Risk of 'severe consequences' for WA healthcare from Trump's budget plan

The Impact of the "One Big Beautiful" Bill on Washington State's Healthcare System

The passage of the so-called “One Big Beautiful” bill, a significant Republican tax reform, has sparked widespread concern among healthcare providers and hospital administrators in Washington state. Many feared that this legislation could lead to the closure of critical healthcare facilities, particularly in rural areas. Among these concerns was Mason General Hospital, which found itself on a federal list of financially vulnerable hospitals. CEO Eric Moll emphasized that while the situation remains stable for now, the long-term implications of the bill are deeply troubling.

Immediate Concerns and Long-Term Implications

The bill, which is considered the largest rollback of federal health care coverage in U.S. history, does not immediately impact the healthcare system. Most of its provisions will take effect after the 2026 midterm elections. However, the stress it places on an already strained healthcare system is evident. Experts warn that the consequences could be dire, with millions of Americans, including many in Washington, losing their insurance coverage.

The bill’s effects are not limited to those who lose insurance directly. As the number of uninsured individuals grows, hospitals and medical providers will face increased costs due to uncompensated care. This financial strain could lead to service cutbacks, layoffs, or even the closure of entire facilities, especially in rural communities where access to healthcare is already limited.

Medicaid Cuts and Work Requirements

One of the most significant aspects of the bill is the reduction in Medicaid spending by nearly $1 trillion over the next decade. This reduction is primarily achieved through work requirements, which mandate that individuals enrolled in Medicaid through the ACA expansion must prove they have worked, volunteered, or attended classes for 80 hours per month. While most Medicaid recipients are working or in school, the administrative burden of meeting these requirements could result in many losing their coverage.

Monica Berhard, CEO of Kitsap Mental Health, highlighted the potential consequences of these changes. She noted that individuals who lose their insurance may delay seeking preventative care, leading to more severe health issues that require emergency treatment. This shift from preventative to crisis-based care could place an even greater strain on hospitals and healthcare providers.

Financial Strain on Rural Hospitals

Rural hospitals like Mason General Hospital are particularly vulnerable. Approximately 25% of its patients are covered by Medicaid, including three-fourths of its deliveries. Researchers from the Cecil G. Sheps Center for Health Services Research have identified Mason General as one of the hospitals at risk of financial distress due to the bill’s provisions.

While the bill includes a temporary $50 billion earmark for a rural health fund, experts argue that this amount is insufficient to offset the permanent cuts to Medicaid and the ACA. The funds come with additional regulatory hurdles, making them less effective as a long-term solution.

State Response and Future Challenges

State leaders have pledged to address some of the gaps left by the bill, such as funding for Planned Parenthood. However, the overall financial impact on the state remains uncertain. Washington is expected to see a $36 billion reduction in Medicaid spending over the next decade, the highest in the country. Governor Bob Ferguson described the legislation as morally bankrupt, warning of potential hospital closures and the loss of health care coverage for vulnerable residents.

Hospitals may also need to revisit their charity care laws, which require them to provide care regardless of a patient’s ability to pay. With more people losing insurance, the financial burden on hospitals could become unsustainable. While emergency services would remain part of charity care, the cost of providing preventative and primary care could become too great for hospitals to manage without state support.

Conclusion

The "One Big Beautiful" bill presents a complex and challenging landscape for Washington’s healthcare system. While the immediate effects may not be felt for several years, the long-term consequences could be catastrophic. Hospitals, particularly in rural areas, face significant financial risks, and the loss of Medicaid coverage could lead to widespread disruptions in care. As the state and local policymakers grapple with these challenges, the need for comprehensive solutions becomes increasingly urgent.