Bold opening: Tens of thousands in Washington could soon lose healthcare coverage and be left navigating a maze of escalating costs and uncertainty. And this is where the story gets controversial, because the consequences ripple far beyond a single policy change.
How did we get here?
In July 2025, President Donald Trump signed HR1, widely referred to as the “Big Beautiful Bill.” A core part of HR1 reshapes Medicaid—known in Washington as Apple Health—shifting more funding responsibilities to states and tightening eligibility rules.
The bill projects roughly $1 trillion in federal Medicaid cuts over the next decade. By December 31, 2026, HR1 requires states to enforce work requirements, meaning adults ages 19–63 who are eligible must work, attend school, or volunteer for at least 80 hours per month to maintain coverage. Additionally, recipients would need to verify their eligibility every six months, rather than annually.
The Washington State Health Care Authority estimates that more than 620,000 residents could be affected by these work requirements and redetermination changes, with the state facing billions in expected federal funding reductions.
For people like Susan Ben-Rubin, the coming changes are already felt. A near two-decade Washingtonian and cancer survivor, she has faced mounting health concerns after a 2015 breast cancer diagnosis and subsequent complications including osteopenia and a serious kidney condition. When she lost her job in May, continuing employer-based coverage through COBRA would have cost about $2,000 per month for her and her child, who also has a chronic illness.
Seeking options, Ben-Rubin turned to Apple Health. She describes the process as exhausting and confusing but ultimately secured coverage for herself and her daughter. Still, she worries about ongoing changes and the possibility of losing coverage, which could leave them facing thousands of dollars in monthly out-of-pocket costs.
“Healthcare should be a right,” she insists. “It shouldn’t be something you have to fight for.”
What might the state do?
Currently, Washington spends roughly $21 billion annually on Medicaid, with more than half of that funded by the federal government. Facing HR1’s effects and a looming budget shortfall, officials warn that replacing lost federal dollars will be challenging.
Representative Nicole Macri (D-Seattle) emphasizes the state cannot fully backfill federal cuts. She anticipates an increase in the uninsured rate as HR1 provisions take effect and notes that back-funding Medicaid would force cuts in other areas. The immediate priority, she says, is to minimize harm for the most vulnerable while pursuing targeted investments to preserve coverage where it matters most.
Macri identifies October as a critical pressure point: an estimated 30,000 Washingtonians could lose coverage due to reduced eligibility for certain non-citizen adults, including refugees and asylees. Of these, about 2,700 people rely on long-term care or live in nursing facilities and would face immediate disruption.
Beyond those directly reliant on Medicaid, Macri warns that rising numbers of uninsured people will strain the state’s hospital system, potentially reducing access to care for everyone.
On the other side of the aisle, Senator Chris Gildon (R-Puyallup) agrees that HR1 will bring changes but argues that Medicaid should serve those who truly need it. He suggests that allowing able-bodied individuals to fall off coverage if they don’t meet work requirements may be appropriate, and that a more precise cleanup of enrollment—removing duplications across states—could save millions. Overall, he believes state administrators closer to the problem understand it best and can respond more effectively.
What’s next? This week, the Washington House and Senate will unveil budget proposals, offering a clearer picture of where cuts will occur, what taxes might rise, and how Medicaid funding will be adjusted in light of HR1.
Macri stresses the central question: what is sustainable given Washington’s budget limits, especially as the state grapples with potential gaps in coverage and the ripple effects on hospitals and other health services? The debate hinges on balancing immediate protections for vulnerable residents with long-term fiscal realities—and on who bears the cost when federal support recedes.
Controversial note to consider: should states bear the primary responsibility for funding eligibility and access to healthcare when federal programs tighten restrictions? What trade-offs are you willing to accept between tighter eligibility and broader coverage? Share your thoughts in the comments: do you support targeted protections for the most vulnerable, or do you favor a more comprehensive approach that preserves funding even if it means tougher budget choices elsewhere?
