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 see how the District of Columbia is performing on a variety of health indicators. Positives include a low prevalence of physical inactivity, a high percentage of quality nursing home beds, and ready availability of home healthcare providers. The District of Columbia’s biggest health challenges include a high prevalence of chronic drinking, a high rate of seniors in poverty, and low flu vaccination coverage.
Another source for public health information is the 2015 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, and the District also accepted Medicaid expansion.
How did Obamacare help the District of Columbia?
According to the Kaiser Family Foundation, about 50,000 District of Columbia nonelderly residents were uninsured in January 2014. About 27,500 of these residents were estimated to 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 qualified for the ACA’s premium tax subsidies to help them purchase medical insurance through the marketplace.
District of Columbia enrollment in qualified health plans
Approximately 10,700 individuals selected a qualified health plan through DC Health Link during the first Obamcare open enrollment period. This is 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.
During the 2014 open enrollment period, 45 percent of the people who signed up for private health plans through the District’s exchange were ages 18 to 34 – the highest percentage in the U.S. Nationwide, 28 percent of enrollees belonged to this age group.
Obamacare’s second open enrollment period saw higher enrollment numbers with 18,465 individuals selecting plans through DC’s exchange. By June 30, 2015, several thousand had dropped coverage or quit paying their premiums and 14,637 remained enrolled. Of those remaining, 10.2 percent received advanced premium tax credits and 2.7 percent received cost-sharing reductions.
Two health insurance carriers will offer plans through DC Health Link for 2016. They include CareFirst and Kaiser. In the District of Columbia there is no off-exchange enrollment for individuals or small businesses. In September 2015, a new Plan Match tool was launched to help DC consumers compare plans and select 2016 coverage.
DC’s Medicaid program
The District of Columbia is one of 31 states that have expanded Medicaid under the ACA. The expansion extends Medicaid eligibility to most nonelderly adults at or below 138 percent of the federal poverty level.
During Obamacare’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.
From before the ACA expansion through July 2015, the District’s average monthly Medicaid enrollment increased 8 percent.
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. Since late-2014, nine CO-OPs have announced their closure.
No CO-OP plans were created in District of Columbia.
Medicare enrollment in DC
As of May 2015, there were 87,811 DC residents enrolled in Medicare in the District of Columbia, about 13 percent of the District’s total population. Nationally, about 17 percent of the total population is enrolled in Medicare. The District spends about $11,157 annually per enrollee and is among the 20 states that spend $10,000 or more. DC ranks 49th in terms of overall Medicare spending with $856 million per year.
In the District of Columbia, Medicare enrollees can select a Medicare Advantage plan instead of Original Medicare as a way to receive additional benefits. Medicare Part D provides many District Medicare enrollees with stand-alone Rx benefits.