Surging health insurance premiums and new limits on Medicaid access left tens of thousands of D.C. residents with worse healthcare options when the clock struck midnight on Jan. 1.
“I’ve been doing this work for 25 years, and I haven’t seen a single year where benefits were cut as deeply for as many people,” said Ed Lazere, director of legislative advocacy at the United Planning Organization, an anti-poverty nonprofit serving D.C.
The scale and speed of changes to local healthcare programs that went into effect at the start of this year, partly set in motion by the budget that the D.C. Council approved in July and exacerbated by federal cuts, have outraged advocates and raised concerns about more people being burdened with unaffordable bills or losing health insurance altogether.
About 16,000 people were pushed off of Medicaid due to a local decision to reduce the program’s income limit. Most of them — 14,490 people — were automatically transferred to a new program called Healthy DC, also known as the Basic Health Plan, which lacks dental and vision coverage.
But 1,600 former Medicaid members make too much to qualify for Healthy DC, according to Mila Kofman, executive director of D.C.’s Health Benefit Exchange Authority. They’ll have to begin paying monthly premiums on D.C.’s Affordable Care Act marketplace — premiums that will be higher than normal because Congress failed to extend premium tax credit enhancements past Jan. 1.
Another 3,500 residents on the local ACA marketplace will also see a jump in their premiums, Kofman said. The most impacted are a group of 1,000 people who will no longer receive any premium relief at all. A 60-year-old couple on the higher end of the marketplace making $85,000 per year, for example, will now have to pay $31,362 annually to maintain health insurance — over a third of their income according to estimates from the Center on Budget and Policy Priorities.
Finally, the lower income limit for Medicaid also reduces access to Emergency Medicaid, which provides coverage during medical emergencies for people who don’t qualify for Medicaid because of their immigration status. The exact number of people affected by this change is fuzzy, but it’s in the thousands.
Back in October, about 2,200 people lost their insurance on DC Health Care Alliance — which covers immigrants who are ineligible for Medicaid — as part of a plan to eliminate adult coverage on that program by October 2027. Meanwhile, around 7,000 other low-income immigrants have stopped receiving insurance since November 2024, likely for reasons related to more restrictive renewal policies and fear of immigration enforcement, according to the Department of Health Care Finance (DHCF).
Claudia Sosa, a student at Briya Public Charter School, described the fear and stress that she and others in D.C.’s low-income communities have already experienced as a result of local cuts to healthcare funding.
“We want to stay healthy so that we can work, raise our children and not have to choose between healthcare or paying rent or [bills],” Sosa said at a December roundtable discussion. “I share my story today because those [changes] are not just a member or policy decision. They affect real people. When service [is] taken away, families delay care, live in pain and lose stability.”
High-stakes decisions
Deputy Mayor for D.C. Health and Human Services Wayne Turnage has presented the changes as essential to balancing the District’s finances in an unusually punishing budget year. At last month’s roundtable, which lasted over six hours, he estimated that changes to Alliance, Medicaid, and the Immigrant Children’s Program will save the District about $1.2 billion over the next four years.
“Despite the many well-meaning comments to the contrary from some of our public witnesses today, the budget implications of these policy changes cannot be responsibly or legally ignored,” Turnage said.
A group of advocates confronted Turnage and other DHCF officials while in the hallway outside the meeting.
A woman pushing a young child in a stroller told Turnage that she lost her insurance on Oct. 1 despite earning no income as a full-time caretaker — something that wasn’t supposed to happen. The Ward 4 resident, who asked to remain anonymous because of her immigration status, said she has pre-diabetes that she fears will get worse without medicine and regular checkups.
“I came here not just to fight for my own health, but our entire community,” the mother of two told The 51st, speaking in Spanish through an interpreter. “I know a lot of people who have chronic illnesses, people who are dying slowly.”
Turnage advised the woman to call his policy director to restore her coverage, and also gave her his own cellphone number to follow up. But advocates worry about others falling through the cracks as a result of such major changes to so many programs — especially since affected populations include many hourly workers whose incomes vary throughout the year, which could risk confusion about eligibility.
Technical problems may also cause people to lose health insurance or experience gaps in coverage. For instance, about 1,100 Healthy DC applications had data issues requiring manual processing. As of Dec. 23, the Health Benefit Exchange Authority was still reviewing 187 of these.
Councilmember Christina Henderson, who chairs the Council’s health committee, noted that historically, D.C. has had one of the most robust healthcare systems in the country. She fears this could change, especially if large numbers of people end up losing coverage unnecessarily.
“Because of fiscal constraints and other policy challenges to no fault of our own, I fear we’re hustling backwards,” she said at the meeting. “Now, how [far] backwards we go? I think that’s up to us, in terms of the work that we do on the outreach side.”
Dropping the Medicaid income limit — from around 215% of the federal poverty level, or $34,000 a year for a one-person household, to 138%, or $22,000 per year — will hit people differently depending on their income and immigration status.
The creation of Healthy DC softens the blow substantially for one tax bracket — but for people who earn slightly more, changes at the federal level exacerbate the impact. The reduced cap also has secondary effects on many low-income immigrants.
