The massive budget bill proposed by President Donald Trump and passed by the U.S. House of Representatives last month will almost certainly have a far-reaching and devastating impact on health care access in rural areas — areas like my home of Okanogan County, where I’m a physician.
Every day, Mid-Valley Hospital in Omak sees patients who have traveled 60 to 90 minutes to seek urgent and emergency care, including women in labor. Financial strain has already caused closure of obstetric services in two of our three critical access hospitals — those with fewer than 25 beds — and we struggle to maintain specialty care services. Our primary specialty care center in Wenatchee is often unable to accept new patients, and in Yakima, the largest city in the region, only one hospital remains to serve more than 100,000 people. Tribal communities like the Yakama Nation and Colville Reservation face even more barriers.
As a family medicine physician, I have delivered dozens of babies whose parents raced down long mountain highways, hoping and praying they will get to us in time. Patients must travel long distances to an urgent care clinic for injuries, heart attacks, strokes and other problems that in more urban areas would be treated in emergency departments.
I also serve as the public health officer for Okanogan County, the geographically largest county in Washington. Because of our size and topography, many residents already find it hard to get quality care. Adding financial burden to these barriers will only worsen patient outcomes.
Okanogan County is heavily dependent on Medicaid and Apple Health. Two-thirds of newborns I deliver at Mid-Valley Hospital are billed to Medicaid. As of 2023, 42% of all children in the county received insurance through that program.
This is emblematic of Central Washington. The 4th Congressional District that U.S. Rep. Dan Newhouse represents is the most Medicaid-dependent district in the state, with nearly 300,000 district residents enrolled. That’s why it was heartbreaking to see the U.S. House pass their budget bill last month, and to see Rep. Newhouse vote for it.
If this bill were to become law without any changes, it will damage rural communities across the country. It is certain that some hospitals, clinics and long-term care facilities, already stretched thin in the current system, will close. A study released last week showed that 14 rural hospitals across Washington are in danger of closure, including many in Central Washington, and including Mid-Valley Hospital in Omak, where I work.
When services shut down, they close for the entire community, not just Medicaid beneficiaries.
I agree with the imperative to root out “waste, fraud and abuse.” The problem is there isn’t very much waste to find. In 2024, 95% of Medicaid payments were proper, according to the Centers for Medicare & Medicaid Services, and 80% of improper payments were due to insufficient documentation. The truth is that Medicaid is the most efficient major health care program in the country. Covering low-income adults through Medicaid costs 45% less than private insurance.
With the proposed Medicaid cuts, people will not just lose their health care coverage. When people are denied insurance, they are more likely to end up sicker and to seek uninsured care through emergency rooms. It will cost patients, hospitals and the public even more.
In my 13 years of practice, I’ve sought to strengthen our rural health system. The programs we’ve built recruit and retain physicians, nurses and essential staff, employ community health workers and case managers, build better clinical services to help patients navigate complex and confusing systems of care, and transform health organizations to be more responsive.
This bill puts all that we’ve worked for at risk. Mass removal of patients from Medicaid and Apple Health will destroy the growth and quality we’ve gained and the hopes we have in further improvement of our systems.
Don’t take my word for it. Just before the vote in May, more than two dozen Republican state legislators wrote a letter to Washington state’s congressional delegation opposing Medicaid cuts. They wrote, “Simply put, we cannot lose another rural hospital or clinic, nor another long-term care facility. We depend on a stable health care system, and we’re counting on your leadership to ensure Medicaid’s survival.”
I agree with these legislators. Our state’s health care system will not be able to withstand this bill if it becomes law, and I encourage our members of Congress to substantially change it to protect Medicaid and ensure patients can continue to access the care they need.
