District of Columbia Highlights

16 District of Columbia's 2020 Rank
To learn more about state rank, visit our 2020 Scorecard on State Health System Performance.
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Source: Commonwealth Fund 2020

Key Demographics

District of Columbia US Average
Total Population 693,418 322,324,172
Median Household Income $91,179 $67,877
Below 200% of Federal Poverty Level (FPL) 27% 30%
% White Race, Non-Hispanic 37% 60%
% Black Race, Non-Hispanic 44% 12%
% Other Race, Non-Hispanic 7% 9%
% Hispanic Ethnicity 11% 18%

Key Health Policies in District of columbia

District of columbia has put one or more rules in place to promote ACA marketplace competition.
District of columbia has stricter short-term coverage regulations than the federal government: short-term coverage is allowed, but contract duration and the length of time a consumer can be enrolled is limited. 
District of columbia expanded Medicaid.

District Of Columbia Performance Data

CSV
Indicator Source 2016 2017 2018
Uninsured adults ages 19—64 American Community Survey, Public Use Microdata Sample (ACS PUMS) 5% 5% 4%
Uninsured children ages 0—18 American Community Survey, Public Use Microdata Sample (ACS PUMS) - - -
Hospital admissions for pediatric asthma, per 100,000 children ages 2-17 Healthcare Cost and Utilization Project (HCUP), via AHRQ National Healthcare Quality Report - - -
Adults age 18 and older who went without care because of cost in past year Behavioral Risk Factor Surveillance System (BRFSS) 9% 11% 8%
Adults age 18 and older with a usual source of care Behavioral Risk Factor Surveillance System (BRFSS) 75% 74% 78%
Adults age 18 and older without a dental visit in past year Behavioral Risk Factor Surveillance System (BRFSS) 24% - 26%
Adults with age- and gender-appropriate cancer screenings Behavioral Risk Factor Surveillance System (BRFSS) 75% - 74%
Adults with age-appropriate vaccines Behavioral Risk Factor Surveillance System (BRFSS) 36% 38% 43%
Adults ages 18–64 who report fair or poor health Behavioral Risk Factor Surveillance System (BRFSS) 10% 9% 12%
Adults ages 18 and older who smoke Behavioral Risk Factor Surveillance System (BRFSS) 15% 14% 14%
Adults ages 18–64 who are obese (BMI >= 30) Behavioral Risk Factor Surveillance System (BRFSS) 22% 23% 25%
Adults ages 18–64 who have lost six or more teeth because of tooth decay, infection, or gum disease Behavioral Risk Factor Surveillance System (BRFSS) 6% - 6%
Mortality amenable to health care, deaths per 100,000 population CDC National Vital Statistics System (NVSS): Restricted Use Mortality Microdata 130 123.4 -
Central line-associated bloodstream infections (CLABSI), Standardized Infection Ratio CDC Healthcare-Associated Infections (HAI) Progress Report 0.95 0.859 0.719
Breast cancer deaths per 100,000 female population CDC National Vital Statistics System (NVSS): WONDER 23.7 24.3 26.7
Colorectal cancer deaths per 100,000 population CDC National Vital Statistics System (NVSS): WONDER 16.4 12.6 12.7
Suicide deaths per 100,000 population CDC National Vital Statistics System (NVSS): WONDER 5.2 6.6 7.5
Alcohol-related deaths per 100,000 population CDC National Vital Statistics System (NVSS): WONDER 11.7 9.3 11.1
Drug poisoning deaths per 100,000 population CDC National Vital Statistics System (NVSS): WONDER 38.8 44 35.4
Infant mortality, deaths per 1,000 live births CDC National Vital Statistics System (NVSS): WONDER 7.2 8.2 -
Hospital admissions among adults ages 18–64 with employer-sponsored insurance for ambulatory care–sensitive conditions, per 1,000 enrollees Truven MarketScan - - -
Hospital admissions among Medicare beneficiaries age 65 and older for ambulatory care–sensitive conditions, per 1,000 beneficiaries Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File 51.7 51.8 47.5
Potentially avoidable emergency department visits among adults ages 18–64 with employer-sponsored insurance per 1,000 enrollees Truven MarketScan - - -
Potentially avoidable emergency department visits among Medicare beneficiaries age 65 and older per 1,000 beneficiaries Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File 243.3 - -
30-day hospital readmissions among adults ages 18–64 with employer-sponsored insurance, per 1,000 enrollees Truven MarketScan - - -
30-day hospital readmissions among Medicare beneficiaries age 65 and older per 1,000 beneficiaries Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File 47.5 48.4 43.7
Individuals under age 65 with high out-of-pocket medical costs relative to their annual household income Current Population Survey Annual Social and Economic Supplement (CPS ASEC) 6% 4.5% 4.8%
Total Medicare (Parts A & B) reimbursements per enrollee Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File $9,259 $9,449 $9,624
Total Medicare reimbursements for inpatient hospital services per enrollee Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File $2,811 $2,813 $2,682
Total Medicare reimbursements for ambulatory Evaluation and Management services per enrollee Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File $1,041 $1,070 $1,100
Total Medicare reimbursements for inpatient skilled nursing care per enrollee Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File $1,039 $999 $946
Total Medicare reimbursements for home health care services per enrollee Chronic Conditions Data Warehouse (CCW), via CMS Geographic Variation Public Use File $344 $343 $349
Home health patients who got better at walking or moving around Outcome and Assessment Information Set (OASIS), via CMS home Health Compare 74% 76% 79%
Home health patients whose wounds improved or healed after an operation Outcome and Assessment Information Set (OASIS), via CMS home Health Compare 94% 95% 94%
Home health patients also enrolled in Medicare with a hospital admission Medicare Claims, via CMS Home Health Compare 16% 15% 14%
Risk-adjusted 30-day mortality among Medicare beneficiaries hospitalized for heart attack, heart failure, pneumonia, or stroke CMS Hospital Compare 13.6% 13.2% 13%
Hospitalized patients given information about what to do during their recovery at home Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 82% 82% 82%
