District of Columbia

Along with Massachusetts and Vermont, the District of Columbia merges their Individual and Small Group markets for purposes of risk pools and risk adjustment. This does not, however, necessarily mean that their Indy and Sm. Group average premium changes are identical. For one thing, there are more carriers which offer small group plans than individual market plans; for another, the market share ratios between the two differ.

A week ago, the DC Dept. of Insurance, Securities and Banking (DISB) issued preliminary 2020 rate filings along with this press release:

Washington, DC – The District of Columbia Department of Insurance, Securities and Banking (DISB) received 181 proposed health insurance plan rates for review from Aetna, CareFirst BlueCross BlueShield, Kaiser Permanente and United Healthcare in advance of open enrollment for plan year 2020 on DC Health Link, the District of Columbia’s health insurance marketplace.

As you can see, after yesterday's deep dive into the potential 10-year cost of the Medicare for America proposal, I'm easing back today with some easy quick hits. The DC Health Link exchange has posted their Individual and Small Business enrollment report as of May 5, 2019.

The numbers are all fairly small, of course, but a few noteworthy items: DC appears to have an 89% QHP enrollment retention rate as of May from the beginning of the year (they had 18,035 QHP selections as of 1/31/19), which is very good. SHOP enrollment is disproportionately high as always for DC, due to both the fact that they require all small business enrollments in the District to be handled via the exchange and the fact that members of Congress and their staff have to use the DC exchange to enroll in healthcare coverage.

Back in early December, I noted that while I applauded both New Jersey and the District of Columbia for creating their own individual healthcare coverage responsibility requirements (aka, The Individual Mandate) in response to Congressional Republicans repealing the ACA's federal penalty, doing so also required making sure that residents of NJ/DC *knew* they had done so:

There's only one problem with this: The impact of the mandate penalty is completely psychological in nature. It only works (to the extent that it does at all) if people know that they'll be penalized financially for not complying with the mandate.

Until now, I've been missing the final 2019 Open Enrollment Period numbers for two state-based exchanges: Vermont and the District of Columbia. VT is still radio silent, but last night the DC exchange authority held their monthly meeting and released their latest data report.

There's a bunch of handy demographic data included in the report...but some of it is also confusing and difficult to get an accurate year-over-year measurement due to a difference of time periods and enrollment status.

I've put in a request to sort some of this out and will update this entry if/when I receive clarification.

For instance, the DC exchange says that they have the following number of residents currently effectuated as of February 10th:

This Just In from DC Health Link...

DC Health Link Extends 2019 Open Enrollment Deadline to Wednesday, Feb. 6

Washington, DC­­ – DC residents will have an additional six days to sign up for 2019 health insurance coverage through DC Health Link.  The new deadline to sign up is 11:59pm on Wednesday, February 6.  Individuals who sign up by that deadline will have coverage beginning March 1, 2019.

DC Health Link customer service representatives will be available today at (855) 532-5465 from 8:00am to 8:00pm and on Monday, February 4th through Wednesday, February 6th to work with individuals seeking to enroll in health insurance coverage effective March 1. In-person assistance will also be available at enrollment centers throughout the District to assist residents with the enrollment process through February 6th.

Believe it or not, the 2019 ACA Open Enrollment Period officially ended last night...but only in 43 states. In the remaining seven (+DC), Open Enrollment hasn't ended yet2019 ACA Open Enrollment is still ongoing for over 23 million people!

In the District of Columbia (population 694,000) and New York (population 19.85 million), open enrollment runs through Jan. 31st for coverage starting March 1st.

BUT ALSO...

via DC Health Link (the District of Columbia ACA exchange):

DC Health Link Pulling Out All the Stops for African-American “Week of Action”
Friday, January 18, 2019

Marching in MLK, Jr. Day Parade, barber shop outreach, and visiting churches highlight opportunities to boost African-American health insurance enrollment

WHAT/WHO:

With less than two weeks left to the January 31 deadline to sign up for 2019 coverage, DC Health Link is ramping up outreach efforts to the African-American community, where the uninsured rate remains high. DC Health Link, in partnership with various community organizations, is encouraging uninsured African-Americans to enroll in quality, affordable health insurance during DC Health Link’s “African-American Week of Action.”

So, it's over, right? Well...not quite. The 2019 ACA Open Enrollment Period officially ended last night...but only in 43 states. In the remaining seven (+DC), Open Enrollment hasn't ended yet2019 ACA Open Enrollment is still ongoing for nearly 10% of the population!

  • In Massachusetts, open enrollment runs through Jan. 23rd, 2019 for coverage starting February 1st

ALSO...

Last week I acquired the DC Health Link enrollment data for the first two weeks of 2019 Open Enrollment. It showed that DC, unlike most of the other state-based exchanges, was lagging behind last year for the first two weeks (although not as much as most of the HC.gov states).

Well, I just received updated data out of DC and the enrollment situation over the following four weeks didn't improve (if anything they dropped off slightly more):

  • Nov. 1 - Dec. 11, 2017: 19,252 QHP selections
  • Nov. 1 - Dec. 11, 2018: 17,825 QHP selections

That's a drop of around 7.4% year over year so far.

As with most other state-based exchanges, the numbers for both years include auto-renewals, which means the vast bulk of 2019 enrollments are likely already baked in. Last year's final tally was 19,289; DC has already reached 92% of that as of 12/11. Keep in mind that DC's Open Enrollment Period does not end on Saturday the 15th; it continues for another 47 days after that, through January 31st.

The numbers are several weeks out of date, but it's better than nothing: Here's the DC Health Link's official 2019 ACA Open Enrollment report through November 13.

Things weren't looking great as of two weeks in: Total enrollments were down 6.8% (1,202 people) year over year as of the same date. We'll have to see whether things have picked up since then.

As with most other state-based exchanges, the numbers for both years include auto-renewals, which means the vast bulk of 2019 enrollments are likely already baked in. Last year's final tally was 19,289; DC had already reached 85% of that as of 11/13.

DC's report also includes all sorts of wonky demographic breakout data, and even closes with currently effectuated numbers for both the individual and small business (SHOP) markets. Remember, DC's SHOP market is unusually high (especially compared to the individual market) because the ACA requires all members of Congress and their staff to enroll using it if they want their 72% FEHB subsidy.

"But the whole point of the doomsday machine is lost if you keep it a secret! Why didn't you tell the world, eh?

--Dr. Strangelove, 1964

No one applauded the New Jersey legislature and Governor Phil Murphy louder than I did when they swiftly passed several laws this past spring which cancelled out much of the Trump Administration's sabotage of the Affordable Care Act. As a reminder, the laws and waivers they put into effect included:

I originally wrote about District of Columbia carrier requested 2019 ACA rate changes back in June. At the time, they were seeking a weighted average increase of around 15.5% across the District.

However, the DC exchange board was also working quickly in an attempt to counter the Trump Administration's #ACASabotage factors, by voting to restrict short-term plans, to lock in DC's Open Enrollment Period at a full 3 months as in years past, and to reinstate the ACA's individual mandate penalty at the local level.

As of early September, all of these things appeared to have been approved by the exchange board and/or the DC Council.

On September 19, the DC Dept. of Insurance, Securities & Banking posted the approved 2019 ACA rate changes, and the average increase for the individual market had been shaved down from 15.5% to 13.0%:

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

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