Making a Case for the Individual Mandate in Washington, D.C.

George Washington University Professor Leighton Ku is a member of the executive board of Washington, D.C.’s Health Benefit Exchange Authority. As he explained in a recent blog, he chaired a working group of District residents and stakeholders in reviewing policies and recommending changes to District law.  After numerous public meetings, the working group recommended a policy to maintain health insurance incentives for D.C. residents.  This recommendation was endorsed by the full board, proposed by Mayor Muriel Bowser and adopted by the D.C. City Council on June 26 as part of the 2018 Budget Support Act.

However, as Ku explained in a blog in Health Affairs published today, on July 19, the U.S. House of Representatives approved amendments, as riders to an appropriations bill, to override D.C.’s new policy. “One of the complaints raised about the D.C. law was that it was ‘quietly passed’ and ‘buried in a budget bill,’” Ku wrote. “In fact, such a complaint could more accurately be applied to the last minute House amendments – sponsored by leaders of the House Freedom Caucus and the Republican Study Committee and approved on party line votes. Such maneuvering moved far more quickly and quietly than the lengthy, public and transparent process used to develop D.C.’s policy in the first place,” he said.

In both blogs, Ku explains that D.C.’s law essentially shifts the payment of the tax penalty to District coffers, rather than to the federal government. This preserves the incentive for District residents to retain health insurance. One important difference between the D.C. policy and its federal predecessor is that it clearly exempts low-income people in the Medicaid eligibility range from tax penalties. A second key difference is that it specifies that revenue gained from the penalty should be used to conduct education and outreach and to stabilize the insurance market.