As Washington, D.C. went about creating its health insurance exchange to comply with President Obama’s national health care law, they had to deal with a unique problem. Given its relatively low population and already generous Medicaid program, officials determined there weren’t enough uninsured residents in the city to make a new exchange viable without more drastic action. So, they have taken the step of forcing all individuals, and businesses with between two and 50 employees, into the exchange. The idea is that by 2014, the Obamacare exchange will be the sole market to purchase health insurance in the District for individuals and small businesses whose plans aren’t “grandfathered in.” By conscripting these individuals and businesses, officials hope to meet the critical mass of participants they believe are needed to make the exchange viable (roughly, at least 100,000 people).
In a meeting with the Washington Examiner on Tuesday, members of the D.C. Health Benefits Exchange Authority tried to argue that their aim was to make the market function better.
“We are trying to find out the best way that we can implement this with the businesses so that there is minimum disruption in the marketplace as we implement this law,” the board’s chairman, Mohammad Akhter, said. “We looked at this not as a government venture, but as an independent venture…We want it to be ultimately self-sustainable to be able to do the work we need to do serving the small business community and uninsured people.”
Yet on top of taking the step of forcing individuals and small businesses into the exchanges, the board will be tasked, within the confines of Obamacare, with designing the health insurance policies that will be offered on those exchanges.
“We decided, generally speaking, to take a passive approach to insurance offerings in the regulatory sense, which means we’re not going to dictate detailed specifics for plan offerings,” vice chairman Henry Aaron insisted. Yet he added, “We do have a responsibility for deciding what is a qualifying health care plan. We have taken no decisions yet on that.”
Specifically, the board has not yet determined whether high-deducible health care plans with lower monthly premiums – plans that would make sense for younger and healthier beneficiaries – will be allowed in the District.
“We have not yet faced the question of what, if any, restrictions would limit the offering of a high-deductible plan within the exchange,” Aaron said. “I cannot answer that because I don’t know where we’re going on that. We haven’t received the staff work, we haven’t even begun to discuss it within the insurance working committee, and it hasn’t gone to the full board.”