D.C. Officials Dispute Study on Health Overhaul

A study that shows medical claims costs will increase by more than 50 percent for District of Columbia residents under the federal health care overhaul is inaccurate in part because it dramatically overstates the number of city residents who lack insurance, District officials said Tuesday.

The study released by the Society of Actuaries to its members said that, nationwide, claims costs will jump an average of 32 percent for individual policyholders. In the District, the increase would be even higher, at nearly 52 percent, the ninth-highest jump of any state, the study says.

The study says 12.3 percent of District residents are uninsured. But city officials say just 42,000 residents are uninsured, or 6.2 percent, which is one of the lowest rates in the nation. The city derived those figures from Census data and a 2009 survey by the Urban Institute.

Mila Kofman, executive director of the D.C. Health Benefits Exchange Authority, said it was difficult to predict exactly how claims costs would be affected in the district once individuals are required to purchase insurance but she said the district would likely fare better than most states because of its small and relatively healthy uninsured population.

“Based on the best available data, we think we're going to have a very good experience, and it's just going to be very different from the other states,” Kofman said Tuesday. The figures in the SOA study, she said, “are actually not very meaningful in terms of what to expect in 2014.”

A spokeswoman for the Society of Actuaries said in a statement that its uninsured numbers were higher because it included people who didn't have coverage for only part of a year. Even then, there was a discrepancy, with the city reporting that 10 percent of residents were uninsured at some point over a 12-month period.

One reason the District has a low uninsured population is that it already provides Medicaid coverage for individuals and families earning up to double the federal poverty level -- about 220,000 people, or more than a third of the city's population. Because of this expanded safety net, the city's uninsured population includes a high percentage of young, healthy people, officials said. Forty-three percent of uninsured district residents have a college degree.

“Our uninsured population is very different from the rest of the nation,” Kofman said. “I don't think there will be this pent-up demand for medical care in the first year that other states are going to see.”

Many other states are expanding Medicaid coverage under the health overhaul, but because the District has already surpassed the threshold mandated by the law, there are no plans for further expansion.

The SOA said it did not take the district's expanded Medicaid coverage into account; instead, “the researchers assumed that states will in the long run take action to move those over 133 percent to the individual market,” Kristi Bohn, an SOA fellow, said in a statement. The District has no plans to take such action.

The city has moved aggressively to establish a health insurance exchange that will give those uninsured residents the ability to buy private insurance similar to what employees of large companies get -- a key component of the health overhaul that some states are asking the federal government to do for them. Officials anticipate being ready for enrollment in October.