Unless the D.C. Council and Mayor Vincent Gray act to intervene, a startling and drastic change in health insurance regulations approved last week by an appointed city board is now looming for a large number of D.C. residents and those who work in Washington.
President Obama’s oft-repeated pledge that “if you like your health plan . . . you will be able to keep your health care plan, period” under the Affordable Care Act (ACA) won’t apply in the nation’s capital.
If you work in the District for a business, nonprofit, organization, association or other private sector employer with 50 or fewer employees and are covered under a group plan, you will not be allowed to retain your current health insurance.
If you live in D.C. and maintain individual health insurance coverage – or will soon be required by the federal government to do so – you’ll grapple with the same restriction.
Upwards of 135,000 people – nearly 30 percent of the private sector insurance market in the District – will be subjected to this policy, along with affected spouses and family members. Even if next month’s national election produces the prospect that Obamacare may be revoked, replaced or reduced in scope, the city intends to independently proceed.
The seven-member D.C. Health Benefits Exchange Authority voted unanimously last week to require that all employee groups of 50 or fewer and individuals be forced to purchase health insurance through the Exchange. These groups and all individuals will no longer have the freedom of retaining current plans or seeking coverage in the open market.
The Exchange set-up shoehorns enrollees into standardized one-size-fits-all insurance plan offerings, picking from a limited number of cookie-cutter coverage choices. Worse, like the massive health care overhaul, Exchange details are undefined and untested. The only certainties are that costs will rise and choices will disappear.
If allowed to stand, this unpopular mandate will undoubtedly be widely reviled. It will prohibit participation in the private insurance market, result in higher premiums and less beneficial coverage options, eliminate or reduce employer-provided coverage for many, end negotiating opportunities for customized group policies and cost-effective coverage, and eradicate the tailored array of coverage configurations designed to best match the unique needs of employee groups.
As news of this pending protocol has spread, a large and diverse ad hoc coalition of local nonprofits, organizations, businesses and community business groups has formed to demand that elected officials reject the plan. D.C. Council action is scheduled for next month.
Although the Authority reversed its recommendation to also restrict groups of 51 to 100 to the Exchange, these larger groups will confront the same compulsory policy in 2016 under ACA rules. As a result, an additional 45,000 workers face an identical future coverage restriction.
The plan creates a perverse incentive for organizations with tight operating budgets and businesses with small operating margins to drop coverage, allowed by ACA for employers with up to 49 full-time employees.
The Authority maintains that the District’s small workforce necessitates compelling mandatory inclusion in this scheme to prevent Exchange costs from rising even higher than anticipated. Consumer advocates argue that other available solutions were not given adequate consideration by the board, including enlisting carrier participation and risk pooling both within and outside the Exchange or the creation of a regional Exchange.
Advocates recommend that the city move forward on a more moderate path evolving on a less frantic schedule and considering alternative Exchange frameworks. At a minimum, they want the city to advance sensibly while discovering what works most effectively with the least disruption – measuring real-world results, monitoring uncertain market consequences, evaluating employer and consumer hardship, responding to unintended and adverse effects, and better serving all stakeholders.
They point out that a well-informed Exchange structure modification is more realistic than reconstituting a small group insurance marketplace demolished by dictate.
Prospects for a commonsense course correction are uncertain. Following the Authority’s decision, At-Large D.C. Council member and Committee on Health chair David Catania enthusiastically endorsed the board plan.
If you oppose this controversial promise-breaking plan, the time to let the D.C. Council know is now.
Mark Lee is a local small business manager and long-time community business advocate. Reach him at OurBusinessMatters@gmail.com.