According to a new report from Senator Maria Cantwell’s office, Washington state hospitals could lose about $5.8 billion over seven years because of Medicaid funding cuts included in federal legislation HR 1. Experts estimate that this will increase the cost of uncompensated care and intensify financial pressure on health care providers.
Apple Health is the name used in Washington for Medicaid and related insurance programs. The system is jointly funded by the federal government and the state but administered by Washington authorities, so its rules and range of services may differ from programs in other states. It provides free or low-cost coverage to low-income children and adults, pregnant women, older people and people with disabilities. For legal immigrants, eligibility depends on immigration status, length of residence and the program category: some qualify for comprehensive coverage, while others are eligible only for limited or emergency care.
The report, prepared with the participation of the Washington State Hospital Association and an organization representing community health centers, also predicts that federally funded clinics could lose up to $118 million by the end of 2027. Cantwell called for the provisions of HR 1 to be repealed or softened, warning that hospitals would have to cut services and staff while limiting access to care. Possible consequences include clinic closures and longer wait times in emergency departments.
The first changes took effect in October, when about 11,000 legal immigrants in the state lost Apple Health coverage. New Medicaid work requirements will take effect on January 1. Officials initially expected that up to 600,000 residents could lose their insurance by 2027, but after the launch of an online system for verifying exemptions, that estimate was lowered to about 200,000. In total, Apple Health provides health coverage to nearly 2 million low-income Washington residents.
Hospital leaders warn that uninsured people will be less likely to see doctors and may later arrive at emergency departments with more serious and costly conditions. Harborview Medical Center in Seattle expects at least $20 million in uncompensated care in 2026. Jefferson Healthcare, a small hospital in Port Townsend, projects a loss of $6–8 million in revenue, while the community health center HealthPoint fears that up to 10,000 of its patients could lose insurance next year.
Rural hospitals are likely to be the most vulnerable. They serve small populations, have fewer sources of revenue and depend more heavily on Medicaid payments because they cannot offset cuts with a larger number of commercially insured patients or profitable specialty procedures. At the same time, these facilities are required to maintain emergency services, while long distances make it harder to transfer patients and recruit physicians. Unlike Seattle’s major medical centers, which have more diverse revenue streams and substantial resources, rural hospitals may face staff reductions, service limitations or the threat of closing individual departments more quickly.
Based on: WA hospitals could lose $6 billion from HR 1 cuts, Cantwell report says