Last month, over 50 District residents and advocates told the D.C. Council that recent changes to the city’s program helping some immigrants get medical care are already putting people’s health at risk.
The program, D.C. Health Care Alliance, provides medical assistance to District residents who are not eligible for Medicaid and Medicare and have no other health insurance. It primarily serves low-income and undocumented residents, connecting around 26,000 people to health care as of the start of 2025.
But in July, the city approved a budget that dramatically cut Alliance funding and created new eligibility requirements, making it harder to access the program and cutting off all coverage for people over 21 by the end of 2027. The council made these cuts because of a projected decline in tax revenue due to the loss of local federal government workers and growing scrutiny over programs that aid the nation’s poorest and undocumented residents, according to reporting from the 51st.
Now, advocates worry uninsured rates will spike, putting a tax on already burdened emergency rooms and hospitals, and people will go without the care they need.
“The severe budget cuts and drastic changes to the Alliance program are akin to the council using a sledgehammer to solve the District’s medical coverage crisis, when what they needed was a needle and some empathy,” Abraham Plaut, the enrollment coordinator at Bread for the City’s medical clinic, testified in December.
As of Oct. 1, no one over the age of 25 can enroll in Alliance coverage. Additionally, the maximum income someone enrolled can earn dropped from $33,600 per year – 215% of the federal poverty level – to $21,600 per year – 138% of the federal poverty level. After these changes went into place, 2,000 people lost their enrollment in the program, according to the Department of Health Care Finance. Those who still qualify can no longer use it to pay for their dental or vision care, transportation to doctors’ appointments, or any at-home care like nurses or aides.
At-large Council member Christina Henderson, chair of the council’s health committee, held a Dec. 3 round table on the immediate impacts of these changes. According to Henderson, during the budget process, the committee worked to reduce the mayor’s proposed cuts to Alliance, but was not able to get rid of the cuts entirely.
Some current Alliance members will transition to other programs, like Healthy DC, which receives federal funding. But Healthy DC is only offered to U.S. citizens and lawfully permanent residents, meaning some undocumented residents may not be eligible. It does not cover vision or dental procedures, so thousands of D.C. residents are expected to lose that coverage entirely.
“If you do not make the right decision to restore coverage and allocate funding to the Alliance program, you will not only be condemning our community to a slow death, but you will also be driving them into bankruptcy,” Claudia, a Ward 5 resident who did not provide her last name, testified in December. Claudia depends on Alliance for heart medication that keeps her alive, she said. If she loses access, she won’t be able to pay for it.
“Today, I want to tell you that if you eliminate the Alliance program, I will simply have no future. I will die,” she said.
Alliance started in 2001 after the city closed one of its only hospitals that treated people without insurance, D.C. General. Since then, the program has become a lifeline for some of D.C.’s most vulnerable, historically providing funding for regular check-ups, vision and dental care, mental health services, and associated costs like transportation and interpretation services. Many advocates testified Alliance helped dramatically decrease the uninsured rate in the city, which went from 18.7% in 1999 to 4.5% in 2024, one of the lowest rates in the country.
Although it is hard to see the full impact of this loss of coverage just a couple of months in, advocates warned it will have extreme effects in the coming years. People who no longer receive preventative care will wait to get help until their conditions are severe, they predicted, which will ultimately cost the city money.
Bianca Palmisano, a Ward 1 resident and nurse, stressed in her testimony D.C.’s health care system is already overburdened. When she worked out of the Medstar Washington Hospital Center’s ER, she said she saw the staff “pressed to the breaking point by their workload,” with the average wait time exceeding six hours.
Dr. Ida Vaziri, a neurologist, also worries about what the lack of comprehensive coverage means for people’s long-term health.
“Preventable strokes become permanent disabilities. Missed appointments turn into ICU admissions. Untreated symptoms in children become developmental emergencies,” Vaziri warned.
Isaiah Livelsberger, a bilingual case manager who submitted written testimony, has seen this firsthand. One of Livelsberger’s clients, a 71-year-old homeless immigrant, has stopped physical therapy that was important to treating her autoimmune disorder because she can no longer afford it, he said.
Three weeks after advocates and residents asked the council to restore benefits, D.C.’s chief financial officer announced that, due to an unexpectedly high tax revenue, the council has $51 million that it can spend on underfunded priorities in the coming year. As the council laid out in the city’s budget, $21 million of the surplus will go to Alliance. But, Alliance lost $220.9 million dollars this year, so the $21 million will not fully restore the program. This leaves people at a continued risk of losing their Alliance membership.
People like Maria.
Maria, who used an alias when she submitted a letter to the council, lost her coverage. She said she is no longer able to pay for tests she needed on her eyes, and can’t receive mammograms, which she needs after discovering a small mass on her breast six years ago.
Maria wrote that reliable health care coverage means everything to her.
“It’s the difference between prevention and suffering. The difference between living with dignity and living with fear. The difference between being healthy and getting sick with no hope of getting better.”
