‘Are we just left to die?’: Spokane health care providers, patients consider Medicaid cuts in roundtable

As an older Spokane resident, Gail Halverson relies on Medicare and Medicaid to live. Right now, she is afraid she could lose that coverage.

“People are going to be sick, and they’re going to have to go to nursing homes – well, who’s going to pay for the nursing homes? That’s Medicare; that’s Medicaid. So, are we just left to die?” Halverson said at a Wednesday roundtable of health care providers and patients U.S. Sen. Maria Cantwell, D-Spokane, hosted.

Democrats claim Republicans are planning for $880 billion of cuts to Medicaid in their budget plans. At the roundtable, health care providers sounded off on the impact such cuts could have on Eastern Washington’s medical system.

“These are our neighbors, these are our friends, family, people you work with are relying on this Medicaid program,” CHAS Health CEO Aaron Wilson said. “If we’re going to take $880 billion out of the system, these systems fail. And it’s not just our patients, but it’s our staff, and it’s everybody across Eastern Washington that are in peril.”

Washington State University Vice Dean for Clinical Affairs Jeff Haney said a majority of medical students at their Spokane campus use Medicaid because most students cannot work while studying for their medical degree and are too old to use their parents’ insurance.

“We rely on these programs to actually develop our future workforce,” he said. “And if we are not providing Medicaid support for our patients and our communities at large, sickness is not going to stop. People will continue to get sick, and actually the challenge without having insurance is that we actually end up spending more money than if we actually provide insurance to patients,” he said.

Medicaid beneficiaries also make up a significant portion of patients at Spokane hospitals. According to 2023 Washington Health Department data, Providence Sacred Heart Hospital generated 26.5% and MultiCare Deaconess Hospital generated 20.5% of that year’s revenue through Medicaid.

According to data from the Washington State Health Care Authority highlighted in a report by Sen. Maria Cantwell, 54% of children and 22% of adults in Washington’s 5th Congressional District, which includes Spokane, are insured by the program.

“This isn’t about waste. This isn’t about fraud. This is about an essential service that is helping us make the health care system work,” Cantwell said at the roundtable.

Do Republicans want to cut Medicaid?

But questions remain about whether Republicans are actually proposing cuts at all.

The budget resolution passed by the House earlier this month directed the chamber’s Energy and Commerce Committee to cut $880 billion in spending over the next 10 years. Republicans argue these cuts may be directed at Medicaid.

“This is not a different interpretation of the facts, they’re just not true,” said Rep. Mike Simpson, R-Idaho, said in debate over the resolution. “There’s nothing in here that cuts Social Security. There’s nothing in here that cuts Medicare. There’s nothing in here that cuts Medicaid.”

But Democrats point to a letter from the Congressional Budget Office stating that 93% of non-Medicare spending under the Energy and Commerce Committee’s jurisdiction is related to the federal share of Medicaid spending. Excluding Medicare spending, which Republicans have taken off the table for cuts, the committee oversees $8.9 trillion of spending.

The committee only oversees $700 billion of spending that is not related to either Medicaid or Medicare, which would not be enough cuts to fulfill the mandate. Meanwhile, the Congressional Budget Office pegs federal Medicaid spending at $8.2 trillion.

After the roundtable, Cantwell said there was “no logical explanation” for the Republican budget outside of Medicaid cuts.

“Not only are you cutting Medicaid, you are talking about massive, massive cuts to Medicaid. So much so that our clinics are in real jeopardy of even being able to stay open,” she said.

In two different town halls March 17, Congressman Michael Baumgartner, R-Spokane, said that, while further spending increases to Medicaid might slow, there would be “no reduction in overall dollars to Medicaid” under the Republican plan.

“Total Medicaid spending will still go up. It won’t go up at the same rate that folks may like. But Medicaid is fundamentally a broken system. It was set up to take care of the truly destitute – the widows that need it with their kids. There’s a lot of working-age males in their 20s that are on Medicaid right now,” Baumgartner said in the Ritzville town hall.

Much of that expansion came after the adoption of the Affordable Care Act, also known as Obamacare, which allowed states to make residents eligible for Medicaid as long as their income does not exceed 138% of the national poverty line. That means in a state that has expanded Medicaid, individuals are eligible for the state insurance if they make $21,597 or less a year.

Baumgartner also said he would like to see a Medicaid work requirement enacted to prevent working-age men from using the insurance without working.

How could Medicaid be cut?

If the Republican budget cuts impact Medicaid, it is unclear exactly how those cuts would be enacted or affect the program. The budget resolution does not specify how the Energy and Commerce Committee would make $880 billion of cuts and what portions of Medicaid could be on the chopping block.

