Health Insurance Coverage in the District of Columbia: Estimates from the 2009 DC Health Insurance Survey

Health Insurance Coverage in the District of ColumbiaEstimates from the 2009 DC Health Insurance SurveyJulie Hudman, PhDDirector Department of Health Care FinanceLinda Elam, PhD, MPHDirectorHealth Care Policy and Planning Administration Department of Health Care FinanceThe Urban InstituteApril 2010 Executive SummaryDistrict of Columbia Department of Health Care FinanceIntroductionThe District of Columbia is a leader in providing health coverage to its residents. Only about 6.2% of the District population reports being uninsured. A somewhat higher share, 10.2%, report having been uninsured at some time during the past 12 months. Types of Insurance CoverageThe majority, 55%, of District residents have health insurance through their employers. Nearly one-third are covered by public programs such as Medicaid, the Alliance, or Medicare. Age, race and ethnicity, family income, employment status, and ward were all important factors associated with type of insurance coverage. Among children, public programs are nearly as important as employer-sponsored coverage. Among the elderly, Medicare is the most important, with supplemental coverage provided most often by private coverage or Medicaid. Health Insurance Options and ChoicesOnly about 10% of children with public coverage have the option of employer-sponsored insurance. In families that have an offer of dependent coverage, higher income is associated with a greater likelihood of children having employer-sponsored coverage. Similarly, the likelihood that adults who are offered employer-sponsored insurance accept it rises with income. The large majority of non-elderly adults who have public coverage are not currently employed. Of those who are employed, a little more than half work in firms that offer insurance coverage. Most uninsured adults indicated that they would be willing to enroll in public insurance programs, but many also indicated that they were not aware of these programs or did not know how to enroll. Health Care Access and UseThe majority of non-elderly adults report that they usually go to a doctor’s office or private clinic for care. But about one fifth usually go to public clinics or hospital emergency or outpatient departments, and another fifth report that they have no usual source of care.Health Insurance Coverage in the District of Columbia 2District of Columbia Department of Health Care FinanceHealth Insurance Coverage in the District of ColumbiaThe 2009 District of Columbia Health Insurance Survey (DC-HIS) was conducted between August and November 2009 via telephone, web, and mail by Social Science Research Solutions. It was available in English and Spanish and took, on average, about 18 minutes to complete. Surveys were completed with 4,717 District households. The sample included only non-institutionalized residents and did not include homeless residents. In order to ensure that the survey covered nearly all residents of the District, a dual sample frame was employed, combining a random-digit-dial (RDD) sample with an address-based sample. The response rate was 43.7% for the RDD-sample and 27.3% for the address-based sample, for a combined response rate of 34.1%. The decision to rely on the dual-frame sample for the 2009 HIS reflects the changing telephone environment as more and more households are relying on cell phones, which are not called in RDD surveys. We believe this dual-frame sampling approach leads to greater confidence in the estimates of the uninsured contained in this report.The survey data were analyzed and charts were prepared by the Urban Institute. For these charts, we define children as ages 0 to 18, non-elderly adults as ages 19 to 64, and elderly adults as ages 65 and older.Table of ContentsExecutiveSummary 1Introduction2Overview of Health CoverageAll residents3Children7Non-elderly adults 15Elderly 27Health InsuranceOptions and Choices 29Health CareAccess and Use40IntroductionThis survey was developed in consultation with Sharon Long, a Senior Fellow at the Urban Institute, who conducted a similar study in Massachusetts. Her guidance was an invaluable asset to the project team, which included Barbara Ormond, Tim Triplett, Ashley Palmer, Lokendra Phadera, and Randy Bovbjerg of the Urban Institute. The survey instrument was modeled on the instrument used for the Massachusetts survey, and we are grateful to the MA Division of Health Care Finance and Policy for this contribution. We also would like to acknowledge the work of Social Science Research Solutions, which implemented the survey. 3All ResidentsDistrict of Columbia Department of Health Care Finance 4District of Columbia Department of Health Care FinanceUninsurance was low among District residents, with 6.2% (representing about 37,000 people†) reporting that they were uninsured at the time of the survey. More residents (10.6%, representing about 63,000 people†) reported being uninsured at some time in the past 12 months. These rates com