The D.C. government submitted a detailed proposal to the federal government on Wednesday outlining its vision for a consumer-friendly marketplace of insurance plans as part of President Obama's health care law, a controversial package of reforms that the District embraced from the start while other states wait for its legal and political narrative to play out.
The lengthy document offers a window into efforts the District has taken to set up its health-benefit exchange since Mayor Vincent C. Gray set up an implementation committee in early 2011, well before the U.S. Supreme Court weighed in on the most controversial components of Mr. Obama's signature health care law in June.
The federal law directs states to set up health-benefit exchanges to help the uninsured, self-insured and small-business owners shop for the most cost-effective insurance coverage.
City officials had to submit their proposal to the U.S. Department of Health and Human Services to obtain an estimated $70 million to $80 million in federal grants to hire staff and upgrade information technology for the exchange before the national law goes into effect in January 2014.
The building of the exchange is the "most daunting" aspect of making universal health care in the District a reality, said Wayne Turnage, director of the D.C. Department of Healthcare Finance. The rollout includes the creation of a large-scale Web portal and the hiring of staff for a new quasi-governmental entity known as the D.C. Health Benefit Exchange Authority.
"Without a properly designed and ultimately successful grant proposal, it would be nearly impossible for the District to move smartly forward under health reform," Mr. Turnage said.
The District enlisted Mercer Government Human Services Consulting to examine the city's insurance market so it could "understand the potential enrollment, costs, and market effects of a District-run exchange." The 55-page project narrative details that study, from performing community outreach among the city's wards to considering staffing levels required of the authority charged with setting up and maintaining the exchange. Mercer's analysis confirmed the District's unique features, including a low population (roughly 610,000 residents) compared to the states; a relatively small number of uninsured residents (about 42,000, or 7 percent); and a large segment -- 30 percent -- of residents who use Medicaid and other public benefits.
Based on Mercer's models, enrollment in the D.C. exchange could be as high as 187,000.
The city also hired Accenture to help determine information-technology needs to implement the exchange and keep it running in the long term. Officials have said the exchange will primarily be Web-based, but offer services by phone and other means.
A Web portal will be an integral part of the exchange. According to the proposal, city officials want the portal to be easy to use, though ensuring its security and capability will be an intricate undertaking.
"The District recognizes the complexity of purchasing health insurance, especially for those who will be first-time purchasers," the proposal said.
The District's proposal also details the exchange's governing structure, including an executive board of seven voting members and four ex-officio members -- the latter consisting of directors of the city departments of Health, Health Care Finance, and Human Services, along with the Commissioner of the Department of Insurance, Securities and Banking.
Dr. Mohammad Akhter, who took a year of leave from his job as director of the D.C. Department of Health to work on the health care reforms, has been selected as chairman of the board.
To avoid conflicts of interest, members of the board "must not be professionally connected to a health carrier or other insurer, an agent or broker, a health professional, a trade association of health carriers, or a health care facility or health clinic while serving."
Members are not compensated for their services and standard prohibitions against the acceptance of bribes or gifts will apply. Members who served on the board or worked for the authority must wait for at least one year before working for a health carrier that does business with the exchange.
State health care policy has been in the national spotlight since the Patient Protection and Affordable Care Act became law in early 2010. Some jurisdictions, such as the District and Maryland, started working on reforms almost immediately. Others, like Virginia, took a wait-and-see approach in light of the political controversy surrounding the reforms and the potential for its repeal if Republicans can take the White House and a majority in Congress this November.
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