Plans for D.C. health insurance marketplace move forward

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The District of Columbia will forge ahead with plans to build a virtual marketplace where the uninsured and small businesses can compare health insurance providers, even if Republican nominee Mitt Romney wins the White House and President Obama’s signature health care law is repealed, city officials said Thursday.

While many states decide whether to set up a state-run health exchange or let the federal government run it for them under the Affordable Care Act, the District has been viewed as a leader among jurisdictions that bought into the federal law from the start. Legislation from the D.C. Council and a $73 million federal grant to set up the exchange’s infrastructure puts the city in a position to move ahead with its plans, no matter what happens on Capitol Hill, according to Dr. Mohammad N. Akhter, chairman of the Health Benefit Exchange board.

“We have the authority from the city council, and we have the resources that have been allocated to us, so we are going to go full speed ahead,” Dr. Akhter said Thursday in a conference call with reporters.

Plus, as board member Kevin Lucia noted, “states have always had the authority to set up exchanges.”

Officials made the assertion one day after the city’s health exchange board approved major decisions about how the marketplace will be structured.

Most importantly, the board said the exchange will be the sole health insurance marketplace for individuals and small businesses — defined as companies with fewer than 50 employees — so the entity can be sustained in “this unusually small market.” The District’s population of about 618,000 makes it smaller than every state except Wyoming.

Under the settled-upon structure, the exchange should have more than 100,000 customers, which officials have pointed to as a key threshold for a thriving exchange.

D.C. Council member David Catania, at-large independent, praised the merger of the individual and small-business markets as “an inspired and correct approach.”

“By merging the two markets, the exchange will have sufficient volume and power of aggregation, which will decrease insurance costs for individuals,” said Mr. Catania, chairman of the council’s Committee on Health.

Yet a coalition of small businesses pushed back against the move during Wednesday night’s meeting, according to reports in the Washington Business Journal and The Washington Post. In a letter to Dr. Akhter in September, they said by “dismantling and recasting the separate health insurance marketplaces that serve small employer groups and individuals in the District, D.C. policymakers would take away the option of keeping the health plan that they now have.”

“Rather, to continue to offer health benefits to employees after 2013, small employers like us would have no choice but to go to an undefined, untested, more expensive entity to obtain coverage,” the letter said.

The board did provide the coalition some relief by defining a small business as one with up to 50 employees, instead of 100. Mr. Lucia told reporters Thursday the 50-employee definition will give the city two years to examine the structure of the exchange and the needs of the business community before federal law mandates the 100-employee definition of a small business in 2016.

Each state’s exchange will go into effect at the start of 2014, but it must be operation-ready by October 2013. Dr. Akhter said the federal government will inspect the District’s plans next month “and give us a conditional certification that says we are capable of running the exchange by October 2013.”

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