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 2oth nationally in the Commonwealth Fund’s 2015 Scorecard on State Health System Performance, up from 21th in 2104. 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 in the top quartile for Access and Equity. See the District of Columbia’s scorecard for additional scores.
America’s Health Rankings does not give the District of Columbia an overall ranking. However, you can check the data to see how the District of Columbia is performing on a variety of health indicators. Positives include few poor physical health days and low prevalences of obesity and excessive drinking. The District of Columbia’s biggest health challenges include a high rate of violent crime, low rate of high school graduation and high prevalence of low birthweight.
Another source for public health information is the 2016 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 it is the only place that individual and small group markets can purchase major medical health insurance plans in DC. The District also accepted Medicaid expansion.
How has Obamacare helped 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.
At 3.7 percent, the District of Columbia’s uninsured rate is tied with Wisconsin for the third lowest in the nation, according to the National Center for Health Statistics’ National Health Interview Survey 2015, which was released in May 2016.
Since DC Health Link’s first open enrollment period began October 1, 2013, more than 221,000 people have enrolled in private health insurance or Medicaid through the exchange.
Nationwide, 46 percent of eligible residents have enrolled in qualified health plans through Marketplace platforms, according to a Kaiser Family Foundation analysis. As of February 1, 2016, DC Health Link had enrolled 74 percent of eligible DC residents.
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.
DC Health Link’s 2016 open enrollment period, including a two-day extension, saw even higher numbers with 22,912 individuals selecting private qualified health plans through the exchange.
Two health insurance carriers offered plans through DC Health Link in 2016: 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.
2017 health insurance rates for DC
In May 2016, four carriers filed 170 proposed health insurance plan rates with the District of Columbia’s Department of Insurance, Securities and Banking (DISB). These carriers are the same four that offered individual and small group plans through DC Health Link in 2016: Aetna, CareFirst BlueCross BlueShield, Kaiser Permanente, and UnitedHealthcare. Their proposed rates included a mix of increases and decreases.
The District’s Medicaid program
The District of Columbia is one of 32 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 March 2016, the District’s average monthly Medicaid enrollment increased 13 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
In 2015, there were 88,421 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 spent about $9,490 per enrollee in 2014, about 6 percent more than the national average.
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.