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District of Columbia health insurance exchange

Appeal filed over DC Health Link funding plan

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The second open enrollment period on DC Health Link started Nov. 15, and individual policies are again available from Aetna, CareFirst BlueCross BlueShield and Kaiser Permanente. Small business can choose from policies offered by Aetna, CareFirst BlueCross BlueShield, Kaiser Permanente and UnitedHealthcare. Average rate increases are in the single digits for individual policies, and one carrier’s rates are decreasing about six percent.

As of Dec. 23, 1,886 new enrollees signed up for coverage through DC Health Link. DC Health Link announced cumulative enrollment from Oct. 15, 2013, through Dec. 21, 2014, of more than 71,500. The total includes about 18,800 people who purchased coverage on the individual exchange, 15,284 people who purchased coverage through the small-business or SHOP exchange, and  37,457 who qualified for Medicaid.

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 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 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 Health Link 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.

2015 rates

The D.C. Department of Insurance, Securities and Banking (DISB) approved 2015 premiums in mid-September. 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 Urban Institute shows that the average increase for individual/family plans in 2015 11 percent. The analysis considered all marketplace carriers and metal levels.

Looking back on 2014 enrollment

DC Health Link reported 2014 enrollment figures: 15,110 people purchased individual or family coverage, 14,486 enrolled through the SHOP marketplace, and 31,175 people qualified for Medicaid. In total 60,771 have enrolled in coverage between Oct. 1, 2013 and Oct. 7, 2014.

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; see the HHS enrollment report. 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.

Who’s shopped on the SHOP?

Nearly all of the DC Health Link SHOP enrollments have been 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.

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. The D.C. City Council in June 2013 unanimously passed temporary legislation supporting the mandate.

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
855-532-5465

DC Health Benefit Exchange Authority

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.