District of Columbia

2018 MIDTERM ELECTION

Time: D H M S

Less than one month ago:

...back in February...the executive board of the DC ACA exchange unanimously voted to reinstate the mandate. It didn't mean all that much at the time, however, because the authority to reinstate it actually belongs to the DC Council.

Well, thanks to Mr. Levitis for the heads up. If you scroll down to Page 138, you can see that the DC Council has indeed done just that:

TITLE V. HEALTH AND HUMAN SERVICES
SUBTITLE A. INDIVIDUAL HEALTH INSURANCE REQUIREMENT

Sec. 5001. Short title.
This subtitle may be cited as the “Health Insurance Requirement Amendment Act of 2018”.

Sec. 5002. Title 47 of the District of Columbia Official Code is amended as follows:
(a) The table of contents is amended by adding a new chapter designation to read as follows:
“51. Individual Taxpayer Health Insurance Responsibility Requirement”.
(b) A new Chapter 51 is added to read as follows:
“CHAPTER 51. INDIVIDUAL TAXPAYER HEALTH INSURANCE RESPONSIBILITY REQUIREMENT.

*(technically Vermont was the third to do so, but theirs doesn't kick into effect until 2020, and they haven't even crystalized exactly what form it would take anyway.)
**(yeah, I know very well that DC isn't actually a state, but it's pretty awkward to put "state and/or territory" in the headline.)

I realize that 110% of the news/media/political attention is on the bombshell announcement that Supreme Court Justice Anthony Kennedy is retiring at the end of July, but there are other things going on as well, so I'll do my best to soldier on...

More big health care action at the state level: yesterday the DC Council passed what would be the nation's third state-level individual mandate, after Mass. and NJ.https://t.co/BmtnDAQvVp

— Jason A. Levitis (@jasonlevitis) June 27, 2018

Several quick tidbits out of the District of Columbia from the DC Health Benefit Exchange Authority May board meeting:

  • Their preliminary 2019 premium rate filings were originally due by May 1st, but this was bumped out until June 1st. Not available publicly yet, however.

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a few weeks ago that as many as 9 states are ramping up plans to reinstate one version or another of the ACA's just-repealed Individual Mandate.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the political risk of imposing a mandate penalty, at least make sure it's more stringent than the one which was just repealed--I'd probably recommend making it something like the same cost as the least-expensive Bronze plan available on the exchange after whatever tax credits they'd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

Huh. Deadline extensions were fairly common in the first couple of years of Open Enrollment, but have mostly been phased out more recently. This is a bit unexpected from the DC Health Link:

.@MayorBowser has extended the deadline for individuals & families to enroll in quality affordable health insurance to Monday, February 5th at 11:59 pm. Take advantage of today's extended hours at enrollment centers across the city. Don't delay #GetCoveredDC pic.twitter.com/8R7zq0EzA1

— DC Health Link (@DCHealthLink) January 31, 2018

 

Of all the state-based exchanges, the one in DC has gone the longest without a formal enrollment update; the last one only included data through December 5th, a whopping 5 weeks ago. Fortunately, the DC board of directors held their monthly meeting last night and produced the following update.

As shown, the tally as of 1/8/18 is 21,352 QHP selections, slightly below last year's 21,437 as of the same date. Since DC (along with California and New York) are sticking with the full 3-month Open Enrollment Period, it should provide a good apples-to-apples comparison (and the fact that very few DC enrollees have CSR assistance also means there's a nominal CSR loading impact, either).

The final, official DC ACA exchange tally last year was 21,248, so technically speaking they've already surpassed that figure...but again, it was 21,437 as of 1/8/17, which means there were at least a few hundred people who were dropped off at the tail end due to cancelling or non-payment of their first premium.

I've just been sent a link to the first official update on ACA exchange enrollment in DC. It includes a whole mess of demographic data (click below for full-size version), but the main takeaway is near the top: 18,740 QHP selections as of December 5th (compared against December 8th of last year). With auto-renewals included, this year's tally is about 2% shy vs. last year, but again, those extra 3 days make a bigger difference than you might think, especially as we approach the mid-December deadline.

It's important to remember that DC, along with California and New York, is sticking with the full 3-month Open Enrollment Period this year, so residents will still have another 6 weeks after 12/15 to sign up for coverage starting in either February or March.