Overall patient hospital experience rating (out of 100 points) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 59 63 -
Patients' experience communicating with nursing staff (out of 100 points) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 70 71 -
Patients' experience communicating with doctors (out of 100 points) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 77 76 -
Responsiveness of hospital staff when called by patients (out of 100 points) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 51 53 -
Patients' experience communicating with hospital staff about medicines they received (out of 100 points) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 56 57 -
Patients felt prepared to manage their care after a hospital stay (out of 100 points) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 43 45 -
Patients discussed discharge plans with hospital staff and received written instructions (out of 100 points) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare 82 82 -
Hospitals with overall patient experience ratings higher than the national average Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), via CMS Hospital Compare - 29% -
Adult diabetic patients ages 18–64 with employer-sponsored insurance with at least one hemoglobin A1c test during the year Truven MarketScan - - -
Adult diabetic patients ages 18–64 with employer-sponsored insurance with at least one LDL-C test during the year Truven MarketScan - - -
Adult patients ages 18–64 with employer-sponsored insurance and a diagnosis of bacterial pneumonia who received an appropriate empiric antibiotic Truven MarketScan - - -
Adult patients ages 18–64 with employer-sponsored insurance and a diagnosis of major depression who were prescribed an antidepressant medication, and who had pharmacy claims of at least 5 months’ worth of the medication Truven MarketScan - - -
Adult patients ages 18–50 with employer-sponsored insurance who had a new primary diagnosis of low back pain with an Imaging study (plain X-ray, MRI, or CT scan) within 28 days of the diagnosis Truven MarketScan - - -
Total employer-sponsored insurance reimbursements per enrollee, ages 18–64 Truven MarketScan - - -
Total employer-sponsored insurance reimbursements for inpatient hospital services per enrollee, ages 18–64 Truven MarketScan - - -
Total employer-sponsored insurance reimbursements for physician office services per enrollee, ages 18–64 Truven MarketScan - - -
Short-stay nursing home residents with a 30-day readmission to the hospital Residential History File 19% - -
Long-stay nursing home residents with a hospital admission Residential History File 19% - -
Medicare beneficiaries who received at least one drug that should be avoided in the elderly Medicare Part D Claims 9.3% - -
Total premium cost for employer-sponsored health insurance plans Medical Expenditure Panel Survey Insurance Component (MEPS-IC) $12,813 $13,991 $14,801
Total premium cost for employer-sponsored health insurance plans as a share of state median income Medical Expenditure Panel Survey Insurance Component (MEPS-IC) 21.4% 20.9% 20.3%
Employee contribution to total premium cost for employer-sponsored health insurance plans Medical Expenditure Panel Survey Insurance Component (MEPS-IC) $3,526 $3,716 $3,960
Employee contribution to total premium cost for employer-sponsored health insurance plans as a share of state median income Medical Expenditure Panel Survey Insurance Component (MEPS-IC) 5.9% 5.6% 5.4%
Employee deductible for employer-sponsored health insurance plans Medical Expenditure Panel Survey Insurance Component (MEPS-IC) $1,719 $1,979 $1,855
Employee deductible for employer-sponsored health insurance plans as a share of state median income Medical Expenditure Panel Survey Insurance Component (MEPS-IC) 2.9% 3% 2.5%
Employee total potential out-of-pocket medical costs (premium contribution + deductible) Medical Expenditure Panel Survey Insurance Component (MEPS-IC) $5,245 $5,695 $5,815
Employee total potential out-of-pocket medical costs (premium contribution + deductible) as a share of state median income Medical Expenditure Panel Survey Insurance Component (MEPS-IC) 8.7% 8.5% 8%
Children ages 19–35 months who received all recommended doses of seven key vaccines National Immunization Survey (NIS) 68% 74% 73%
Children ages 10–17 who are overweight or obese (BMI >= 85th percentile) National Survey of Children’s Health (NSCH) 34% 36% 28%
Children ages 0–17 with all components of a medical home National Survey of Children’s Health (NSCH) 49% 54% 43%
Children with age-appropriate medical and dental preventive care visits in the past year National Survey of Children’s Health (NSCH) - - 63%
Children ages 3–17 who received treatment or counseling from a mental health professional when needed during the past 12 months National Survey of Children’s Health (NSCH) 84% 89% 76%
Adults age 18 and older with any mental illness reporting unmet need National Survey on Drug Use and Health (NSDUH), via State of Mental Health in America 26% 25% -
Adults age and older with any mental illness who did not receive treatment National Survey on Drug Use and Health (NSDUH), via State of Mental Health in America 58% 55% -
Long-stay nursing home residents with an antipsychotic medication Minimum Dataset (MDS), via CMS Nursing Home Compare 12% 11% -
High-risk nursing home residents with pressure sores Minimum Dataset (MDS), via CMS Nursing Home Compare 9.1% 10.4% -
Deaths from suicide, alcohol, and drug use per 100,000 population CDC National Vital Statistics System (NVSS): WONDER - - -
State-based public health spending per resident Trust for America’s Health (TFAH) $139 $135 -
Primary care spending as share of total health care spending among adults ages 18–64 with employer-sponsored insurance Truven MarketScan - - -
Primary care spending per enroleee among adults ages 18–64 with employer-sponsored insurance Truven MarketScan - - -
Primary care spending as share of total health care spending among Medicare beneficiaries age 65 and older CMS Limited Data Set (LDS) 5.22% - -
Primary care spending per Medicare beneficiary, age 65 and older CMS Limited Data Set (LDS) $681 - -

