Thousands of Washington, D.C. residents lost full Medicaid coverage Jan. 1 due to new income limits introduced in a 2025 budget act, shifting 14,490 people to the more limited Healthy DC Plan and moving others into the Affordable Care Act (ACA) marketplace with higher premiums.
These changes to healthcare coverage are part of the Fiscal Year 2026 Budget Support Act of 2025 and have been exacerbated by federal cuts. The legislation was enacted in part due to D.C.’s unusually strenuous budget in 2025, and it is estimated to save approximately $1.2 billion over the next four years.
In particular, the income limit in D.C. has dropped from 221% and 215% of the federal poverty level (FPL) for adult caregivers and childless adults, respectively, to 138% of the FPL. Individuals whose income now exceeds the new Medicaid limit are eligible to be transferred to the Healthy DC Plan.
The Healthy DC Plan is a new, cost-free plan that covers essential healthcare services, but lacks dental and vision coverage, which Medicaid covers. However, over 1,000 former D.C. Medicaid members make too much to qualify for Healthy DC (with incomes higher than 200% above FPL) and now must pay monthly premiums on D.C.’s ACA marketplace.
ACA premiums have also increased, primarily due to the expiration of premium tax credits in 2025 that previously helped over 20 million people afford health coverage in the ACA marketplace.
Jeffrey Spike, a clinical ethicist and philosophy professor at Georgetown University, said rising ACA premiums may lead to an increased number of middle-class people unable to pay for insurance.
“If the ACA premiums rise, then there will also be more middle-class people who will be forced to go without insurance,” Spike wrote to The Hoya. “The number of people affected will be in the millions, somewhere between 8-24 million according to reliable models.”
Beyond individual residents, Spike said hospitals will also suffer from Medicaid cuts, with revenue loss being particularly detrimental in rural hospitals and hospitals located in D.C.’s Wards seven and eight, where people have very limited or no access to healthcare services.
“Almost every hospital in the U.S. will be negatively affected,” Spike wrote. “The higher the percentage of patients who are on Medicaid, the more the hospital will be harmed. Rural hospitals will be the worst affected, but urban hospitals will also be affected, especially ones in medical deserts like the seventh and eighth wards.”
The Medicaid cuts will also leave thousands of undocumented people in D.C. with fewer healthcare options. In particular, the lower income limit for Medicaid will reduce access to Emergency Medicaid, which provides medical coverage to uninsured individuals who do not qualify for Medicaid due to citizenship or immigration status.
Brandon Hu (SOH ’28), a pre-medical student at Georgetown, said that with the reduction in Emergency Medicaid, he has grown concerned for individuals who may face overwhelming medical debt and hospitals that may have to provide care without reimbursement.
“If someone doesn’t qualify for Emergency Medicaid and then has a medical emergency, the most obvious issue is going to be the large sum of medical bills the individual is left with,” Hu told The Hoya. “However, I imagine it would also put a lot of financial strain on hospitals because they will end up having to cover the costs themselves when patients can’t pay.”
Spike ultimately said that these cuts leave both people and institutions worse off, especially since decisions about healthcare should be based on ethical considerations, not political motivations.
“The big picture conclusion is that we do a lot of harm when we politicize what should be ethical questions, and that is what is happening,” Spike wrote to The Hoya.
