District of Columbia: DC exchange board unanimously recommends bringing back the individual mandate & more

2019 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

I noted a few weeks ago that as many as 9 states are ramping up plans to reinstate one version or another of the ACA's just-repealed Individual Mandate. I concluded:

My only advice is that if they do take the political risk of imposing a mandate penalty, at least make sure it's more stringent than the one which was just repealed--I'd probably recommend making it something like the same cost as the least-expensive Bronze plan available on the exchange after whatever tax credits they'd otherwise have applied.

Well, I don't know about the details, but it looks like the District of Columbia, at least, is full-steam ahead:

DC Health Benefit Exchange Authority Executive Board Recommends Policies to Protect Health Insurance for District Residents
Friday, February 23, 2018

(Washington, DC) –The DC Health Benefit Exchange Authority (DCHBX) Executive Board Wednesday unanimously adopted recommendations from its Affordable Care Act (ACA) Working Group to improve affordability and stability of private health insurance in the District of Columbia. The recommendation would establish an individual responsibility requirement modeled on the federal requirement to maintain continuous insurance coverage.

The recommendation would make the District the first state since the ACA was passed to adopt a continuous coverage requirement to keep private health insurance markets stable and make coverage more affordable for District residents with individual and family private coverage.

In her January 10, 2018 charge to the DCHBX Board, Mayor Bowser wrote that:

“The repeal of the Affordable Care Act (ACA) individual mandate will lead to an increase in premiums and loss of coverage for millions across the country and thousands here in the District. While I continue to call on the federal government to expand access to health care coverage, it is clear that the current Congress and administration refuse to show leadership on this issue. I ask that the Health Benefit Exchange Authority Board reconvene the Affordable Care Act (ACA) Working Group, with the charge of recommending actions the District government should take to protect coverage gains and ensure affordable health care coverage for individuals and small businesses. I am requesting that the Working Group consider whether there are actions the District of Columbia should take in light of the repeal of the individual mandate.”

The DCHBX Board established the ACA Working Group to identify local policy options to strengthen the ACA protections. Recent federal government actions have jeopardized the stability of private health insurance. The DCHBX ACA Working Group began its work in the summer of 2017, initially met ten times and voted unanimously for a number of market stability and affordability recommendations.

In January 2018, Mayor Bowser asked DCHBX to reconvene the ACA Working Group to reexamine and amend the initial policy recommendations after the individual responsibility requirement was repealed in the federal tax overhaul of 2017. The group met eight times this year and unanimously recommended to the DCHBX Board to add a District individual responsibility requirement to their initial recommendations.

The local policy recommendations include:

  • A District individual responsibility requirement that is modeled on the federal requirement with changes to enhance protections for District residents;
  • A local reinsurance program to help make premiums more affordable for the District’s 18,000 residents with private individual health insurance; and
  • A local supplement to the federal premium subsidy to increase the affordability of health insurance for the approximately 1,000 residents who are currently subsidy eligible.

Together, these recommendations help ensure a stable individual health insurance market and more affordable private health insurance.

I have no idea what "changes to enhance protections for District residents" refers to. It could mean a larger penalty, or more strict enforcement, or something else. However, the political risk is much smaller given the unique nature of DC, as well as the fact that Medicaid eligibility extends all the way up to around 210% of the Federal Poverty Line anyway. As a result...

“In Washington, DC the uninsured rate of less than 4% is at its lowest point in city history, thanks to the Affordable Care Act and the efforts from DC Health Link, the Bowser Administration, DC Council, and partners throughout DC government and our community. It is important to build on this success,” said Dr. Leighton Ku, DCHBX Executive Board Member and Chair of the ACA Working Group.

In any event, the combination of re-adding the penalty, along with some sort of reinsurance program and beefing up the subsidies themselves should do the trick...if it actually happens.

“In the District, we want to make health coverage affordable and accessible," said Jodi Kwarciany, Health Policy Analyst at the DC Fiscal Policy Institute and Vice Chair of the DCHBX ACA Working Group. “Policies like these will really help District residents in our individual marketplace and ensure a robust and stable marketplace.”

The DCHBX ACA Working Group’s diverse membership included health plans, consumer advocates, insurance brokers, the small business community, community health centers and other providers. View the resolution presented to the DCHBX Executive Board by the ACA Working Group today. Viewthe resolution approved by the DCHBX Executive Board by the ACA Working Group in November 2017. View more information on the ACA Working Groups.

The DC Health Benefit Exchange Authority (DCHBX) is a public-private partnership established to create and operate DC’s state-based online health insurance marketplace, DC Health Link.