RWJF Report on Lessons for Employers’ Use of Exchanges

The Robert Wood Johnson Foundation (RWJF) has released a report titled, "Employer’s Use of Health Insurance Exchanges: Lessons from Massachusetts." The report contains both data and personal interviews – including interviews with brokers — leading to a series of factors states may adopt to encourage employer participation in exchanges.

http://www.hcfo.org/files/hcfo/HCFO%20Report%20Hall%202012.pdf

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Health plan takeover in D.C. eases concerns but doesn’t erase them

Health plan takeover in D.C. eases concerns but doesn’t erase them

By Mike DeBonis, Published: October 22

The District government’s takeover of its largest health contractor has eased concerns among care providers, but anxieties remain about the effects on the city’s half-billion-dollar system of providing health care to the needy.

Insurance regulators seized control of Chartered Health Plan on Friday, weeks after firm representatives notified city officials of serious “irregularities” in the company’s accounting. The company, owned by embattled businessman Jeffrey E. Thompson, manages the care of about 110,000 city residents eligible for federal Medicaid benefits and a local insurance program.

The move will allow Chartered to continue operating through April, when its contract is set to expire, easing concerns that a more rapid withdrawal would have thrown patients and providers into chaos.

“It would have totally destabilized the system,” said Vincent A. Keane, chief executive of Unity Health Care, which runs a network of 29 clinics for low-income residents and is one of Chartered’s largest providers. “Any time patients change, there can be bureaucratic problems. My hope is that it stays intact without any destabilization until the spring.”

The city’s top insurance and health-care finance officials have sought to assure doctors, clinics and hospitals that their bills will continue to be paid as a receiver takes over the company’s management and auditors work to straighten out the books.

Thompson, who is under investigation over allegations of campaign finance violations but has not been charged with a crime, may no longer exercise any control over the company he bought in 2000 at a bankruptcy sale and grew into the city’s largest contractor. A. Scott Bolden, an attorney for Chartered, said Friday that the mutual decision to enter receivership was “in the best interests of the company.”

The receiver, Kansas lawyer Daniel L. Watkins, will oversee efforts to rehabilitate and perhaps sell the company — a scenario complicated by the accounting issues, said to involve millions of dollars of missing funds, and the firm’s tenuous hold on its city contract, virtually its only source of business. Chartered could also be implicated in the Thompson criminal investigation; federal investigators earlier this year examined District records on the firm’s dealings, according to a city official who spoke on the condition of anonymity because of the ongoing investigation.

But Chartered has a significant asset in its familiar name and vast customer base, accounting for about two-thirds of all residents enrolled in government health-care programs.

Sharon Baskerville, executive director of the D.C. Primary Care Association, said the Chartered brand could be desirable to an outside managed-care firm looking to enter the D.C. market.

“This is not an easy town to break into,” she said, adding that the brand, in her view, has not been tarnished by its association with Thompson’s alleged campaign dealings: “People in the community . . . don’t know or care who Jeff Thompson is; they just know that when they go get their health care, it’s there.”

But David A. Catania, chairman of the D.C. Council’s health committee, said he did not expect Chartered to survive the government takeover as a city contractor. “This receivership is the epitaph for Chartered,” he said. “The time Chartered may have had to find a purchaser, that time has passed.”

Catania (I-At Large) said he thinks a new solicitation, expected to be issued by month’s end, will attract “larger, more established, better capitalized organizations” than Chartered, whose only client was the District.

Even though Chartered is the dominant player in the District’s Medicaid market, it has struggled to make money in recent years, fighting the city over what it says are subpar premiums. The firm has sued the city for $25 million alleging unfair rates; the takeover probably means the end of that suit.

The city contracts with two other health-care managers, subsidiaries of the MedStar and UnitedHealthcare companies. Had Chartered’s contract been abruptly canceled, as city officials had threatened last week, its members would have been divvied among them. The takeover will allow more time to notify residents about the potential changes and manage the transition to a new system.

Keane lamented that the new players might not have the deep community ties Chartered established over two decades.

“There’s a loss in not having a homegrown HMO,” he said. “To me, that’s a value, being in touch with the local community, with the providers, and making sure that that sensitivity to the unique needs of a very underserved population is attended to.”

Catania is holding a hearing on the takeover Thursday, when he is expected to press city officials for additional details on the receivership arrangement.

