D.C. mandates health insurance market for businesses

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Photo - Patient getting blood pressure taken (Examiner file photo)
Patient getting blood pressure taken (Examiner file photo)
Local,DC,Liz Farmer
A board has required D.C. small businesses and individual buyers to purchase health insurance through the newly minted health exchange, and though it's unclear whether the regulations require D.C. Council approval to take effect, members said Thursday that they apply to any company that has an office in the District with 50 or fewer employees.

"If you have a business license here in the District of Columbia, then you participate through the exchange," said Dr. Mohammad Akhter, chairman of the D.C. Health Benefit Exchange board.

A spokeswoman later clarified that those companies did not have to be headquartered in D.C.

New regulations:
• The exchange is the sole health insurance marketplace for individuals and small businesses.
• Applies to small business with 1 to 50 employees.
• Health insurance plans meeting minimum requirements for qualified health plans, as well as any requirements created by the exchange authority, can be offered in the D.C. exchange.
• Small businesses and individuals merge into a single risk pool to make quality, affordable health coverage available to all.
• Opt into the federally administered risk adjustment and reinsurance programs for the exchange's market.

In addition, board members said they believed their vote of approval was enough to enact the new regulations -- even without all the details being finalized.

"I think we would still make sure we talk with [the D.C.] Council ... that makes sense," said board member William White. "If I need their approval for something, I will ask the council after I put together whatever legislative change we need."

The board, which oversees the city's health exchange mandated by federal health care reform, voted unanimously late Wednesday to approve regulations making the exchange the District's sole health insurance marketplace for individuals and businesses with 50 employees or less. Akhter estimated that would give the exchange at least 100,000 consumers, which is a pool large enough so that the exchange can negotiate competitive rates with insurers.

Those who represent the city's businesses have spoken out against the move, saying their members are worried they'll end up with a different insurer and higher rates. Employers can stick with their current health insurer if that provider opts into D.C.'s exchange, but they may see their rates increase by 2 to 3 percent, experts said.

DC Chamber of Commerce spokesman Max Farrow said not allowing either an off-market exchange or a regional market exchange "imposes severe difficulties for small businesses."

The chamber also disagrees that the exchange's vote does not require the city council to pass legislation.

"It is our goal to see D.C.'s success in keeping residents insured continue," Farrow said. "We are just not sure this is the way to do it."

But one thing is certain: No matter what the outcome of the presidential election in November, a repeal of the federal act would not change D.C. law. The District has already passed legislation establishing the health exchange and has received $73 million in federal funding to roll it out.

"We're going full speed ahead," Akhter said.

lfarmer@washingtonexaminer.com

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