All right, good morning.

I'm at large councilmember Christina Henderson, Chair of the Committee on Health.

Today is Wednesday, May 6, 2026.

The time is 9 31 a.m.

We are in room 123 of the John A.

Wilson building.

This is a hybrid hearing with uh government witnesses testifying in person, and we'll hear from public witnesses on both in person and online.

This hearing is being broadcast live on Cable Channel 13 as well as on my YouTube page at CMC Henderson.

I'm calling to order this meeting of the committee on health for the proposed FY27 budget for the health benefit exchange.

We'll hear testimony from both again today.

Let me tell you a little bit about health benefit exchange.

So DC Health Benefit Exchange Authority or HBX is a quasi-governmental agency of the District of Columbia government charged with implementing and operating the district's health benefit exchange.

The exchange operates DC HealthLink, an online insurance marketplace for district residents and small businesses.

DC HealthLink fosters competition and transparency in private health insurance market, enabling individual small businesses to compare health insurance prices and benefits and to purchase affordable quality health insurance.

The health benefit exchange has expanded their scope of services available in the last year by developing the basic health plan, also known as the Healthy DC Plan, which is a coverage option for individuals between one hundred and thirty-eight and two hundred percent of the FPL who lost Medicaid coverage this past year.

HBX works closely with the Department of Healthcare Finance to make this transition as smooth as possible.

And I want to commend Director Kaufman and her team for their quick and effective work.

If you're here in person, there are timers here.

If you're virtual, if you go to gallery view, you'll be able to see the timer there in the box.

Patricia Quinn.

Okay, Jacob, when you're ready.

Thank you to the chair for the opportunity to testify today.

My name is Jacob Spidel, and I'm a staff attorney at LegalAid DC.

First off, we strongly support the proposal to add dental and vision benefits for basic health plan enrollees.

And we urge the council to approve the five point seven million dollars the mayor proposed to support basic health plan dental and vision benefits.

The loss of dental coverage and vision coverage have been devastating for those who are transitioned from Medicaid to Healthy DC, which currently does not cover dental care except in mental medical emergencies.

The cost for restoring dental and vision coverage to the healthy DC population is a fraction of the district's annual budget, but will have an outsized positive impact on those individuals who have been moved from Medicaid to Health E DC.

Next up, we urge the council to increase the income limit for healthy DC from 200% of FPL up to what was the Medicaid limit.

215% of FPL for childless adults and 221% of FPL for parents or caretaker relatives.

When healthy DC was created, the lower income limit meant that about over 1,500 people previously enrolled in Medicaid did not qualify for healthy DC, even though their income had qualified them for Medicaid.

More broadly, the council should ensure that everyone losing Medicaid coverage due to cuts in that program can qualify for healthy DC if at all possible.

Similarly, the district should support healthy DC enrollment for DC residents who lose their affordable health coverage due to changes in federal law and do not qualify for alternative coverage.

Healthy DC has become an essential last resort to DC residents whose affordable health insurance is stripped away through cuts to Medicare, Medicaid, and the health care exchange.

Under the one big beautiful bill act, many DC residents will lose their Medicaid coverage on October 1st, 2026.

More will lose coverage January 4th, 2027, and others will lose access to affordable plans under the Affordable Care Act in January 2027.

When DC residents lose access to health insurance due to these changes, DC should have funding allocated to allow them to enroll in healthy DC to the greatest extent allowed by federal law.

Last, we encourage healthy DC to use continuous enrollment beyond the first year.

Healthy DC is using continuous enrollment for the first year, allowing people to enroll as soon as they're eligible.

After the first year, however, Healthy DC plans to switch to an open and special enrollment process that will force people to wait for certain enrollment periods, even if they're eligible.

This has higher administrative costs and is a difference from Medicaid, which has continuous enrollments.

Thank you for the opportunity to testify.

Thank you.

Anne?

Chair President Henderson, thank you for the opportunity to testify.

My name is Ann Gunderson, and I'm a senior policy analyst at DC FPI and member of the Under 3 DC coalition.

My verbal testimony focuses on the importance of preserving the investment in health care for child care.

And my written testimony provides feedback on the new healthy DC plan.

These programs ensure that district residents and workers maintain access to low-cost health care so they can thrive and meaningfully contribute to the district's economy.

To continue supporting health care in DC, lawmakers should maintain the mayor's proposed investment of 12 million dollars annually in health care for child care and maintain her proposed investment of 5.7 million dollars annually for restoring dental and vision benefits to healthy DC.

To date, more than 3,500 child care employees and their families have benefited from health care for child care, many of whom are receiving employment-based health care for the first time.

Many educators have testified before the council about how life-changing this program has been for them in every dollar DC invests in health care for child care, and that's over a dollar in premium value, making it a beneficial program for the entire district.

The exchange's commitment to creating a well-designed health care program is likely one reason why the pay equity funds has been so effective at attracting more educators to early childhood classrooms, increasing the retention of qualified educators, and expanding access to high-quality affordable care to district families.

As a result, health care for child care has become a national model that other states are studying and helping to implement for their child care sectors.

For example, North Carolina is exploring creating its own workforce compensation program for early educators, including a health care component, modeled after health care for child care.

Ensuring that child care workers have access to health care is central to closing persistent staffing shortages and building the workforce needed to provide families with accessible, affordable, high-quality care.

While the mayor's proposed budget for health care for child care is sufficient for fiscal year 27, if health care rates go up significantly, 12 million dollars may not be enough to cover everyone currently enrolled.

And it certainly will not be enough to eliminate the need for the wait list for this program.

There are also additional child care employers in the districts who are not currently enrolled in health care for child care group group coverage who would benefit from it.

But the exchange's outreach to new child care providers has stopped because there is not enough funding to cover new employers.

As the pay equity fund and subsidy program face real threats in this budget cycle, it's critical to protect every penny currently dedicated to health care for child care and anticipate how the cost of the program will grow in future years.