Kishanee Haththotuwegama: Washington must preserve health care for all, especially the poor

“Ma’am, could I sit here?” a burly, sun-tanned older man gestured toward a folding chair. As he sat down, he grabbed his lower right belly and let out a sharp breath.

He had just been discharged from a hospital in north Spokane the day before, following hernia surgery. It is the kind of surgery a doctor tells patients to rest after. But without a ride or a bus pass, he walked 5 miles to a shelter downtown. When he woke up this morning, he was shuffled out, as it closes during the day. He had walked slowly and carefully to find our team, trying not to sweat through his bandages in the summer heat.

As a medical student working with unhoused people in Spokane for the past year, this situation was frustrating, but not unfamiliar. Getting care without housing or transportation is an uphill battle. But despite the odds, he’d had the surgery. This is what Medicaid makes possible: his surgery, medications and post-operative follow up were covered. He could schedule this surgery before it became life-threatening. Without coverage, he would have had to wait until the hernia twisted and cut off the blood supply to his intestines – a surgical emergency called strangulation.

Hospitals in the U.S. are required to provide emergency surgery. He would have had to pay $11,535 out of pocket. Since he had no way to pay, the hospital would have eaten the cost or passed it on to the rest of us.

Though he still did not have a roof over his head, he kept positive about his hard-earned, 43-days sobriety, and his relief from pain. He brought this energy to other people stopping by for services, and I could see him becoming a great peer counselor someday. What would have happened if he had lost Medicaid because of the new work requirements or bureaucratic hurdles in the congressional budget megabill? Evidence-based peer counseling programs he could work for are covered by Medicaid too – one of many services that will be gutted to give the biggest tax cuts to the wealthy few.

People working low-wage jobs without insurance or those who lose jobs because they are too sick to keep them, fall through the cracks without Medicaid. If their Medicaid dollars no longer reach clinics and hospitals, those cracks may be the breaking point for our fragmented health care system.

In Eastern Washington, 30% of people are on Medicaid. More than half of them are children. Because of the cuts in the budget megabill, 350,000 patients will lose health coverage through Medicaid. Washington is estimated to lose 18% of our federal funding over the next 10 years, approximately $37 billion. That shift will upend individual lives but is also enough to shake our state health care system. At rural critical access hospitals Mount Carmel and St. Joseph’s in Stevens County, for example, about a quarter of patients are on Medicaid. Losing this revenue could reduce hospital operations, if they are able to keep operating at all.

Medicaid is not the only type of health coverage affected by federal actions. The ongoing government shutdown hinges on subsidies included in the Affordable Care Act. Without them, insurance costs will skyrocket for many, adding to the growing list of people unable to access care.

As a future physician, I worry about these unseen systemic costs. When Medicaid spending decreases, individuals will lose access to primary care, planned surgeries and community health centers. I am being trained to practice medicine through preventive care, not to wait until a condition becomes critical. It costs us more to respond to a crisis. And it is already hard enough seeing patients wait months for an appointment. These cuts will leave us with a far more expensive and dangerous model of care for everyone.

We need to invest in our health. Our state representatives must fill the funding gap from federal cuts to Medicaid in the 2026 session. When they ask where the money would come from, we should argue for progressive taxation that would finally require our state’s multimillionaires and wealthiest corporations to pay the taxes that they truly owe our communities. It is only when they contribute the same way the rest of us already do that our state can make up for this deficit.

Our state can be a lifeline for Eastern Washington residents like the man I met if we choose to fund basic health care. Our alternative is losing the health and lives of hundreds of thousands of Washingtonians and crippling our system’s ability to care for everybody.

Kishanee Haththotuwegama is a third-year medical student at Washington State University in Spokane. She is a member of Washington Physicians for Social Responsibility’s Economic Inequity & Health Task Force.