Adviser to governor warns residents could lose health care ‘immediately’ due to federal changes

As state officials continue to assess how provisions in the recently passed “One Big Beautiful Bill” will impact the health care of Washingtonians, a senior adviser to Gov. Bob Ferguson warned this week that as many as 80,000 residents could lose their coverage in the coming months.

“We’re going to start seeing coverage losses pretty immediately,” Caitlin Safford, a senior policy adviser for the Office of the Governor, told members of the Senate health and long-term care committee. “Between the combination of federal rule, HR-1 and the potential expiration of enhanced premium tax credits, we’re going to start seeing coverage losses in January.”

Safford’s testimony came as state officials continue to review the impact of the legislation, which includes, among other things, more than $1 trillion in cuts to Medicaid over the next decade by imposing new work requirements and other reforms to the program.

The governor’s office has estimated that across the state, at least 250,000 residents will lose Medicaid coverage, while around 150,000 people will be priced out of the state’s health care exchange.

While Washington reported the lowest uninsured rate in the country in 2024 at 4.8%, the governor’s office said the funding cuts could “balloon that number into double digits.”

Following the bill’s passage, Ferguson said estimates show the state will lose between $31 billion and $51 billion in federal Medicaid funds in the next decade, which averages at least $3 billion per year. Charissa Fotinos, Medicaid director for the Washington Healthcare Authority, said Tuesday that while officials can’t say for certain how much federal funding the state will lose or how many people could lose coverage through Medicaid, “we can probably say it will be 100,000 plus people and billions of dollars.”

“The impacts will be significant,” Fotinos said.

Following the bill’s passage, the governor’s office said that the loss of funds could have far-reaching effects and result in hospital closures in rural areas due to coverage losses. Patients may find longer wait times and a lack of services for substance abuse or mental health.

Fotinos said Tuesday that the $50 billion included in the legislation meant to support rural hospitals and health care providers over five years would likely prove insufficient to fully support their needs.

“That’s not a lot of money, it doesn’t fix things,” Fotinos said. “So, will this be enough to mitigate the impacts of all of the other changes? Likely not, but when you don’t spend all day, every day, thinking about this stuff, it sounds like it could.”

While many of the provisions overhauling Medicaid are delayed for future years, Safford said legislators are likely to hear constituent concerns over the loss of coverage as lawmakers return to Olympia in January.

“We’re probably going to start seeing, at a minimum, about 80,000 people not being able to afford coverage starting in January,” Safford said. “And so, that’s going to take an immediate hit to our uninsured rate, it’s going to be a hit to our providers, we’ll probably see some counties that don’t have individual market coverage, which is going to be really tough.”

During her testimony, Safford also told lawmakers that they face a much tighter deadline to implement many of the changes as compared to the passage of the Affordable Care Act in the Obama administration.

“When the ACA passed, we had about three and a half years to implement it. Three and a half years to, in again, one of the toughest financial environments that our state has ever faced,” Safford said. “This time, we’re in the worst budget crisis we’ve ever had, and we have about a year and a half to make some really tough decisions about how our health care system is going to operate.”

While Democrats have continued to attack the wide-ranging legislation, though, Republicans in the Washington Legislature have sought to defend the bill, accusing Democrats of “fear-mongering” on a newly created website.

Pushing back on Ferguson’s accusation that the legislation is “morally bankrupt” the Senate Republican website alleges “it’s Washington Democrats’ policies that are doing real harm to Medicaid.”

The website asserts that because the immediate benefit cuts won’t impact children, seniors or individuals with disabilities, the Legislature “will not need to act on those populations.” The section adds that benefits “will remain unchanged in the short term.”

On Friday, the top Republican on the Senate health and long-term care committee also sought to push back against Safford’s testimony.

“Our committee was told by the administration that the decisions our state must make regarding the health-care arena are going to be tougher because Olympia is in its worst budget crisis ever,” Sen. Ron Muzzall, R-Oak Harbor, said in a statement Friday. “The reality is our state’s Medicaid system has been in dire need of reform for years, and the budget situation is self-inflicted.”

Muzzall added if the “sky was truly falling,” Ferguson could opt to call for a special session of the Legislature, something he has yet to do.

“I agree there are challenges ahead, but let’s deal in facts, not fiction,” Muzzall said. “I trust the people to handle the truth. No one should be misleading them.”

Earlier this month, Ferguson said the state would look to “mitigate those harms” from the legislation and may backfill the loss of federal funding for organizations “if those dollar amounts are, on a relative sense, smaller and more manageable.”

Ferguson has pledged that the state would backfill approximately $11 million that Planned Parenthood in Washington stands to lose in federal funding, though he warned the state lacks the resources to account for the full loss of funds included in the bill.

“The state of Washington does not have billions of dollars lying around every year to backfill that,” Ferguson said during a July 9 news conference.