If I Lived in Washington, DC and Needed Health Care, I’d be Awfully Worried Right Now

As you settle in with friends and family to give thanks for another year, add one more thing to your list. Be thankful you don’t live in Washington, DC, where the city government is about to dragoon every healthy body and business it can grab into its shiny new Obamacare exchange.

As Washington, D.C. went about creating its health insurance exchange to comply with President Obama’s national health care law, they had to deal with a unique problem. Given its relatively low population and already generous Medicaid program, officials determined there weren’t enough uninsured residents in the city to make a new exchange viable without more drastic action. So, they have taken the step of forcing all individuals, and businesses with between two and 50 employees, into the exchange. The idea is that by 2014, the Obamacare exchange will be the sole market to purchase health insurance in the District for individuals and small businesses whose plans aren’t “grandfathered in.” By conscripting these individuals and businesses, officials hope to meet the critical mass of participants they believe are needed to make the exchange viable (roughly, at least 100,000 people).

You’d expect those on the health exchange board would have worked out as many of the angles as they could before conscripting the entire city into the service of the bureaucracy. That’s what I would have done. Surely an operation with so many moving parts, with such potential for disaster around every corner, requires a careful approach and as many details tacked down as possible.

Then again, I don’t work for the DC health exchange board.

“We have not yet faced the question of what, if any, restrictions would limit the offering of a high-deductible plan within the exchange,” [vice chairman Henry] Aaron said. “I cannot answer that because I don’t know where we’re going on that. We haven’t received the staff work, we haven’t even begun to discuss it within the insurance working committee, and it hasn’t gone to the full board.”

Aaron conceded that younger residents and some small businesses could be subjected to higher premiums as a result of the law.

“I have always said when looking at this bill, that if I were a young person, I can see elements of this bill that I wouldn’t like in the short run,” Aaron said.

He also said that, “some companies are going to face higher premiums…If I employ a bunch of 25 year-old programmers and I’m in a large pool that includes a large company that hires a bunch of 55 year-old plumbers as well, then things are going to average out in that pool and there will be shifts in premiums and some companies will pay higher premiums as long as they’re not grandfathered.”

In other words, even though they don’t know what plans they will allow, what companies will participate, nor how much it will eventually cost city residents and businesses (though the short answer is “more”), they’re still going forward with the exchange.

Hmmm. “Forward”. Where have I heard that before? Never mind. I’m sure it’ll come to me.

All kidding aside, the DC health exchange already looks like a disaster in the making. The President and his Democratic allies set a number of unreasonable deadlines that won’t give health exchange boards ample time to figure out how to do what they need to do under the law.

[Chairman Mohammed] Akhter said that D.C. has met every federal deadline and expects to continue doing so, but conceded that the time pressures have made it difficult for them to fully explore all possible methods of complying with the law. Exchanges will have to be ready to accept enrollees by next October.

“If you look at the whole implementation of the Affordable Care Act, the time pressure is brutal frankly,” Akhter said. “Things have to be done so fast and quick that there is not enough time to go through the whole litany of things that one could.”

He later added, “There’s no doubt that if there was better timing this thing could have been done better. There would have been a lot more consultation, a lot more discussion, a lot more debate. But the reality is this is the way the timing is presented. So, we have to run with what the deadlines are to meet the deadlines.”

I don’t feel much sympathy for Akhter and the rest of his board members. The city can refuse to set up the exchange and force the federal government to handle all the heavy lifting, as Governors of at least 15 states have already done. There are options to rushing through a plan Akhter himself isn’t sure will work at all. I’d say the city owes its residents more than a shrug and a hastily-mumbled prayer before they take control of their health care choices. Don’t you?

(The graphic at the top of the post comes from a PricewaterhouseCoopers site, which has a couple more useful graphics, including a timeline for Obamacare implementation)