Insurance and Uninsurance in the District of Columbia

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Preface

The District of Columbia is the urban center of the Washington Metropolitan Statistical Area (MS). The city is bordered by Arlington County and the City of Alexandria in northern Virginia, and by Montgomery and Prince George's Counties in Maryland. In 2000, census data reported that the District had 572,059 residents, representing broad cultural and ethnic diversity. Females represented 52.9 percent while males represented 47.1 percent of the total population.

The Department of Health's mission is to promote healthy lives, prevent illness, provide equal access to quality healthcare services, and protect the safety of all in the nation's capital. primary motivation for the Department of Health's efforts to improve access to quality healthcare services is to improve health outcomes. One of the most effective ways to improve people's health status is to make sure they have health insurance coverage. Numerous studies suggest that provision of coverage for individuals improves access to health care services and ultimately leads to improvement in health outcomes.

While the uninsurance rate in the District is lower than average for a state, and substantially lower than comparable metropolitan areas, there still remain residents who are uncovered, even among workers, particularly those with relatively low wages or in small firms. According to the most recent Current Population Survey data (2003-2004), 13.8 percent of the total population in the District is uninsured, compared with 15.7 percent in the nation as a whole.¹ If Alliance members are excluded from the uninsured, the District's rate would fall by some four percentage points.² Approximately 17 percent of non-elderly adults and approximately 10.4 percent of children are uninsured. Above age 65, almost 100 percent are covered by Medicare.

The District of Columbia Department of Health (DOH) received a grant from the U.S. Department of Health and Human Services (DHHS) to identify policy options for providing health care coverage to the uninsured population of the District of Columbia. In collaboration with the Urban Institute, sub-grantee, and an Advisory Panel, which consists of members of the community, health care professionals, and academicians, the DOH is working to formulate a plan to move toward full access to coverage, with an overall goal of improving health outcomes for residents of the District of Columbia.

Providing access to good health insurance coverage for all citizens is important not only to the health and wellbeing of the population but also to the attractiveness of the District of Columbia as a place to live and do business. Mayor Anthony Williams has shown strong commitment to improving such access. District Medicaid and the State Children's Health Insurance Program rank among the nation's highest in shares of population covered; and Mayor Williams also developed a locally funded public-private collaboration, popularly known as the Health Care Alliance, that runs a pioneering managed-care program for otherwise uninsured residents with incomes up to 200 percent of the federal poverty level. Additionally, the DC Insurance Commissioner has recently drafted a plan to create insurance access for all in a new program modeled on the Federal Employee Health Benefits Program. Legislative leaders in the Council of the District of Columbia are also exploring ways to expand coverage.

In order to design successful insurance expansion initiatives, information on how many people fall into the different subgroups of the uninsured, and which of the different reform options for private or public coverage would be most accessible or attractive to them is vital. Toward that end, this document describes the uninsured in the District of Columbia and the factors influencing insurance coverage in the city. The focus is on working-age adults since these individuals make up about 85 percent of the uninsured population in the District.

Policy, Planning, and Research Administration
Department of Health, District of Columbia
September 2005

Notes from this section of the report

1. DeNavas-Walt, Carmen, Bernadette D. Proctor, and Cheryl Hill Lee, U.S. Census Bureau, Current Population Reports, P60-229, Income, Poverty, and Health Insurance Coverage in the United States: 2004, U.S. Government Printing Office, Washington, DC, 2005. N.B. More detailed breakdowns of these data, released in August 2005, are not available. Therefore, CPS data in the remainder of this report will use 2002-2003 data.

2. DC Health Care Access Survey, 2003, Kaiser Family Foundation.

Note: This report is available in its entirety in the Portable Document Format (PDF).

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