Now, that\u2019s set to change: a package of staggered health-care rollbacks<\/a> in this year\u2019s budget mean all Alliance members over age 21 are expected to lose their coverage by October 2027. The first cuts go into effect next week and will impact around 2,700 people, according to the Office of the Deputy Mayor for Health and Human Services.\u00a0<\/p>\n \u201cI\u2019m really going out of my mind, just trying to understand \u2014 what am I supposed to do? How am I supposed to afford it? I can\u2019t. I just can\u2019t,\u201d N.S. said. She particularly worries about being the sole caretaker for her son, who has autism.<\/p>\n In January, some Alliance members will be able to join the Healthy DC Plan<\/a>, also known as the Basic Health Plan<\/a>, which is primarily meant to serve people who are getting cut off from Medicaid. However, since this federally funded program only supports lawfully present residents, just a fraction of Alliance members will be eligible.<\/p>\n During budget talks, Deputy Mayor for the D.C. Health and Human Services Wayne Turnage characterized the plan to dismantle the decades-old health insurance program as a way to navigate grim revenue forecasts while managing surging healthcare costs. While Alliance enrollment increased by just 31% between 2011 and 2026, Alliance expenditures shot up by 384% during the same period.<\/p>\n \u201cDue to a challenging fiscal environment, the changes to Medicaid and Alliance are both being made to reduce overall cost to the District,\u201d Turnage\u2019s office told The 51st. A fiscal impact statement<\/a> from May forecast $48 million in savings in fiscal 2026 as a result of Alliance cuts.\u00a0<\/p>\n However, Councilmember Christina Henderson, who chairs the Council\u2019s health committee, said that threats from Congress also played a role in the decision.<\/p>\n The day that all Alliance coverage for ages 21+ is supposed to end entirely \u2014 Oct. 1, 2027 \u2014 is the same day that, in the original House-passed version of the \u201cBig, Beautiful Bill,\u201d steep financial consequences would have gone into effect for states that provide health care to undocumented people. But this provision did not make it<\/a> into the final version of that bill, which passed a few weeks before D.C. Council approved this year\u2019s budget.<\/p>\n \u201cI do feel like there were some decisions that were made by the Bowser administration on the front end, that were based on assumptions of what we thought was going to happen on the federal side,\u201d said Henderson. \u201cNot all of those things seemed to pan out.\u201d<\/p>\n In the meantime, advocates are throwing themselves into a final push to enroll those who are still eligible: The last day anyone over 25 can register for Alliance is next Tuesday.<\/p>\n The first stage of a two year phase out will occur the following day, on Oct. 1, when the maximum income<\/a> for Alliance patients will drop from 215% of the federal poverty level \u2014 about $34,000 a year, for a one-person household \u2014 to 138%, or about $22,000 per year. In October of 2026 the income limit is expected to drop to 19% of the federal poverty level before ending entirely for ages 21+ the next year.<\/p>\n Advocates also have their eye on a bigger goal: restoring Alliance funding and reversing a plan that experts say will inflict serious harm on patients who are forced to skip check-ups and go without life-saving medication.\u00a0<\/p>\n \u201cThey\u2019re telling my patients, \u2018I don\u2019t care if you go blind. I don\u2019t care if you die from diabetes. I don\u2019t care if you die from untreated heart disease,\u2019\u201d said Dr. Kate Sugarman, a family doctor in Ward 1 who works extensively with immigrant patients. \u201cNo! It\u2019s not acceptable.\u201d<\/p>\n D.C. Council\u2019s last-minute judgment calls<\/p>\n On a recent Sunday morning at Shrine of the Sacred Heart, while some parishioners had coffee or chatted after Spanish and Portuguese mass, others approached the bustling booths of healthcare organizations.<\/p>\n In the middle of the busy scene was Unite Here Local 25 organizer Amanda Gomez. Low wages and poor benefits make many of their members in the restaurant industry dependent on Alliance, Gomez said.\u00a0<\/p>\n \u201cIt\u2019s a big slap in the face because, like, you already have your federal government saying to immigrants, you know, \u2018you don\u2019t belong here,\u2019\u201d Gomez said. \u201cAnd now you have your city government saying, \u2018And we\u2019re not gonna support you.\u2019\u201d<\/p>\n Henderson said that while Congress backed off from its threat to defund states that provide health care to undocumented people, it happened too late to pivot.<\/p>\n When the D.C. Council received its budget draft from Mayor Muriel Bowser\u2019s office \u2014 which happened two months later than normal this year \u2014 that provision was still included in the \u201cBig, Beautiful Bill.\u201d This was still the case when D.C. Council\u2019s Committee on Health approved its recommended edits<\/a> to the budget in late June.\u00a0<\/p>\n The Senate removed those penalties from the final version of the bill that Trump signed into law on July 4. But that happened so close to the final budget vote on July 28 that making major changes would have been particularly difficult, Henderson said.<\/p>\n The thought of D.C. leaders making sweeping policy decisions based on fears that never materialized infuriates Kate Coventry, deputy director of legislative strategy at the DC Fiscal Policy Institute.<\/p>\n \u201cWhy are we preemptively acting? Wait until they tell us we can\u2019t have this insurance,\u201d Coventry said. \u201cPeople are going to die because of lack of health insurance, because of what Congress might do. Why are we obeying before we are told?\u201d<\/p>\n Turnage, by contrast, made no mention of any direct pressure from Congress in prepared testimony to the Committee on Health in June (and wouldn\u2019t comment on whether it played a role in the cuts).\u00a0<\/p>\n \u201cThe challenging nature of the city\u2019s finances, combined with the unsustainable cost growth in both the Medicaid and Alliance programs, required saving actions that have no historical precedent in the District,\u201d he said in June. \u201cHowever, the strategies put forth were thoughtfully deliberated and crafted in a manner to minimize the loss of access to quality health care.\u201d<\/p>\n Henderson suggested that there might still be ways to avoid fully eliminating Alliance, perhaps beginning with changes in the fiscal 2027 budget. But she noted that the District\u2019s financial problems aren\u2019t going away anytime soon, and neither is the threat of federal lawmakers who have proven themselves increasingly willing to force changes<\/a> on a city that they don\u2019t represent.<\/p>\n \u201cEspecially [with] D.C. not being a state, it is really hard for us to have the stability and consistency of some of these policies, particularly around health insurance, when we\u2019re dealing with a president and a Congress that is constantly moving the goalposts on what they\u2019re trying to do with federal policy,\u201d Henderson said.<\/p>\n Maria G\u00f3mez, the founder of the community health organization Mary\u2019s Center, fears returning to what D.C. was like before Alliance started in 2001.<\/p>\n \u201cPeople had to, like, beg different clinics and beg hospitals to see them,\u201d said G\u00f3mez. \u201cSo people went without dialysis. People went to prenatal care at the last minute, when they were about to deliver.\u201d<\/p>\n![\"The](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2025\/09\/erik-mclean-4JaWGHzlwvk-unsplash-2.jpg\")
(Erik Mclean\/Unsplash<\/a>)Health experts fear for patients<\/p>\n