On the one hand, Kofman, who has been overseeing the creation of Healthy DC, characterized shifting thousands of people from Medicaid to the new program as a smart piece of footwork, at least from a budget perspective. Unlike Medicaid, Healthy DC is fully federally funded and requires no local dollars.
While it has fewer benefits than Medicaid, its members still receive coverage with no out-of-pocket costs.
“This is a really good deal for states, in terms of budgets and balancing where resources go,” Kofman said.
However, Healthy DC has an income cap at 200% of the federal poverty level, as opposed to Medicaid’s previous 215%. Kofman is worried about the 1,600 people who are getting pushed off of Medicaid and will now have to figure out whether they can pay ACA marketplace premiums.
She also worries about those already on the marketplace who just lost their tax credit enhancements — especially the 1,000 people who, she said, will receive no relief at all because their income is too high. This group includes many small business owners and other self-employed people.
“I’m very concerned about this population,” Kofman said. “Even people who qualify for some premium relief — it is not going to be sufficient, especially [for] people who need medical care and … will be faced with deductibles and other out-of-pocket costs.”
Many undocumented people in D.C., meanwhile, now have fewer healthcare options than ever as a result of the Medicaid changes.
Back in October, Alliance cut 2,200 people loose from care: lowering its income limit in a way that mirrors the new Medicaid change. A large portion of these beneficiaries were undocumented or had a tenuous immigration status, so only 55 were identified as potentially eligible for Healthy DC or other programs, according to DHCF.
Now, as of Jan. 1, the reduced income limit for Emergency Medicaid took away one of the only remaining coverage options for these former Alliance members if they end up in an emergency room. In many cases, healthcare experts say, they’ll now either be left with severe medical debt, or hospitals will have to shoulder the costs of uncompensated care.
“If they don’t qualify for Emergency Medicaid, I think they’ll probably get those bills,” said Andrew Patterson, senior counsel on Legal Aid DC’s Public Benefits Law Unit. “Maybe they can try to work something out with the hospital. Maybe there’s a charity care application. But there won’t be an insurance option for those folks, if they’re not able to get Emergency Medicaid.”
While Alliance membership took one of its biggest hits in October, it also fell throughout the rest of 2025. Between November 2024 and November 2025, according to data from DHCF, the number of people enrolled in Alliance and the Immigrant Children’s Program (which combined with Alliance in October) decreased by a total of 7,720 adults and 1,412 minors.
Part of this decrease was because, since April, Alliance members without social security numbers can no longer automatically renew their coverage. They now have to re-enroll manually in order to keep their health insurance. Turnage also attributed part of the drop in enrollment to concerns about immigration arrests.
“People became less visible and less active in the community, and unfortunately, that probably also meant some of them were disenrolling from Alliance,” he said.
Turnage predicted that declines in Alliance membership will continue throughout 2026, further increasing the number of D.C. residents without health insurance.
Healthcare advocates score a win
In spite of the new cutbacks, a piece of good news arrived over the holidays for the remaining 24,000 members of Alliance. On Christmas Eve, D.C.’s Chief Financial Officer approved a transfer of $21.5 million in contingency funding that the D.C. Council had set aside for the program if revenue allowed for it.
While Alliance members lost some of their benefits, like dental and vision insurance, on Oct. 1, the new funding suggests that current members will see some or all of their previous benefits restored through at least this October.
“What might seem like a Christmas miracle is really the result of persistent organizing,” DC Jobs With Justice data organizer Alex Samuels wrote in a recent newsletter. “Since the spring, we have been unrelenting in our demand that DC restore the DC Healthcare Alliance.”
More clarity on the impact of the additional funding is expected to come by the end of the week. This could end months of uncertainty for care providers over what medications Alliance will cover, while lessening pressure on health centers that have stepped up to provide Alliance members with dental care.
Legal Aid DC and Bread for the City are hosting two clinics later this month to answer questions from people affected by various healthcare changes:
Jan. 22 from 10 a.m. to noon at Bread for the City’s southeast center (1700 Marion Barry Ave. SE)
Jan. 30 from 10 a.m. to noon at Bread for the City’s northwest center (1525 7th Street NW)
Advocates, meanwhile, have been gearing up for a fight over the future of Alliance and D.C.’s healthcare system as a whole during this year’s budget season.
At last month’s meeting, the Rev. William Young, pastor of Covenant Baptist United Church of Christ in Ward 8, cast upcoming decisions in religious terms: arguing that the District’s leaders, including those on the D.C. Council, have a moral imperative to protect what he sees as a basic human right.
“Do you really want it to be said, when the history books are written about you, about how the District of Columbia survived the time of tyranny, that you aided and abetted in the decline of healthcare in a city that you serve?” Young said. “The story that could be told about this Council could be glorious: that it resisted in the face of tyranny, that it fought for the ones that Jesus called the least of these, that it was a model of righteous government in a time of normalized racism and xenophobia. That story could still be told about this Council.”
Daniel Egitto is a freelance reporter in D.C. and the managing editor of ARLnow in Arlington. He has previously worked as a local reporter in Florida and in California.
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