Republican Medicaid cuts could mean ‘Armageddon' in D.C., official says

Washington Post

30-04-2025

D.C. Mayor Muriel E. Bowser (D), her staff and health-care providers have been lobbying Congress for months to stave off Medicaid cuts that one top city official said would amount to 'Armageddon' for low-income residents and wreak havoc on the region's health network.
House Republican proposals to slash government spending on Medicaid would devastate the insurance program that covers 40 percent of District residents and makes it possible for hospitals and clinics to care for the most vulnerable, they say. Under one scenario, D.C. could lose $1.1 billion, forcing the city to drop some residents from the rolls and scale back services for others.
'I have lost many hours of sleep over that possibility,' said Wayne Turnage, deputy mayor for health and human services. He likened the possibility of crafting a bare-bones health-care finance budget to 'Armageddon.'
Cuts targeting Medicaid in the District are among the proposals the House Energy and Commerce Committee is expected to consider next week. Republicans also have floated reductions in federal contributions to D.C. and the 40 states that expanded Medicaid under the Affordable Care Act, as well as governments, such as the District's, that use local dollars to insure undocumented immigrants.
'The Medicaid cuts that are being contemplated really will be devastating really for everywhere nationwide, but there are many reasons to especially worry about D.C.,' said Joan Alker, executive director of the Center for Children and Families at Georgetown University.
Democratic lawmakers in Virginia and Maryland sent a letter Tuesday to leaders on the Energy and Commerce Committee urging them to consider how cuts could weaken health care in the nation's capital.
Reducing the federal payment in D.C. 'will undermine health care not only for Medicaid recipients in the District but for everyone in the region, regardless of their insurance status. Families will lose coverage,' Rep. Steny H. Hoyer (D-Maryland) said in a statement. 'Republicans' effort to cut Medicaid is cruel and nothing short of catastrophic for the health of the American people.'
City officials already face a $1 billion shortfall that prompted Bowser to institute a hiring freeze and other 'extraordinary measures.' The city also lost its coveted triple-A bond rating because of cuts to the federal workforce, a sluggish real estate market and the uncertainty over Medicaid funding, Moody's said.
Federal Medicaid payments for states are based on a formula that considers average per capita income, but in D.C., the rate was fixed in 1997 when the District teetered on the edge of financial collapse. Then-House Speaker Newt Gingrich and Thomas M. Davis III, a GOP congressman from Northern Virginia, brokered a deal that said the federal government would pay 70 percent of Medicaid costs and the District 30 percent.
But Davis said the national debt has ballooned since then. 'Everybody's taking a haircut,' he said Tuesday. 'We just have to understand that the circumstances have changed, and the Congress is looking around anywhere they can.'
The arrangement recognized that the District's tax revenue is limited by the amount of tax-exempt federal property within its borders and the inability to levy a commuter tax on people who work in the District but live elsewhere, said Del. Eleanor Holmes Norton, the District's nonvoting representative.
D.C.'s federal payment 'is higher than that of many states in part to compensate for those revenue-generating restrictions,' Norton said in a statement. Reducing it 'would be devastating for the nation's capital and the sizable number of residents from other jurisdictions who receive care within D.C., including federal officials and their staffs, federal employees, visitors, and the children from all 50 states who receive vital care at one of the hospitals in this region. To even consider this reduction is misguided and irresponsible.'
Bowser and her federal affairs staff have talked to House Speaker Mike Johnson (R-Louisiana) and members of the committees overseeing Medicaid and D.C.
Members of the House Energy and Commerce Committee, which has jurisdiction over health care, are expected to consider cutting spending by as much as $880 billion over 10 years, which they can't do without shrinking Medicaid. Members are at odds, with moderates saying they won't vote for a bill that cuts the public insurance program.
Sen. Chris Van Hollen (D-Maryland) said he'll oppose such cuts if they come to the Senate.
'We'll be fighting back every step of the way against Republican efforts to strip Americans of their health care in order to pay for their giant tax giveaway for the rich,' he said in a statement Tuesday.
Trade groups representing D.C. hospitals, community health clinics, behavioral health providers and others have met with lawmakers and strategized for months on how to protect the city's Medicaid payment.
Officials at hospitals serving D.C. and parts of Maryland and Virginia say cuts will probably force some to close, jeopardizing thousands of jobs and critical services such as labor and delivery and trauma care. They estimate caring for uninsured people could cost $232 million.
About half of patients treated at Children's National Hospital receive Medicaid, putting the highly specialized care at D.C.'s only Level 1 pediatric trauma center at risk.
'This potential threat is the most concerning in my 26-year career as a health-care administrator. The impacts would be immediate and devastating,' Children's National Hospital chief executive Michelle Riley-Brown said.
Community health clinics, which care for low-income patients — many of whom have complex needs — would also be hit hard by cuts. Unity Health Care, the city's largest network of clinics, receives about 70 percent of its funding from the federal government.
'Any significant cuts to these major programs would likely lead to reduced access for patients, including those who need it most — pregnant individuals, people with substance use disorders, people needing behavioral health services, among other key groups,' Unity Chief Medical Officer Benjamin Oldfield said.
Compared to states, the District has generous income eligibility limits — up to 215 percent of the federal poverty level, which is $33,600 a year for a single adult and about $71,000 for a family of four.
Adults without children — about 91,500 — make up the biggest part of Medicaid in D.C. and are most likely to lose coverage if the program is slashed, city officials say. The second-highest number of D.C. residents are children under 20 years old — about 90,600.
D.C. consistently ranks second, behind Massachusetts, with the lowest number of uninsured residents.
'It's a very laudable goal of city councils and mayors over time that they would provide so much emphasis on providing health insurance for everybody who can't afford commercial insurance,' Turnage said. 'It's a wonderful thing.'
Meagan Flynn contributed to this report.