Famous homeowners like Taylor Swift have helped polish the image of Westerly, R.I. But the tony image belies a harsher reality for the year-round folks in this beach town.

More than one in five of the town’s roughly 23,100 residents – close to 5,000 people – are enrolled in Medicaid, the government insurance program for people with low-incomes or disabilities, according to the latest monthly report released by the Rhode Island Executive Office of Health and Human Services. 

Now, many of those residents who work in the restaurants, hotels, bars and beach clubs which have made Westerly a vacation destination are at risk of losing their Medicaid coverage under a proposed plan by House Republicans, according to local health advocates and U.S. Democratic Rep. Seth Magaziner. 

The House Budget Committee voted on Feb. 13 to seek at least $880 billion in mandated spending cuts on programs overseen by the House Energy and Commerce Committee. The committee oversees Medicaid, which is expected to bear the brunt of those cuts. 

House Republicans, who have a narrow majority in Congress, are expected to vote on the budget proposal this week. 

Magaziner said he plans to “try to convince at least a handful of House Republicans not to gut the health care of millions of people in order to pay for tax cuts for rich people.” 

The proposed cuts, Magaziner and local health advocates said, would especially hurt nonprofit federally qualified health centers, the safety net of last resort for the uninsured, the underinsured, and other vulnerable people. 

“But it’s not just low-income people,’’ Magaziner said in an interview Monday. “Many people who are solidly middle class qualify for Medicaid, and this would pull the rug out from under them as well.”

On Monday, Magaziner talked about the proposed cuts during a visit to the Wood River Health Services, a nonprofit community health center with offices in Westerly and Hope Valley. About 40% of Wood River Health’s patients are covered by Medicaid, said Alison L. Croke, the center’s president and CEO. 

During the last five years, Wood River Health’s patient population has grown by nearly 50 percent, from 6,700 patients in 2019 to more than 10,000 patients last year, according to Croke.

In response to the increased demand for care, Croke said, Wood River Health has expanded its offices in Westerly, built a new facility in Hope Valley and begun offering dental care on Block Island. 

And the demand is not just from Medicaid patients. Wood River Health also cares for seniors on Medicare (about 20% of its population) and people with commercial insurance coverage.

“We have folks that are landscapers, people who are bartenders, people who are barbers, hairdressers, (people who) clean houses,” Croke said, as well as “doctors and lawyers and bankers.’’

The center’s finances are already strained, she said. For the first time since she joined Wood River Health six years ago, Croke said, the center is projecting a deficit for the fiscal year that ended June 30, 2024.

And the projected deficit, she said, is before any of the proposed federal cuts to Medicaid.  

It’s unclear which, if any, of the proposed cuts to Medicaid that Magaziner has outlined will be approved by House Republicans. But among the ideas being circulated, he said, is cutting people from the Medicaid rolls added during the expansion of the Affordable Care Act. Rhode Island was among the first states to expand its Medicaid rolls, in 2014. Many of the newly insured during the expansion were working single adults who did not have employer coverage. 

Any significant cuts to Medicaid also are expected to have a ripple effect throughout the health care system, which depends on the funds to reimburse health clinics, nursing homes and hospitals, among others. Health centers, already strained by a national provider shortage and a rise in patients since the pandemic, could be forced to cut staff and services – or shut down altogether. 

“The reductions that are being considered…would require the health centers to really dramatically reduce their workforce,’’ said Elena Nicolella, president of the trade group the Rhode Island Health Care Association. And cutting workers, she said, would result in more overworked clinicians leaving, longer wait times for patients to get appointments, and more delays in care resulting in more and sicker patients winding up in hospital emergency rooms.

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