The Mayor Gray Report — October 23, 2012

THE MAYOR GRAY REPORT

October 23, 2012

District Unemployment Rate Drops For the Seventh Straight Month

Mayor Gray welcomed news that the District of Columbia’s unemployment rate continued to steadily decline, as preliminary September job estimates show a decrease of 0.1 percent to 8.7 percent. The number of unemployed District residents dropped by 300 from 31,200 in August to 30,900 in September. September’s numbers mark seven straight months of unemployment decline in the District. Since Mayor Gray took office in January 2011, the District economy has created over 23,300 jobs. September job estimates show an increase of 7,600 jobs for a total of 736,000 jobs in the District.

“The first strategy of my One City Action Plan is to grow and diversify the District’s economy to create jobs and today’s numbers show that we’re on the right track. The continued drop in employment is further evidence that the economy is continuing to heal from the worst economic downturn since the Great Depression,” noted Mayor Gray. “I welcome the drop to 8.7 percent, but we must continue to push to lower unemployment in all wards of the city.

From the Washington Post: ‘DC Had the Nation’s Third-Highest Job Growth in September’

“Only Texas and Pennsylvania added more than the 14,200 jobs D.C. added, according to seasonally adjusted numbers. The District had by far the largest over-the-month job growth by percentage (2 percent), ahead of Maine (0.9 percent). The growth, according to Labor Department statistics, was mainly driven by 11,700 additional government employees.

But according to unadjusted numbers released by the D.C. Department of Employment Services, the city added 7,600 jobs in September, all but 200 of them in the private sector. Education jobs — particularly in “colleges, universities, and professional schools” — were by far the largest driver, adding 6,900 jobs for the month. That would suggest a seasonal bounce as higher-ed students come back to classes; the seasonally adjusted numbers show only 2,800 new jobs in the education and health sectors.” Read more.

Mayor Gray Announces Reforms to District’s Certified Business Enterprise (CBE) Program

Mayor Gray and Department of Small and Local Business Development (DSLBD) Director Harold B. Pettigrew announced comprehensive program, regulatory and legislative reforms to strengthen the District’s Certified Business Enterprise (CBE) program and support DC’s small businesses. The announcement follows Mayor Gray’s request for a comprehensive review of the CBE program and recommendations for its reform.

“Building resilient, diversified small and local businesses is a critical part of my strategy for developing a new economy in the District of Columbia,” said Mayor Gray. “The CBE program supports the businesses that anchor our communities and create jobs for District residents. By addressing its shortcomings now, this administration is strengthening those businesses and ensuring that they can continue to grow and create jobs for District residents.” Read more.

Mayor Gray, District Officials and Civic Leaders Open New Rosedale Library

Mayor Gray, Ward 6 Councilmember Tommy Wells and DC Chief Librarian Ginnie Cooper joined Ward 6 community members for the grand opening of the new Rosedale Library. Located at 1701 Gales Street NE, Rosedale increases the number of libraries in the District to 26.

The state-of-the-art, 5,000-square-foot library features separate spaces for adults, teens and children, 15,000 new books, DVDs and other library materials, 22 computers (including four Macs for teens and four PCs for children), an early literacy station for young children and comfortable lounge seating.

“Across our city, I’ve been talking about how important it is for our children to receive a great education and for adults to be able to get quality training in growing job fields,” said Mayor Gray. “Libraries help make this happen, and in this new building, the things that make our city’s libraries great will all be available to the Rosedale community.” Read more.

Mayor Gray Kicks Off District’s Largest Tree Planting Season

Mayor Gray and the District Department of Transportation (DDOT) officially kicked off the District’s tree planting season by planting a tree on Edmunds Street, NW near the Naval Observatory. This year’s campaign will be the largest single planting effort DDOT’s Urban Forestry Administration (UFA) has ever undertaken.

“This is an investment that will help grow a more sustainable DC,” said Mayor Gray. “Trees are so important to our quality of life and future generations will reap the benefits of the work we’re doing to expand the District’s canopy.” Read more.

Top Federal, District and Maryland Leaders Unveil the Design for the Anacostia Riverwalk Trail’s Final Link to Maryland

Following up on a commitment made last fall to deliver this key trail project, officials from the District of Columbia, Maryland and key U.S. federal agencies, including the Department of the Interior and the Department of Transportation, gathered at River Terrace Park along the Anacostia Riverwalk Trail to unveil the design of the final trail link, which will connect the District of Columbia and Maryland. This four-mile trail project, known as the Kenilworth Aquatic Gardens segment, will be advertised by the end of the year with construction to begin next spring.

