Health Care Reform

On May 4, 2011, DC Mayor Vincent C. Gray announced the creation of the Mayor’s Health Reform Implementation Committee. The committee has been advising and making recommendations to the mayor’s office on the implementation of the sweeping health care reform passed by the U.S. Congress in 2010.

Moreover, the District’s new Health Benefit Exchange Authority Executive Board (HBX) was officially sworn in by Mayor Vincent C. Gray on July 17, 2012. The District’s Health Benefit Exchange Authority will guide implementation of a crucial part of the Affordable Care Act (ACA) – state-level insurance exchanges that will provide health insurance customers with more choice and buying power in purchasing affordable health care plans.

More information on local health reform implementation can be found at Health Care Reform.

Medicaid Expansion

The District of Columbia was one of the first two jurisdictions in the country to take advantage of the early adoption of Medicaid expansion through federal health reform. By moving several newly Medicaid-eligible DC HealthCare Alliance beneficiaries over, the District saves money and improves the benefits package for District residents. The District was able to expand Medicaid eligibility to 133 percent of the federal poverty level (FPL), and cover those at 134 to 200 percent of the FPL through an 1115 Waiver demonstration project. Of the District’s 600,000 residents, more than 200,000 are currently on Medicaid and more than 17,000 are in the Alliance.

The District has been quite progressive in moving residents who are eligible for Medicaid over from the DC HealthCare Alliance, and by doing so the District saves money and improves the benefits package for DC residents. Additionally, DCPCA supports the Medicaid Expansion and Eligibility Subcommittee of the Mayor’s Health Reform Implementation Committee in its work to develop a single-point of entry for District public benefits, as well as examine the impact of the transition to Modified Adjusted Gross Income or “MAGI” for determining Medicaid income eligibility.

Pre-Existing Condition Insurance Plan

People who have had difficulty finding health coverage or have been turned down for coverage because of a pre-existing condition and feel like they are out of options are not out of luck. They may now be eligible for a new program created by the Affordable Care Act – the Pre-Existing Condition Insurance Plan (PCIP). The PCIP is one way the Affordable Care Act helps uninsured people with pre-existing conditions get high quality care at affordable prices. The PCIP is designed as a bridge to 2014 when the nation transitions to a new marketplace and all Americans – regardless of their health status – will have access to affordable, quality health coverage through a competitive marketplace for health plans called a Health Insurance Exchange. This health coverage program is administered at the state level in 27 states and by the federal government in 23 states and the District of Columbia.

Health Insurance Exchange

Currently, the District is exploring the opportunity for developing a Health Insurance Exchange (HIE). In preparation for putting into effect the ACA, the Council of the District of Columbia passed legislation creating an exchange on December 20, 2011. Exchanges are the central mechanisms created by the federal health reform bill to help individuals and small businesses purchase health insurance coverage. Beginning in 2014, an exchange will be established in each state to help consumers make valid comparisons between plans that are certified to have met benchmarks for quality and affordability. The exchanges will also administer the new health insurance subsidies and facilitate enrollment in private health insurance, Medicaid and the Children’s Health Insurance Program. Nobody will be required to purchase health insurance through the exchange, though subsidies will only be available for plans sold through the exchange.

More Information

DCPCA’s 2012 Policy and Advocacy Goals Remain Focused on:

(1) Efforts to Achieve 100% Health Insurance Coverage Among District Residents;
(2) Efforts to Develop Public-Private Partnerships in Prevention and Health Service Delivery;
(3) Efforts to Facilitate the Development of a Fully Integrated Health System; and
(4) Continue to Build and Strengthen Relationships with Media to Ensure Maximum Coverage.

For more information, read the one-pager about our Policy, Advocacy, and Health Reform efforts, visit Increasing Primary Care Coverage, our Health Equity Blog, or read our Testimony.

For additional information about health reform in the District of Columbia, contact Howard Liebers, MPH, DCPCA’s Director of Policy, at (202) 552-2316.

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