Who Has Insurance and Who Does Not in the District of Columbia?

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Abstract

DC fares better than the nation as a whole in the share of its population that is uninsured. Lower rates of employer-sponsored coverage are more than offset by higher rates of public coverage. The District’s relatively generous Medicaid eligibility standards, and the DC HealthCare Alliance, a locally funded coverage program, contribute to the high share of publicly insured residents. Although all low-income individuals are eligible for either Medicaid or the Alliance, some 66,000 residents remain uninsured. These are among the findings of this data brief on insurance status in DC by age, employment, income, family status, and health status.

Introduction

Residents of the District of Columbia are more likely to have health insurance than the rest of the U.S. population. Most get their coverage at work, as do other Americans, but many have publicly financed coverage from Medicaid or DC Healthy Families. Uninsured low-income residents not eligible for these programs can enroll in the DC HealthCare Alliance, whose benefits resemble Medicaid’s and are more extensive than most employer-based coverage. A small share of residents have individual health insurance or coverage through federal programs, such as Tricare. Despite these options, some 66,000 D.C. residents remain uninsured.

Uninsured individuals get less medical care than they need. They often have lower health status and reduced ability to work, save, pay taxes, and contribute to community life. Thus, uninsurance affects not only the uninsured individual but also the larger community. The data presented below show how insurance status relates to age, family income, work status, and health status in the District of Columbia. Such data, though limited, can help policymakers identify who most needs help in obtaining coverage.

Who Has Insurance?

District residents are less likely to have employersponsored insurance than other Americans—56 versus 61 percent—but are more likely to have public coverage—23 versus 13 percent. The differences are even greater when D.C. is compared to it neighbors, Virginia and Maryland, where employer coverage is higher than the national average and public coverage is lower (exhibit 1). Employer-sponsored coverage is lower in the District despite the fact that District employers are more likely to offer coverage to employees than employers in the rest of the nation—in large part because nearly three-quarters of people who work in D.C. live elsewhere.

The lower rate of employer-sponsored coverage is more than made up for by the higher rates of public coverage. As a result, the percentage of residents who are uninsured is lower in D.C. than in the nation as a whole or in Virginia or Maryland. The District’s government bears a large share of the cost of insuring its residents, while in Maryland and Virginia, employers bear a larger share.

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Disclaimer: The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.