In 2007, nearly 10 percent of Washington, D.C. residents reported they were unable to see a doctor when needed due to cost. Between 2003 and 2009, District families saw the cost of their health insurance increase 32 percent with average annual premiums rising to $14,222, representing more than 25 percent of the median household income in the district. Single policyholders saw their rates rise by 36 percent over the same period.  Of the District residents who do have health insurance, 48 percent are covered through employment. Public programs such as Medicaid and Medicare insure 34 percent of District’s residents, and seven percent of the population purchases individual private policies. This leaves nearly 65,000, 11 percent of residents, uninsured. 
Who are the uninsured in D.C.?
The District’s children are uninsured at a rate of five percent, with Medicaid covering 85 percent of the children who live in households with incomes less than the Federal Poverty Level (FPL). More than a quarter of adults in these lower-income households, 26 percent, lack health insurance.  Of the District’s non-elderly Hispanic population, 22 percent are uninsured. The Black population is uninsured at a rate of 13 percent. Seven percent of Whites have no health insurance. 
In 2007 and 2008, District residents living in households with at least one full- or part-time employed member made up more than 68 percent of the uninsured. The remaining 32 percent of uninsured residents were seeking employment or were not in the labor force because they were disabled, chronically ill or family caregivers. 
How does the Affordable Care Act affect D.C. residents?
The Affordable Care Act (ACA) requires states provide access to an online marketplace, also called an exchange, where individuals and small businesses may compare, select and purchase private health insurance policies that offer a minimum level of coverage. States have the option of establishing their own exchange, operating an exchange in cooperation with the federal government, or turning all administration of the health care marketplace over to the federal government. In December 2012, The U.S. Department of Health and Human Services conditionally approved the District’s plans to establish its own health insurance exchange.
Under the ACA, all new policies, and in-force policies upon renewal, must cover a package of essential health benefits, including hospitalization, emergency services and mental health treatments. Annual wellness checkups and other preventative screenings must be covered with no co-payments or deductibles. Residents may not be denied health insurance for pre-existing health conditions, and insurers may not place a lifetime cap on benefits. Households with incomes at or below 400 percent of the FPL may be eligible for tax credits to offset premium costs. An April 2013 Families USA report estimates that nearly 42,000 District residents are be eligible for these tax credits.
D.C.’s health Insurance exchange
In January 2012, Governor Vincent Gray signed into law legislation creating the Health Benefit Exchange Authority (HBX). The exchange is governed by an 11-member Board and operates as an independent authority of the District’s government. District residents are able to shop for and enroll in health plans through the exchange web portal DC Health Link. Plans offered through DC Health link will cover essential health benefits based on Group Hospitalization and Medical Services’s Blue Preferred plan. In May 2013, the exchange authority announced that Aetna, CareFirst BlueCross BlueShield, Kaiser Permanente and United Healthcare submitted a combined total of 293 plans for inclusion in the District’s exchange.
Plans are offered in four categories of coverage levels, with the least expensive plan, the bronze tier, covering 60 percent of medical costs. Plans in the silver tier cover 70 percent of costs. Gold plans cover 80 percent. The most expensive tier, platinum, covers 90 percent of medical costs. Additionally, adults younger than 30 may purchase limited coverage catastrophic plans. By applying through the exchange, District residents can determine eligibility for Medicaid and health insurance premium tax credits.
Small Business Health Options Program (SHOP)
Under the ACA, small business employers with fewer than 50 full-time workers, or full-time equivalent workers, will not be required to offer health insurance to their employees. (Check here for a definition and calculator to determine who qualifies as a full-time worker.) However, the ACA encourages many small business employers to provide health insurance by offering small business health care tax credits.
Many small businesses were already offering health insurance packages to their employees before the ACA was passed and signed into law. These plans are accepted, or grandfathered in, under the ACA.
For small business owners who wish to change their coverage plans, or for those who did not offer health insurance before the new law, the ACA establishes the Small Business Health Options Program or SHOP. SHOP allows employers to compare and shop for quality insurance plans side by side for their employees. Washington small business owners may access SHOP through DC Health Link. For more information about the ACA and small businesses, visit the U.S. Small Business Administration.
Certified in-person enrollment organizations
The U.S. Department of Health and Human Services has approved the health centers below in the District for assistance in outreach and enrollment.
- Community Of Hope, Inc.
- Family And Medical Counseling Service, Inc.
- La Clinica Del Pueblo, Inc.
- Mary’s Center For Maternal & Child Care, Inc.
- Unity Health Care, Inc.
For the full list, visit the U.S. Department of Health and Human Services.
External resources for D.C. residents
- Health Benefit Exchange Authority
- Centers for Medicare & Medicaid Services
- Department of Insurance, Securities & Banking
- The Kaiser Family Foundation
- State Refor(u)m
Gillian Burdett is a freelance writer covering all things home and living. Her work can be found on Examiner.com.