“This latest segment of the Anacostia Riverwalk Trail is an important part of the Anacostia Waterfront Initiative’s efforts to create a healthy, green, equitable and prosperous city – goals that go hand-in-hand with my Sustainable DC plan,” said DC Mayor Gray. “I’m excited today to unveil the trail’s unique design, which will give the public a window into the host of benefits this new regional trail link will provide to our neighbors in Maryland as well. We look forward to continued collaboration with our regional and federal partners as we move forward with construction and press ahead with our efforts to create a world-class Anacostia Riverfront in our city.” Read more.

Mayor Gray Announces DC Streetcar Financing and Governance Task Force

Mayor Gray announced he has established a Streetcar Financing and Governance Task Force to advise him on potential sources of funding and forms of governance for the District of Columbia’s emerging streetcar system.

“The District has the most ambitious streetcar plan in the nation. We are the only city talking about putting down 37 miles of tracks,” said Mayor Gray. “I want to make sure we have the best minds inside and outside the government working on the important issues of financing and governance to ensure the system has a firm foundation.”

The 14 member Task Force will be chaired by City Administrator Allen Y. Lew and will include 6 public members, appointed by the Mayor, with expertise in transportation systems design or engineering, public-private development partnerships, project financing and/or economic development. Read more.

Mayor Gray Congratulates Deputy Mayor for Education De’Shawn Wright on New Position

Mayor Gray congratulated Deputy Mayor for Education De’Shawn Wright on his appointment to the top education post in the nation’s third most-populous state. New York Gov. Andrew Cuomo (D) announced that he was naming Wright Deputy Secretary for Education, the Empire State’s highest education official.

Jennifer Leonard, Wright’s Chief of Staff, will transition to serving as Interim Deputy Mayor for Education in November, and serve in that capacity through the Fiscal Year 2014 budget season.

“De’Shawn is a brilliant educational innovator and a tireless public servant, and our loss is definitely New York’s gain,” Mayor Gray said. “He has done a spectacular job serving the children, families and educators of the District of Columbia, and we will miss his extraordinary gifts sorely. I congratulate Gov. Cuomo on a wise choice for his state. I’m also thankful that Jennifer has agreed to step-in in the interim and provide a seamless transition as we continue to move forward with ensuring that every child in the District of Columbia has access to a top-quality education.” Read more.

Mayor Gray Announces Largest Playground Renovation Project in DC History; 32 Playgrounds to be Renovated in Fiscal Year 2013

Mayor Gray, DC Department of Parks and Recreation (DPR) Director Jesús Aguirre and Department of General Services (DGS) Director Brian Hanlon announced that the District government would be undertaking the largest playground renovation project in its history. The announcement was made at Benning Park Recreation Center, one of the sites scheduled to be renovated under the expanded and accelerated Playground Improvement Project.

“Improving every resident’s quality of life is one of the main goals of my One City Action Plan, and every child in the District should have a safe and inviting place to play,” said Mayor Gray. “Renovating these playgrounds is an investment in the well-being of our children that will pay dividends for years to come.” Read more.

Mayor Gray Unveils Plans for St. Elizabeths East Gateway Pavilion

Mayor Gray announced the design-and-construction team and unveiled plans for the new St. Elizabeths East Gateway Pavilion. KADCON, Davis Brody Bond, and Robert Silman Associates – a collaboration of firms whose individual portfolios include such internationally renowned landmarks as the National September 11th Memorial and Museum, the reconstruction of Eastern Market and the forthcoming National Museum of African American History and Culture – were awarded the contract by the District Department of General Services (DGS) on behalf of the Office of the Deputy Mayor for Planning and Economic Development.

“We now have a seminal opportunity to activate the site for commercial activity prior to the St. Elizabeths East project’s Phase I completion in 2015,” Mayor Gray said. “The design excellence and architectural and construction prowess that the winning firms will bring to the Gateway Pavilion are what the District’s proposal for interim use here demanded, and we look forward to its construction and use by local and regional consumers.” Read more.

Mayor Gray Breaks Ground on Renovation of Engine Company 28 Fire Station

Mayor Gray, Deputy Mayor for Public Safety and Justice Paul Quander, Jr., Fire and Emergency Medical Services Department (FEMS) Chief Kenneth B. Ellerbe, and Department of General Services (DGS) Director Brian J. Hanlon officially broke ground on the construction project to renovate Engine Company 28’s fire station.