District Of Columbia Policy Data

CSV
Policy Source Action Taken Notes Info
Medicaid expansion status The Commonwealth Fund 1 Traditionally expanded Medicaid -
Medicaid work requirement status The Commonwealth Fund 0 No work requirement -
Affordable Care Act health insurance marketplace type Center on Health Insurance Reforms, Georgetown University Health Policy Institute 3 State-based marketplace The state is responsible for all marketplace functions, including health plan management, consumer assistance, eligibility and enrollment, financing, and marketing and outreach. The state manages its own marketplace website where individuals can enroll in coverage.
State-operated individual market reinsurance programs supported by federal funding from an ACA innovation waiver J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States." The Commonwealth Fund 0 State does not operate a reinsurance program Has not applied for a future waiver
State requirements for individuals to maintain adequate health coverage (individual mandates)                                               J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States." The Commonwealth Fund 1 State requires individuals to maintain adequate health coverage (effective 2019) -
State subsidies for individual market coverage                  J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States." The Commonwealth Fund 0 State does not provide premium or cost-sharing subsidies for individual market coverage -
State regulation of short-term limited duration coverage J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States." The Commonwealth Fund 2 State regulations are stricter than the federal government: short-term coverage is allowed, but contract duration and the length of time a consumer can be enrolled is limited Short-term coverage contract duration limited to 3 months, and coverage cannot exceed 3 months per insurer in a 12-month period
State decisions to extend the annual open enrollment period for ACA marketplace coverage J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States." The Commonwealth Fund 2 2018 and 2019 open enrollment periods extended Open enrollment for 2018 extended through Jan. 31, 2018, and enrollment for 2019 extended through Feb. 6, 2019
Rules to a promote competitive marketplace J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States." The Commonwealth Fund 4 Individual and small-group markets are merged to the create a broader risk pool; Individual market coverage must be sold through the ACA marketplace The District requires insurers to merge the claims experience of its individual and small-group markets for purposes of developing the premium index rate. The index rate may then be modified to account for market-specific effects of risk adjustment.
State decisions regarding whether to allow non-compliant transitional policies in the individual market J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States." The Commonwealth Fund 0 State prohibits insurers from selling non-compliant transitional policies in the individual market -
State decisions to exempt other coverage products from federal and state consumer protections J. Giovannelli, K. Lucia, and S. Corlette, "To Understand How Consumers Are Faring in the Individual Health Insurance Markets, Watch the States." The Commonwealth Fund 0 State does not exempt other coverage products from federal and state rules for individual market insurance -
Status of state Affordable Care Act innovation waivers J. Giovannelli and K. Lucia, "States See Opportunities for Flexibility in the ACA’s Innovation Waiver Program." The Commonwealth Fund 0 No waiver -