Washington, DC

(Washington, DC) – Today, Mayor Bowser sent a letter to House Majority Leader Kevin McCarthy urging caution as Congress considers a possible repeal of the Affordable Care Act, which has helped to expand healthcare coverage to more than 96 percent of District residents.

The Mayor's letter comes in response to a request from Leader McCarthy asking states to share their ideas for reforming the nation's healthcare system. Among the states with the lowest rate of uninsured residents, the District of Columbia ranks among the top three.

“Washington, DC has long been a leader in expanding access to critical health care services, and the Affordable Care Act has propelled the District to extend coverage to 96 percent of residents. ACA has also created more competition and driven down costs, and now many District residents and small businesses have affordable health coverage for the first time,” said Mayor Bowser. “The repeal of all or part of the Affordable Care Act would disrupt our insurance market, impair insurers, and increase costs to the District and consumers. The fiscal impact of the repeal could be as high as $623 million annually.”

See below for the full text of Mayor Bowser’s letter to House Majority Leader Kevin McCarthy.

Dear Majority Leader McCarthy:

The District of Columbia has been a leader in expanding access to affordable health care for our residents.  Because we leveraged the Affordable Care Act (ACA), more than 96% of District residents now have health coverage.  And, we rank among the top 3 states with the lowest uninsured rates in the country.  Since we opened DC Health Link, the District’s on-line health insurance marketplace, we have cut our uninsured rate in half.

Many District residents and small businesses have affordable health coverage for the first time:

1 in 4 people who signed up for private health insurance during the last open enrollment were uninsured prior to enrollment;

1 in 2 people eligible for Medicaid were previously uninsured; and,

4 in 10 small businesses did not offer health insurance to their employees prior to enrolling through DC Health Link.

Currently, there are approximately 19,000 people with private health insurance through the individual marketplace and more than 60,000 people through the small business marketplace.

Importantly, the District expanded Medicaid coverage immediately and as a result, 75,000 childless adults now have coverage.  Without federal support, such expansion would not have been possible.  While the cost for expanded coverage for childless adults is more than $468m, the local share of this cost is approximately $58m.  We estimate that by the end of FY2018, there will be 90,000 people at a total cost of more than $623m, with the local cost of approximately $60m.  Many of these persons have complex medical problems, would be considered high risk in the private market, and could not afford unsubsidized premiums.

DC Health Link provides consumer decision support tools to empower people to make informed decisions about their private health insurance options while providing transparent and easy-to-understand material with a simple and easy enrollment process.  Monthly premiums and health care coverage are made more affordable for District residents through federal tax credits and cost sharing reductions for deductibles, coinsurance, and copayments.

Small businesses have 151 different health plans from major insurers -- Aetna, CareFirst Blue Cross Blue Shield, Kaiser Permanente, and United companies.  There is strong competition in the small group marketplace with price competition among insurers competing for small business customers.   Small businesses now have the kind of purchasing power only traditionally available to large employers. And, a large majority of small businesses offer a choice of all products from an insurer or products from all insurers. This competition led to premium decreases for some products in 2017.

The repeal of all or part of the ACA would disrupt our insurance market, impair insurers, and increase costs to the District and consumers.

As Congressional leaders begin to investigate alternatives to the Affordable Care Act, the District of Columbia will be looking at whether:

·         Alternatives proposals provide at least the same affordable quality coverage people have today;

·         Coverage is secure and accessible;

·         The District is not placed at greater financial risk; and,

·         District residents maintain their coverage under any new scheme.

Expanding upon, not limiting or reducing, affordable health care coverage is a priority.

Sincerely,

Muriel Bowser

Mayor​