FEMS is currently implementing a capital modernization program that includes replacing the deteriorated HVAC, structural and electrical components, and architectural features at several fire stations. The $4.7 million renovation of Engine Company 28’s fire station includes widening its doors to provide firefighters/paramedics with safer working conditions while also maintaining the station’s historic features. Read more.

From the Hill Rag – ‘Making Obamacare Happen in DC: Key Steps Ahead’

“Health care reform is not a new thing for the District. For more than a decade, our city has been in the forefront of innovative health care policies. The city provides health insurance to a broad range of families with children, and it created the DC Healthcare Alliance to offer locally funded health care coverage for our low-income neighbors who don’t qualify for programs such as Medicaid.

Now DC officials are using the same proactive approach to tackle national health reform – the Affordable Care Act or “Obamacare.” Full implementation begins in 2014, but the District is facing a few big decisions this fall that will determine how health reform will play out here.

Compared to many other states, the District starts in a strong place. DC has a low rate of uninsured residents and a high proportion of employers providing health benefits, due to the large presence of the federal and local governments. But these statistics don’t tell how well insurance plans are actually meeting the needs of residents or of small businesses trying to provide benefits for employees. For many, full and affordable access to essential services does not easily happen even if they have health coverage.

The District is weighing three major pieces of federal health reform: the “health insurance exchange, which is the regulated market individuals and small businesses will use to shop for insurance; the package of what will be considered “essential health care benefits,” the minimum floor of services that plans must offer in the market; and the way in which low-income residents can access coverage.” Read more.

Michael Brown says he’s not a target of campaign probe

Michael Brown says he’s not a target of campaign probe

By Mike DeBonis, Washington Post, Updated: October 9, 2012

D.C. Council member Michael A. Brown, facing a tough re-election fight, issued a statement Tuesday seeking to quiet some unanswered questions about the biggest issue with his campaign — the nearly $114,000 that went missing from it in what Brown alleges was a theft.

Police Chief Cathy L. Lanier said on WTOP last week that the matter was still under investigation more than three months after Brown first leveled the fraud allegations, accusing former campaign treasurer Hakim Sutton.

“Until we have substantial information to support that, there’s not going to be charges brought,” Lanier said.

So what’s the deal, then? In the statement, Brown’s campaign attorney tries to reassure those who might be willing to credit the suggestion made by Sutton’s lawyer that Brown had knowledge of the missing money.

“The United States Attorney’s office confirmed that Michael Brown is not a target of the investigation,” said attorney Jeanett P. Henry, reiterating that Brown “had no involvement in the stolen funds” and is “cooperating with the authorities and wants the suspect to be brought to justice for his criminal acts.”

Note that the U.S. attorney’s office might be confirming things to the Brown campaign, but they are not confirming anything to The Washington Post. “The has no comment on the statement,” spokesman William Miller wrote me in an e-mail.

Note that “target” is a term of art in federal investigations. Per Title 9 of the Department of Justice’s official manual for U.S. attorneys, if a grand jury or prosecutor has “substantial evidence linking him or her to the commission of a crime and who, in the judgment of the prosecutor, is a putative defendant,” you’re a target. If they don’t, you’re not a target.

In other Brown campaign news, he was one of two D.C. Council incumbents who did not win an endorsement Tuesday from the D.C. Chamber of Commerce‘s political action committee. (Marion Barry, running unopposed, is the other.)

While Brown has tried to maintain good relations with business interests, he has sought to playing a leading role in advocating for social service spending and union-backed interests. Brown broke with the business groups early on after he introduced a bill that would mandate union labor at a huge swatch of city construction projects. He later supported strengthening less onerous “First Source” laws requiring the hiring of D.C. residents on those projects — again, not a position Chamber of Commerce types smile upon.

Brown addressed the endorsement snub in a tweet to the Washington Business Journal’s Michael Neibauer: “[W]ith my record of support 4 working class families, it comes as no surprise that I didn’t get it.”

Problems lingered at D.C. tax office for years after 2007 scandal, audits show

Problems lingered at D.C. tax office for years after 2007 scandal, audits show

By Debbie Cenziper, Washington Post, Published: October 8

The mail was strewn in 15 postal tubs in a storage room at the District’s tax office. Some of the postmarks were months old, but the envelopes had never been opened.

