on the exchange. Many insurers that sell health-related insurance products outside of the marketplace are vehemently opposed to the plan, and the American Council of Life Insurers filed suit claiming the tax is unconstitutional and a violation of the ACA.
A U.S. District Court judge dismissed the suit in November 2014, writing that the ACA gave state-run exchanges broad authority to establish funding mechanisms.
In December 2014, the American Council of Life Insurers appealed the November ruling to the U.S. Court of Appeals for the D.C. Circuit.
DC marketplace insurers back for 2015
All of the insurers that sold policies through DC Health Link in 2014 are participating again in 2015. Aetna, CareFirst BlueCross BlueShield and Kaiser Permanente are again selling individual and family plans, while those three plus UnitedHealthcare are selling polices through the small-business or SHOP exchange. CareFirst dominated marketplace sales in 2014.
In total, 227 plans are available on DC Health Link for 2015: 31 plans for individuals and 196 small group plans.
The D.C. Department of Insurance, Securities and Banking (DISB) approved 2015 premiums in September 2014. For individual plans, average rate changes by carrier vary from a 6.1 percent decrease to a 7.6 percent increase. For small group plans, the range is -17.2 percent to 12.7 percent. See the DISB website for details.
Analysis by the Commonwealth Fund shows that the average increase for individual/family plans in 2015 is 11 percent. The analysis considered all marketplace carriers and metal levels.
Looking back on 2014 enrollment
During 2014 open enrollment, 10,714 people signed up for individual or family coverage through DC Health Link.
At 45 percent, the District led the nation in the percentage of people ages 18 to 34 signing up for private health plans during 2014 open enrollment. Nationally, the figure was 28 percent.
The selection of health plans was quite evenly spread across the metal levels in the District. Twenty-nine percent of health plan enrollees selected bronze plans, 25 percent selected silver plans, 22 percent selected gold plans, and 19 percent selected platinum plans. An additional four percent selected catastrophic plans, which are available only to those under 30 or those who qualify for a hardship exemption. Nationally, 2014 enrollment was heavily skewed to silver plans, with 65 percent of enrollees selecting these mid-level plans.
Who’s shopping on the SHOP?
DC Health Link is the designated marketplace for members of Congress and their official office staff following a rule issued by the Office of Personal Management, which oversees benefits for federal employees. 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. In 2014, the vast majority of people enrolling through the DC Health Link SHOP were members of Congress and their staff.
An organization named Judicial Watch filed a lawsuit challenging the DC Health Link’s SHOP acceptance of enrollment by Congress and staffers. The case was dismissed in February, but Judicial Watch immediately appealed. Louisiana Sen. David Vitter also filed a suit challenging Congressional use of the DC Health Link small business exchange.
Use of the SHOP is mandated for District small businesses in a decision that drew strong criticism and pushback. Exchange officials said the mandate was necessary given the small population in the District. Without requiring small employers to participate, officials said, enrollment simply wouldn’t be high enough to sustain exchange operations. Small business protested the decision. The board maintained the requirement, but did allow some businesses until 2015 to comply.
In January 2015, brokers and small business were reporting technical problems with DC Health Link. Officials said the problems surfaced a year after the SHOP launch as volume increased. DC Health Link and its call center vendor added staff to help with the higher volume.
History of the District’s exchange
The District of Columbia was an early adopter in moving to implement a health insurance exchange. The Health Reform Implementation Committee (HRIC), formed at the direction of Mayor Vincent Gray, issued its final recommendations in October 2011. The D.C. City Council adopted many of the committee’s recommendations and passed a bill to create the District of Columbia Health Benefit Exchange Authority, which Gray signed it into law in January 2012. The District of Columbia received federal approval to operate a state-based exchange in December 2012.
In June 2013, the exchange was rebranded as DC Health Link.
District of Columbia health insurance exchange links
DC Health Link
Implementing Health Insurance Exchanges: District of Columbia
The Henry J. Kaiser Family Foundation overview of the District of Columbia’s progress toward creating a state health insurance exchange.