District of Columbia health insurance exchange
District of Columbia health insurance exchange
By Carla Anderson
July 24, 2014
Open enrollment for coverage in 2014 has ended. People who get married or divorced, change jobs, have a child or experience another qualifying event may be eligible for a special enrollment period to purchase commercial insurance before the next open enrollment period (which begins Nov. 15, 2014, for coverage in 2015). Enrollment through the SHOP exchange and for Medicaid or the Children’s Health Insurance Program continues throughout the year.
Individuals who remain uninsured may face a tax penalty of $95 or one percent of income, whichever is greater.
DC Health Link announced its latest figures on May 2: 11,106 people purchased individual or family coverage, 13,230 enrolled through the small-business (SHOP) marketplace, and 20,497 people qualified for Medicaid. In total 44,833 have enrolled in coverage since open enrollment began on Oct. 1.
The Washington Post reported that nearly all the signups through the small-business, or SHOP, exchange are members of Congress or Congressional staffers. 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.
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, enrollment is heavily skewed to silver plans, with 65 percent of enrollees selecting these mid-level plans.
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.
While planning and implementation of the DC exchange was less contentious than in many of the states, one decision by the D.C. Exchange Authority drew strong criticism and pushback. In October 2012, the Authority announced that small employers must use the exchange for health insurance purchases. 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. While the board seemed intent on maintaining the requirement, it did vote to allow some businesses until 2015 to comply. The D.C. City Council in June 2013 unanimously passed temporary legislation supporting the mandate. That legislation is set to expire in October 2014.
A long-term funding plan for DC Health Link is also controversial. Federal grant money for operational expenses is ending, and all state-run exchanges must 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 temporarily approved a one percent tax on premiums for all health-related insurance plans sold in the District — not just those sold on the exchange. A number of insurers that sell long-term care, disability, vision, dental and other health-related insurance products are vehemently opposed to the plan and may sue.
Aetna, CareFirst BlueCross BlueShield, and Kaiser Permanente sold policies for individuals and families on DC Health Link for 2014 coverage. Those insurers plus UnitedHealthCare are selling small-business policies. The insurers offered 34 options for individuals and families and 267 options for small businesses.
Prior to the launch of the marketplace, there were 42,000 uninsured people in D.C (7 percent of the population).
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.