‘Perfect storm’ coming for WA amid federal health care cuts, authorities warn

OLYMPIA – Washington will start seeing health care coverage losses in the individual marketplace early next year, state lawmakers learned in a Tuesday morning committee presentation.

At least 80,000 people in Washington will likely be priced out of their coverage beginning in January, the Senate Health and Long-Term Care Committee heard during an update on recent federal health care changes. The meeting comes weeks after the passage of the controversial “One Big Beautiful Bill Act.”

The prognosis was grim.

“That’s going to take an immediate hit to our uninsured rate. It’ll be a hit to our providers,” said Caitlin Safford, senior policy adviser with the Office of the Governor. “We’ll probably see some counties that don’t have individual market coverage, which is going to be really tough.”

The looming marketplace losses are a result of “federal rule,” the new federal law, and the possible expiration of enhanced advance premium tax credits, she said.

Then, the following year, the state is bracing for “pretty significant Medicaid hits,” Safford said – a reality for which providers are preparing.

“So there’s going to be some tough decisions that are going to have to be made on the ground around how we’re structuring our health care system,” Safford said.

Washington state officials have been racing to understand the far-reaching implications of the federal tax and spending bill signed into law by President Donald Trump on July 4. Deep federal funding cuts are expected to fray the social safety net, including food stamp benefits and Medicaid, which provides health coverage for low-income people.

Much of the megabill’s effects are still unknown, but state lawmakers will no doubt need to address the consequences in next year’s legislative session.

They’ll have to figure it out fast.

“Coming into January, into our 60-day short session, from a constituent point of view, a lot of the concerns that you’re likely going to hear will be about the individual market,” Safford told lawmakers on the committee. “So we’re going to see premium increases.”

Democrats have especially focused on the bill’s Medicaid cuts, condemning them as “cruel.” But Republicans such as Senate Minority Leader John Braun view the federal measure as protecting the program by rooting out fraud and ensuring that benefits are directed toward those most in need.

When the Affordable Care Act passed, the state had about 3½ years to implement it during a difficult financial time, Safford said. Today, it has about a year and a half to make hard choices about how the health care system will run.

Many of the changes to Medicaid reportedly won’t be felt until after next year’s midterms.

Dr. Charissa Fotinos, the state Health Care Authority’s Medicaid director, didn’t mince words during the presentation.

“As I was reviewing these slides and reading about it over the last few months, I will say, as a person and a primary care provider, it just hurts,” Fotinos said. “It hurts to read these, and it’s painful.”

Fotinos said estimates vary when it comes to the new law. It can’t be said with certainty how many people stand to lose health coverage or how much it’ll wind up costing the state over 10 years, she said.

An accompanying slideshow presentation stated that between 200,000 and 320,000 Washington residents are projected to lose their Medicaid coverage. From now until 2034, the state is expected to lose billions of dollars in federal funding.

Gov. Bob Ferguson has committed to filling an $11 million funding gap over the next year if federal dollars are allowed to be stripped from Planned Parenthood under the bill, Fotinos noted.

Under work requirements starting in December 2026, adults ages 19 to 65 receiving full Medicaid coverage will need to show that they’re working, training or participating in community engagement 80 hours per month, with some exemptions. But Fotinos said most Medicaid adults – about 64% nationally – already work. If burdensome requirements take effect, then people may not seek care until they have to go to a hospital emergency department, she said. At the same time, hospitals will be feeling the effects of federal funding cuts.

“Unfortunately, a perfect storm brewing,” she said.