Our nation’s capital is home to the state-run health insurance exchange DC Health Link. Those living in the District of Columbia can only purchase individual and small group coverage through this marketplace; there is no off-exchange option.
Since the ACA’s individual shared responsibility provision took effect, the state’s uninsured population continues to decline. With an uninsured rate of 3.7 percent, DC is tied with Wisconsin for the third-lowest rate in the country, according to National Center for Health Statistics.
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 20th 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.
Based on 2014 data, DC had the nation’s second-lowest uninsured rate in the rankings. To become the best-performing state for that indicator, a total of 9,146 more adults would need to become insured. DC also ranked second for the number of individuals under age 65 with high out-of-pocket medical costs relative to their annual household income. 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.
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.
District of Columbia enrollment in qualified health plans
Approximately 10,700 individuals selected a qualified health plan through DC Health Link during the first Obamacare 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.
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.
DC Health Link’s 2016 open enrollment period, including a two-day extension, saw 22,912 individuals select private qualified health plans through the exchange. As of March 31, effectuated enrollment stood at 17,266, and just 6.9 percent were receiving premium subsidies, which is the lowest percentage in the country. According to a Kaiser Family Foundation analysis, DC’s exchange enrolled 74 percent of eligible residents as of February 1, 2016 – nationwide, the average was 46 percent and in Vermont, the only other state that did not offer off-exchange plans in 2016, only 49 percent of those eligible to enroll did so.
2017 health insurance rates, plans for DC
DC Health Link’s 2017 carriers will be the same as those who offered QHPs in 2016; however, the total number of individual market plans available will drop from 26 to 18. The participating carriers and their proposed rate increases are as follows:
- CareFirst HMO:3 percent average rate increase
- CareFirst PPO: no requested change
- Kaiser Health Plan of the Mid-Atlantic (HMO only): 12 percent average rate increase
Final plans and rates will be available on or before November 1, 2016, when 2017 open enrollment begins.
District of Columbia and the Affordable Care Act
While a delegate represents the District of Columbia 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.
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 June 2016, the District’s average monthly Medicaid enrollment increased 12 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. Of District Medicare enrollees, 13 percent select Medicare Advantage, a number much smaller than the 31 percent who do so nationwide. Medicare Part D provides 45 percent of District Medicare enrollees with stand-alone Rx benefits.