Cantwell said she expects Republicans to reveal further details of the cuts in the next 30 days.

“They will have to come clean with what this proposal actually is. But it is safe to say that if you were looking for this kind of massive cut, you would have hospitals close, clinics would close, and many people would not have access to care,” she said.

In January, Politico reported on a list of proposed spending cuts distributed to House Republicans from their leadership. These included different methods by which Medicaid could be cut, which were largely similar to cuts in the failed 2017 attempts to repeal Obamacare.

• Right now, the federal government pays states a specific percentage of overall Medicaid costs. That could be changed to a fixed amount per beneficiary, which would place more of the financial burden on states over time as health care costs grow.
• With the Medicaid expansion under Obamacare the federal government covers 90% of the costs of the expansion. That could be changed to match the lower percentage the federal government pays to states for Medicaid spending not included in the Obamacare expansion.
• Republicans could also institute work requirements for beneficiaries to receive Medicaid, which would lower the number of beneficiaries and its cost to the federal government.

Rural health

Cuts to Medicaid could lead to slashed services and closed facilities in rural areas where Medicaid rates are higher, which would affect other patients with Medicare or private insurance.

In northeast Washington, 30% of nonprofit NEW Health’s patients are on Medicaid. Without Medicaid, NEW Health would have to lay off about a third of its staff and close its clinics in Springdale, Loon Lake and Ione, CEO Desiree Sweeny said.

“In some of these small towns, we are the only health care provider in the community,” she said.

The health system’s clinics and pharmacies serve Ferry, Stevens and Pend Oreille counties. With the state’s highest rates of suicide, smoking and opioid disbursement, life expectancy in the three counties is 12 years lower than the state average, Sweeny said.

Elisanne McCutchen, 64, lives across the street from NEW Health’s clinic in Springdale.

McCutchen, who doesn’t own a car, said she pays someone once a month to take her grocery shopping in Spokane, but it’s expensive.

“Without this clinic here, life would be significantly more difficult,” McCutchen said. “I’m not even sure I could stay in Springdale. I would probably have to move to Spokane, which I don’t really want to do.”

The clinic treats her adrenal deficiency, a chronic illness she has had for more than 30 years. Her adrenal glands don’t produce cortisol, so she takes supplements. For her condition, it’s also important to avoid both emotional and physical stress.

NEW Health does a good job managing her condition holistically, McCutchen said. When she lived in Tennessee she had to travel to different specialists.

“Because my condition is properly managed, the rest of my health improved as well,” she said.

With 189 employees, NEW Health is one of the largest nongovernment employers in the rural region north of Spokane. Besides economic impacts from job cuts, cutting Medicaid and interrupting preventive care could cost the health system more in the long run.

Patients who are able to will seek care in Spokane, which could become overburdened, some providers say. Meanwhile, patients who lose access to primary care may have delayed diagnoses that cost hospitals more to treat. Preventive health care is more cost effective by treating problems before they grow out of control, providers say.

“The more access to primary care … the better health outcomes and the total cost of care goes down by a significant margin,” said Haney.

Medicaid cuts would not only hurt clinics like NEW Health – rural public hospital districts would also face tough decisions.

Newport Hospital and Health Services in Pend Oreille County treats patients from across the border in Idaho as well as Washington. About 23% of patient reimbursements come from Medicaid.

“There is no way the cuts being considered will not hurt us financially,” CEO Kim Manus said in an email. “We already are paid less than the cost of care for Medicaid. Any cuts to Medicaid would likely result in cutting services, especially those that are expensive to provide with little reimbursement. … If forced to cut services, we can’t cut a service only for Medicaid patients – if cuts are made, they are made for all patients.”

In 2023, Medicaid paid for 21% of services at Garfield County Hospital District. The hospital’s operating margin for 2024 was down 5%, but it was able to maintain positive net revenue through grants and taxes, according to a February snapshot report on rural Medicaid by Cantwell’s office.

“Even a small reduction in our Medicaid reimbursement or a reduction in our patient volumes due to lost or decreased coverage would push our facility into the red and could put us at risk of closure,” Garfield County Hospital District CEO Mat Slaybaug said in the report.

Medicaid disparities are even more pronounced in central Washington. Eight rural hospitals in Washington receive over 25% of their total reimbursements from Medicaid – seven of which are east of the Cascades.

That includes Samaritan Healthcare in Moses Lake with 30% and Othello Community Hospital with 58%. More than 98% of children ages 0 to 19 are on Medicaid in Adams County, where Othello is located, according to the Washington State Health Care Authority.

“We need our rural health care system to work,” Cantwell said. “And Medicaid is a big part of that.”