A new audit shows the District could lose up to $1 billion annually over the next decade if congressional Republicans succeed in repealing the Affordable Care Act (ACA).
A report released Wednesday by D.C. Auditor Kathleen Patterson shows that more than 100,000 city residents could lose their health insurance coverage. D.C Council member Jack Evans, Ward 2 Democrat, requested the audit.
D.C. leaders, including Mayor Muriel Bowser and council member Vincent Gray, have vowed to help the city’s most vulnerable residents from losing their health insurance, but that could be a costly proposition, the audit shows.
If Congress rolls back the Medicaid expansion that came under the ACA, the city would lose $563 million in federal subsidies in 2018. And over the next 10 years, that figure could grow to $1.1 billion per year in federal money that currently covers Medicaid.
If the ACA’s Medicaid program is replaced by block grants to states, which all take federal money for the insurance program, or by per-capita allotments, the figures become more grim. Under those plans, the District could lose nearly $2 billion per year over the next 10 years, according to the audit.
Ms. Patterson concluded that the District could not make up the losses in federal funding.
“Given the magnitude of these possible losses, it is clear that the District could not readily supplement the lost federal funding to maintain the level of coverage for residents who currently benefit from the ACA and the Medicaid expansion program,” Ms. Patterson wrote in the report.
Miss Bowser has said she will do whatever she can to make sure residents who need health coverage the most don’t end up without any. She said she’s waiting to see details before she can assess how to move forward, but noted that access to health care is a “core value” for the city.
“There still remains a great deal of uncertainty around repealing the Affordable Care Act and what a replacement, if any, might look like,” Bowser spokesman Kevin Harris said Wednesday. “Without all those pieces, it’s hard to know what our options are for helping residents who would need coverage, but the mayor’s commitment is to always try and find ways to help people who need coverage.”
In an interview with The Washington Times earlier this month, Mr. Gray vowed not to leave the city’s most vulnerable residents without health insurance if Congress repeals the ACA.
At the time Mr. Gray made his comments, city leaders had estimated a $623 million shortfall for health care coverage in the District.
“We’re not going to leave people in the cold. That just won’t happen,” said Mr. Gray, Ward 7 Democrat and chairman of the council’s Health Committee. “Just from a moral or ethical perspective, we need to find a way to make sure those folks are covered. It’s something to be very worried about.”
But he acknowledged that some compromises might be needed to extend coverage under a city-run plan.
“We’ll be faced with what we can and cannot cover,” said Mr. Gray, himself a former D.C. mayor. “There will be some very difficult choices. What the Medicaid expansion provided might not be possible.”
• Ryan M. McDermott can be reached at email@example.com.
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