Medical providers and patients this week told the D.C. Council health committee that as a result of cuts to the city’s safety net health care programs, low-income residents cannot afford care, their conditions are worsening and some will die.
Advocates are also pushing city officials to reverse changes that this fall cutabout 2,200 people from an insurance program called Health Care Alliance Program that covers 30,000 residents who have no other options, regardless of their immigration status. And starting next year, changes to the city’s Medicaid program could leave thousands more uninsured.
Mayor Muriel E. Bowser’s budget this summer slashed Alliance and Medicaid programs to help plug a $1 billion shortfall that city officials attributed to President Donald Trump’s federal workforce cuts, declining consumer spending and a weak commercial real estate market.
They didn’t know at the time, however, that cuts would coincide with the Trump administration seizing temporary control of the city’s police department and mobilizing federal officers to arrest people who were in the country illegally or had open asylum applications or work permits, stoking fear and confusion among immigrant communities and the city at large.
Low-income residents are also bracing for the expiration of premium tax credits for Affordable Care Act plans and upcoming changes to Medicaid, such as a work requirement.
“We are witnessing violent attacks such as people being enforced and taken from their homes and streets,” said Daniela Gonzales-Rious, health justice coordinator at the D.C. nonprofit Advocates for Justice and Education. “Families left without hearing from their loved ones. Children are already losing parents and caregivers. We cannot compound that trauma by denying their families medical care.”
Gonzales-Rious was one of 60 people who spoke during a health committee meeting Wednesday convened by committee chair Christina Henderson (I-At-large) to examine how the Alliance cuts and planned Medicaid cuts are affecting residents and city finances.
They urged the council to restore full benefits and income eligibility, create a task force to find ways to cover this population and improve communication with recipients, providers and pharmacists. Others questioned the city’s priorities as officials commit more than $1 billion in taxpayer funds and more than $1 billion in incentives to bring a new football stadium to the old RFK Stadium site.
Henderson said the first round of Alliance changes can’t be rolled back, but the issue will be part of budget discussions next year. She recommended city officials meet with health care providers to work out a way to save the program, as an alternative to creating a task force, which she said would add bureaucracy to an already complex process.
The Health Care Alliance Program covers people whose income qualifies them for Medicaid, but are blocked for another reason, such as their immigration status. They could be undocumented, in the country legally under a work permit or have temporary protected status because they cannot return to their country safely.
On Oct. 1, the Alliance stopped accepting new enrollees age 26 and older and cut income eligibility for adults 21 and older from 215 percent of the federal poverty limit to 138 percent of the federal poverty limit.
Coverage was also scaled back. Adults still receive primary care, generic-only prescription drugs, hospital services, emergency transportation and some behavioral health services. But they will lose coverage for nonemergency transportation, and podiatry, vision and dental services. The cuts do not affect children, and pregnant women are covered for a year postpartum.
Wayne Turnage, deputy mayor for health and human services, said restoring the cuts would cost the city $300 million annually, but noted it’s too early to tell how much the city will save from shrinking the program.
Overall enrollment in Alliance is down by 9,000 from the start of the year, the lowest in a decade, he said. In addition to 2,200 people cut off because of changes to income limits, and others probably failed to reenroll over fears of arrest and deportation under Trump’s immigration crackdown, Turnage said.
“ICE is clearly a factor in the declines,” he said.
The next round of cuts is set for next fall and by Oct. 1, 2027, the program will cease to exist.
“Taking Alliance away will lead to many preventable deaths,” said Allison Miles-Lee, managing attorney at Bread for the City, a nonprofit social service agency and clinic.
Physicians explained how the disappearance of basic care can have unintended consequences. Alliance reimburses providers for primary care and specialty care — including mammograms and colonoscopies — to detect and treat illness early. Without this care, conditions can worsen until people have no choice but to go to already crowded emergency rooms.
“Places like [MedStar Washington] Hospital Center will become primary care with cuts like this,” said Kate Denson, a volunteer at Capitol Hill United Methodist Church.
Medicaid changes will exacerbate the situation, advocates said. As of Jan. 1, about 18,000 parents or caregivers and childless adults covered under the expansion of the Affordable Care Act who earn more than 138 percent of the federal poverty level will lose coverage. (Undocumented immigrants are not eligible for Medicaid.)
The city has already automatically enrolled about 13,000 of them in a new basic plan on the health benefit exchange called Healthy DC Plan. Another 1,600 earn too much to be eligible for the new plan, but could enroll in commercial plans, which come with out-of-pocket costs.
The basic plan does not cover vision or dental, which city officials say could return if Congress extends the ACA premium tax credits.
Kurt Gallagher, executive director of the DC Dental Society, and others said dentists will see fewer patients for routine cleanings, leading to life-threatening infections like abscesses, which require emergency care.
Advocates also asked city officials to clarify in notices who in a household is actually losing coverage, as many incorrectly assume their children will be uninsured and will avoid taking them to appointments.
“None of us believe there is ever enough outreach,” said Mila Kofman, the executive director of the DC Health Benefit Exchange Authority. “We have to go where people are.”
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