Investigators found the stash in December 2010, and two cashiers were immediately dispatched to open, sort and count the payments, found in the Recorder of Deeds unit at the tax office. The probe revealed unprocessed payments from D.C. taxpayers worth $2 million, along with real estate documents required to complete property transactions.

That account comes from one of about a dozen internal audits and reports citing significant security lapses in the District’s Office of Tax and Revenue in the five years since a mid-level manager was caught embezzling tens of millions of dollars and the city vowed sweeping reforms, The Washington Post found.

(Related: D.C. tax office was warned more than once about database security )

Chief Financial Officer Natwar M. Gandhi, who oversees the tax office, has drawn praise for turning a city once on the verge of bankruptcy into a Wall Street winner, with high bond ratings and balanced budgets. In July, Gandhi was appointed to his third term as the $199,700-a-year independent financial overseer for the District.

But problems linger just below the surface, according to reports obtained by The Post that have not come to public attention. Time and again, auditors have warned Gandhi about weak controls and oversight in the tax office — which handles $6 billion in annual revenue — including insufficient tracking of payments, “dummy accounts” with fictitious Social Security numbers and lax supervision of adjustments to taxpayer accounts. The reports describe a tax operation that has “inadequate controls” and a lack of “management oversight,” and that is “vulnerable to undetected errors, manipulation and fraud.”

Gandhi’s agency did not respond to repeated requests for comment about most of the reports and audits reviewed by The Post. But in a previous interview, Gandhi and his senior managers said they have made major improvements to accountability since manager Harriette Walters was caught in 2007 stealing $48 million through phony property tax refunds — the largest embezzlement in city history.

“We reinforced, strengthened to the utmost degree, all the controls and processes to make sure that something like that is most unlikely to happen again,” Gandhi said.

The audits and reports were written by Gandhi’s internal affairs unit, run for the past two years by William J. DiVello, a former assistant inspector general in the city. Last week, DiVello abruptly resigned, telling The Post that Gandhi and his senior managers were pushing to leave audits in draft format. Gandhi’s office has taken the position that draft reports are exempt from disclosure under public records laws.

The Post obtained one draft report, produced by internal auditors in March but not made public until The Post published a story in August, that described a “significantly flawed” system for tracking property assessments that allowed tax office supervisors to access property records and alter them without being detected.

DiVello said he quit on the spot last week when senior managers said in a meeting that they would not release to the D.C. Council a revised version of the audit — which includes additional findings and recommendations — in advance of an oversight hearing on the tax office on Wednesday.

“I prayed that they would see the light,” DiVello told The Post on Friday. “Just sign the report, clear the air.”

He said five or six additional reports about various aspects of Gandhi’s agency, including the tax office, are still lingering in draft.

Gandhi’s spokesman, David Umansky, said Friday that the revised report was not yet complete. Late Friday, after The Post raised questions, the agency delivered the revised report to members of the council. Umansky said the agency does not keep reports in draft form to prevent public disclosure.

The Post was able to independently obtain the draft report about the tax office. About a dozen finalized reports were provided by Gandhi’s agency after a public records request. Finalized reports are not publicly circulated because the agency fears that the findings would provide a road map for employees with nefarious intentions, Umansky said.

Head of internal affairs for D.C. Office of the Chief Financial Officer resigns

Head of internal affairs for D.C. Office of the Chief Financial Officer resigns

By Nikita Stewart and Debbie Cenziper, Washington Post, Published: October 4

The head of internal affairs for the Office of the Chief Financial Officer abruptly resigned Thursday, less than a week before he was expected to testify before the D.C. Council about deficiencies in the city’s tax office.

William J. DiVello, who had headed the Office of Integrity and Oversight since March 2010, confirmed his resignation in a brief interview. “I don’t want to work there anymore. I don’t like the direction the agency is going,” he said, declining to comment further.

A request for comment from Chief Financial Officer Natwar M. Gandhi, who oversees the D.C. tax office, was not returned Thursday.

This year, DiVello’s office completed an audit critical of the city’s assessment procedures. The audit concluded that the tax office employed a “significantly flawed” computer database made vulnerable by office managers who could change assessed property values without detection.

The audit was made public after The Washington Post obtained a copy and wrote about its findings in August.

The council will hold a hearing Wednesday on how assessments are conducted.

DiVello, whose resignation was effective immediately, had been expected to brief council members Thursday in advance of the hearing.

