All told, the spending bill includes seven attempts to override the will of local elected officials — the most in at least a decade.
The provisions must clear several legislative hurdles, and city officials said they will lean on their allies in the Senate to stop that from happening.
Mayor Muriel E. Bowser (D) said the heavily Democratic nation’s capital will continue to be vulnerable to similar attacks as long as its laws and finances remain under the thumb of the GOP-controlled Congress.
“Until we have statehood, the will of Washingtonians will continue to be overturned by members of Congress who represent neither the people nor values of Washington, D.C.,” she said in a statement. “Rather than working to erase progress that has made Washington, D.C. a safer, stronger city, Congress should focus on the many pressing issues before them.”
Instead, they have worked to strip the health-care law
of key tenets. The requirement that most Americans carry health insurance is scheduled to end in January.
In reaction, the District and several states instituted their own mandates. In D.C., lawmakers approved the Health Insurance Requirement Act of 2018, set to take effect in January when the federal requirement goes away.
D.C. has been touted as one of the Affordable Care Act’s greatest success stories. The rate of uninsured D.C. residents was cut in half after the law was enacted, from 7.6 percent in 2010 to 3.8 percent in 2015, according to a report last year by the D.C. Auditor’s Office.
The bulk of those who benefited were Medicaid participants. During fiscal 2016, D.C. had a monthly average of 261,768 people covered under Medicaid, or nearly 40 percent of the population. Of those, 75,828 gained coverage through the ACA Medicaid expansion.
The District’s health-insurance exchange — a marketplace where consumers can shop for and compare coverage plans, sometimes with help from federal subsidies — covered nearly 17,000 people as of December 2016, with an additional 59,000 people insured through the small business marketplace, according to the auditor’s report.
Rep. Gary Palmer (R-Ala.) introduced an amendment on Wednesday evening to an appropriations bill that includes D.C. spending to prohibit the city from carrying out the Health Insurance Requirement Act of 2018, which Bowser has yet to sign.
“Individuals should be allowed to make their own decisions about the type of insurance they want to purchase without being subjected to punishment from the government,” Palmer said in a statement titled, “Palmer Protects Individual Freedom.” “The D.C. individual mandate would restrict patient choice and force people to purchase insurance that they may not need, desire, or be able to afford.”
Rep. Keith Rothfus (R-Pa.) introduced an amendment targeting a narrow section of the D.C. law that he says would allow the city to seize the property of residents who are unable or unwilling to pay the tax penalty.
“Regardless of what anyone on either side of the aisle thinks about a requirement to buy health insurance, governmental seizure of a citizen’s private property for those who cannot afford health insurance is draconian,” he said in a statement.
Rothfus added that in 2015, 6,902 residents of the District were forced to pay the mandate penalty and 75 percent of them made less than $50,000 a year.
But advocates of the D.C. mandate said it will help keep premiums flat.
“Without a requirement in place, we will likely see an increase in premiums, and an increase in our rate of uninsured, and those are all things we want to avoid,” said Jodi Kwarciany, health policy analyst at the D.C. Fiscal Policy Institute, a left-leaning think tank. “We want to preserve our gains.”
Del. Eleanor Holmes Norton (D), the District’s nonvoting delegate in Congress, said the GOP amendments show that the Republicans have not gotten over failed attempts to repeal the Affordable Care Act.
“I do not intend to allow D.C. to become Republicans’ scapegoat as they fume about the ACA’s continued popularity,” she said in a statement.
In addition to the insurance mandate limits, the House spending bill includes measures to block the city from using local tax money to subsidize abortion for low-income women and to regulate the sale of recreational marijuana — both of which were enacted last year.
Not yet enacted are provisions to prevent the city from using local tax money to implement its assisted-suicide law, known as Death With Dignity, and to repeal the District’s right to spend its own tax money.
Palmer previously introduced a measure to block a city law that says employers cannot discriminate against workers based on their reproductive health decisions, known as the Reproductive Health Non-Discrimination Amendment Act, but that was already in the spending proposal this year.
Palmer joined Reps. Mark Meadows (R-N.C.) and Mark Sanford (R-S.C.) in introducing a measure to stop the city from implementing Initiative 77, which voters approved last month to increase wages for tipped workers. That effort died in a committee this week, but a Democratic majority on the D.C. Council is also seeking to repeal the ballot measure.
Fenit Nirappil contributed to this report.