Until now, it looked like the District of Columbia was gonna be hit with rate increases of at least 26% or more. However, it looks like the powers that be negotiated a much better deal, especially from CareFirst:

Washington, D.C. – The District of Columbia Department of Insurance, Securities and Banking (DISB) approved health insurance plan rates for the District of Columbia’s health insurance marketplace, DC Health Link, for plan year 2018.

Insurers filed their initial rates with the Department in May. Since then, DISB engaged in its rate review process resulting in two out of the four insurers revising their rates down from their initial filings, one as much as half of what was proposed. The Department also held a public hearing during the rate review process to allow residents to provide input in the rate review process.

The District of Columbia is the 6th state (OK, it's not a state but it's considered one legislatively for purposes of the ACA) to post their initial 2018 rate filings (h/t to Louise Norris for the heads up). For 2017, the weighted average rate increase for the individual market was a mere 7.3%, highly unusual for this year, while the small group market increase was almost non-existent: Just 0.4% overall.

I've been cautioned that these numbers are preliminary, but that's true of all of the "final" enrollment numbers to date; there are often minor clerical corrections and the like before the final numbers are baked in.

Anyway, here's the OE4 QHP enrollment numbers for the DC exchange, which is up about 3.1% over last year.

However, according to the official ASPE report for 2016 Open Enrollment, DC's QHP tally was slightly lower (22,693); since that's the official total used by HHS, that's what I'm going with, which means they've enrolled about 4.1% more this year.

Yay! The DC exchange has issued their first OE4 enrollment report of the year! Boo! It doesn't include renewing enrollees (either active or passive):

DC Health Link Enrollment up Nearly 50% at First Deadline for 2017 Coverage  •  60% of new enrollees are 34 years old and younger

Washington, DC­­ – Today, the DC Health Benefit Exchange Authority (HBX) released preliminary individual marketplace data for the fourth open enrollment period for DCHealthLink.com, the District’s online health insurance marketplace for individuals, families and small businesses.

These preliminary data show that through December 19, 2016:

Hmmm...the Colorado exchange hasn't issued an official enrollment update since the end of November, when it stood at 37,142 QHPs.

Today, in an article about the overall national numbers (mainly noting today's Week 5/6 Snapshot report), Kimberly Leonard of U.S. News & World Report cited a number I haven't seen elsewhere; I presume she simply called up the exchange directly. It seems about right to me:

Open enrollment began a week before Election Day, and several states reported that they didn't begin running ads until after that, saying they didn't want to compete with the attention the election was getting and noting that space sold during that time was particularly expensive.

That was the choice for Colorado, where enrollment is 16.3 percent higher than last year, totalling 50,207 people.

In addition, Leonard provides a couple of quick updates/corrections for some other states:

As I keep noting, the DC exchange insists on presenting their enrollment numbers as cumulative since October 2013.

As a result, I have to subtract the prior numbers from the current ones to find out the net increase in QHP selections, Medicaid enrollments and SHOP enrollments.

Here's the latest update, through the end of October:

  • 262,928 people enrolled through DC Health Link in private health plans or Medicaid (includes open enrollment and SEPs):

  • 38,468 people have enrolled in private health plans through the individual and family marketplace;

  • 175,012 people have been determined eligible for Medicaid coverage; and

  • 49,448 people have been enrolled through the small business marketplace (includes Congressional enrollment)

Subtracting the prior numbers (which ran through June 10th) gives us:

Two bits of news out of the DC exchange today: First, they announced that the uninsured rate has been slashed in half over the past 3 years thanks in no small part to the Affordable Care Act. Not a huge shocker given the recent surveys/studies released by the CDC, Gallup, Kaiser and so on of late, but still good to see:

District's Uninsured Rate Drops by Half

Washington, DC­­ – A new survey by the Center for the Study of Services conducted for the DC Health Benefit Exchange Authority (DCHBX) concludes that the District of Columbia made huge gains during the most recent open enrollment period to provide access to health insurance coverage to people who were previously uninsured. Results from this survey show that more than 25,500 people, who were not previously covered in 2015, gained access to health insurance coverage in 2016 through DC Health Link, the District’s online health insurance marketplace.

...Additional findings show:

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