But he resigned after a heated meeting with the Office of the Chief Financial Officer’s general counsel and director of operations over what to present at the council hearing, according to two people with knowledge of the meeting who spoke on the condition of anonymity to speak freely about Thursday’s events.

Council member Jack Evans (D-Ward 2), who scheduled next week’s hearing, said he was told that DiVello resigned after refusing to agree with the office that his team made a mistake when it concluded changes to the database were not detectable.

“The question is, ‘Where does the truth lie?’ ” Evans said. “From my perspective, we should call this guy” to testify.

DiVello’s team updated the audit to respond to questions from council members and reviewed recommendations with the tax office. The audit was then formally submitted.

Council members, who have demanded more information about the database, received the final revised audit this week. The tax office has promised to implement several changes to strengthen internal controls by Nov. 1.

DiVello, 65, is a certified inspector and fraud investigator, according to his biography on the city government’s Web site. He previously oversaw citywide financial audits as an assistant inspector general in the Office of the Inspector General.

The internal affairs unit is responsible for reviewing the operations of the Office of the Chief Financial Officer, investigating alleged violations by employees and performing background checks on employees and contractors, according the site.

An anonymous complaint from a staff tax office employee prompted the internal affairs unit and the FBI to investigate reductions in property assessments through settlements by the tax office, several people with knowledge of the probes have told The Post.

The Post found that the tax office lowered the proposed taxable value on 500 commercial properties by a total of $2.6 billion this year through the settlements.

The Post also found that chief appraiser Tony L. George was terminated from a previous job in Fulton County, Ga., after complaints about how assessments had been lowered. He did not disclose the termination on his D.C. job application.

Jennifer Jenkins contributed to this report.

D.C. mandates health insurance market for businesses

D.C. mandates health insurance market for businesses

October 4, 2012 | 12:30 pm
8Comments


Patient getting blood pressure taken (Examiner file photo)

Liz Farmer

Examiner Staff Writer

The Washington Examiner

@LizFarmerDC Liz on FB

A board has required D.C. small businesses and individual buyers to purchase health insurance through the newly minted health exchange, and though it’s unclear whether the regulations require D.C. Council approval to take effect, members said Thursday that they apply to any company that has an office in the District with 50 or fewer employees.

"If you have a business license here in the District of Columbia, then you participate through the exchange," said Dr. Mohammad Akhter, chairman of the D.C. Health Benefit Exchange board.

A spokeswoman later clarified that those companies did not have to be headquartered in D.C.

New regulations:
• The exchange is the sole health insurance marketplace for individuals and small businesses.
• Applies to small business with 1 to 50 employees.
• Health insurance plans meeting minimum requirements for qualified health plans, as well as any requirements created by the exchange authority, can be offered in the D.C. exchange.
• Small businesses and individuals merge into a single risk pool to make quality, affordable health coverage available to all.
• Opt into the federally administered risk adjustment and reinsurance programs for the exchange’s market.

In addition, board members said they believed their vote of approval was enough to enact the new regulations — even without all the details being finalized.

"I think we would still make sure we talk with [the D.C.] Council … that makes sense," said board member William White. "If I need their approval for something, I will ask the council after I put together whatever legislative change we need."

The board, which oversees the city’s health exchange mandated by federal health care reform, voted unanimously late Wednesday to approve regulations making the exchange the District’s sole health insurance marketplace for individuals and businesses with 50 employees or less. Akhter estimated that would give the exchange at least 100,000 consumers, which is a pool large enough so that the exchange can negotiate competitive rates with insurers.

Those who represent the city’s businesses have spoken out against the move, saying their members are worried they’ll end up with a different insurer and higher rates. Employers can stick with their current health insurer if that provider opts into D.C.’s exchange, but they may see their rates increase by 2 to 3 percent, experts said.

DC Chamber of Commerce spokesman Max Farrow said not allowing either an off-market exchange or a regional market exchange "imposes severe difficulties for small businesses."

The chamber also disagrees that the exchange’s vote does not require the city council to pass legislation.

"It is our goal to see D.C.’s success in keeping residents insured continue," Farrow said. "We are just not sure this is the way to do it."

But one thing is certain: No matter what the outcome of the presidential election in November, a repeal of the federal act would not change D.C. law. The District has already passed legislation establishing the health exchange and has received $73 million in federal funding to roll it out.

"We’re going full speed ahead," Akhter said.

lfarmer

Kevin Wrege, Esq.

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