The signing into law of the ‘One Big Beautiful’ Bill by Donald Trump raised concerns among the public about the potential closure of Mason General Hospital. This apprehension was magnified by the inclusion of the hospital in a federal list of rural hospitals marked as financially vulnerable. The smoke hasn’t cleared yet as the majority of the bill’s provisions, a watershed Republican tax deed, are due to commence only after the midterm 2026 elections. The added stress on the already strained health care system is palpable and foreseeably will bring about severe consequences.
Effectively, the Republican bill has resulted in the biggest rollback of federal health care coverage in the nation’s history, with its impacts not expected to be immediate. The full extent of these consequences is still being assessed as lawmakers comb through the details of the reconciliation statute that has now been passed into law. However, long-term projections paint a grim picture, suggesting catastrophic outcomes.
Of serious concern is the potential loss of insurance coverage for millions of American citizens. It has been estimated that hundreds of thousands of residents of Washington state alone could be impacted. Rural health providers, including hospitals, are predicted to find themselves in precarious financial positions, which could force reductions in service, staff layoffs and even closure of facilities.
Washington, a state that has stoutly backed expanded Medicaid programs, is likely to rank among those most detrimentally impacted. The KFF, a nonprofit entity engaged in health policy research, forecasts a decline in coverage of up to 26% by the year 2034. Moreover, it’s not just Medicaid recipients who will be affected. As the number of uninsured individuals starts to climb, the resulting rise in uncompensated care is expected to unsettle budgets of hospitals, medical providers, and the state.
An alarming estimate suggests that by 2034 around 11.8 million Americans could lose their insurance coverage due to the One Big Beautiful bill, as suggested by initial estimates from the Congressional Budget Office. In fact, this bill serves as a partial repeal of the landmark Affordable Care Act, which was instrumental in significantly reducing the uninsured population in America by widening access to Medicaid.
To accommodate its tax cuts, the Republican bill works to retract much of the expanded access to Medicaid enabled by the Affordable Care Act. The proposed cut to Medicaid spending is nearly $1 trillion over the coming ten years. This reduction aims mainly at nudging current recipients out of the program by implementing work requirements.
Starting from as early as 2027, compliance with these work requirements will be mandatory for all those enrolled in Medicaid through an ACA expansion. They would need to demonstrate that they are employed, studying or volunteering for a minimum of 80 hours per month or hold a valid exemption. Admittedly, a majority of individuals on Medicaid are employed or pursuing education. However, these measures are unlikely to increase employment rates among adults; instead, they are foreseen to cause Medicaid subscribers to lose their insurance due to noncompliance with administrative processes and reporting procedures.
The consequences of these losses are serious. People who are without insurance still get sick. However, instead of tackling their physical or mental health issues preventively, which is usually more cost-effective, they tend to seek medical assistance in hospitals and inpatient units during emergencies. Medicaid covers the cost of care for a variety of services, making it particularly valuable for rural areas where enrollment is typically high. Moreover, most hospitals and nonprofit providers depend on Medicaid as a source of revenue.
Approximately a quarter of the patients at Mason General Hospital are Medicaid beneficiaries, including three-quarters of all births. These recipients are often young, working families who lack access to insurance through their employers. The Republican bill does make provision for a temporary $50 billion fund for rural health, with the intention of preventing closures of rural hospitals. However, it stands as an inadequate alternative to the significant cuts proposed for Medicaid and the ACA.
In the Kitsap Peninsula, hospitals derive roughly 11 to 13% of their annual income from Medicaid, as per state data. While it might be less than in some areas, specifically east of the Cascades, it still represents a critical source of revenue. Due to the loss of insurance coverage, the provisions for basic community behavioural and physical health needs will be scarcely accessible. While state leaders have pledged to compensate the losses of approximately $11 million to Planned Parenthood, depending on the outcome of an imminent lawsuit, other gaps persist with the shortfall from Medicaid cuts doubtful to be rectified.
Washington state is likely to experience a reduction of $36 billion in federal Medicaid expenditure over the forthcoming decade. This represents a 17% decrease, the highest across the nation. Criticism of this legislation has been vociferous, calling it a devastating blow to Washingtonians, jeopardizing the health care coverage of the most vulnerable residents, potentially causing hospital closures statewide and serving as a means to finance tax cuts for the wealthiest factions in America.
Revisions may be looming for the state’s charity care law that mandates hospitals to provide treatment to all individuals regardless of their ability to pay. While the count of uninsured patients has been on the downward trend, mostly attributed to the ACA, expansion of the state’s charity care program has taken place with hospitals being obligated to offer more preventive and primary care services to uninsured patients.
However, with increased rollback on the ACA gains and more people becoming uninsured, hospitals won’t sustain the same long-term standard of care. Emergency services will still be covered under charity care, but the state would have to bear the additional cost of preventive services to alleviate the financial burden on hospitals. This additional financial burden is a warning sign of tougher days for health care ahead.