As a nurse practitioner, I’ve spent over a decade working with patients during some of the most vulnerable moments in their lives. In Washington state, we were the first to face the COVID-19 pandemic, and we’re still feeling the long-term strain on our health care system. But I’ve never felt more uncertain about the future of health care in this country as I do now, because of the passage of H.R. 1.
On July 4, President Donald Trump signed the tax and spending bill into law — legislation that health care professionals and leaders across the political spectrum warned would devastate access to care and jeopardize the health of millions. In Washington alone, we’re facing a projected 17% cut in Medicaid funding, or $36 billion over 10 years — some of the steepest losses in the nation. While the significant cuts in the bill won’t take effect until after the 2026 midterm elections, patients will see some immediate changes as hospitals close and services are reduced.
It is rare to see total alignment across health care groups, but H.R. 1 led to unified and urgent opposition. Nurses, physicians, public health leaders, hospitals and even conservative-leaning legislators raised the alarm. And yet, several Pacific Northwest lawmakers like U.S. Reps. Dan Newhouse and Michael Baumgartner, both Washington Republicans, ignored us. Two of the three nurses in Congress, Rep. Jen Kiggans, R-Va., and Rep. Sheri Biggs, R-S.C., shamefully dismissed the loud warnings from their own nursing associations and chose party loyalty over patients by voting for the bill.
One of the most pivotal individual swing votes came from Sen. Lisa Murkowski, Republican from Alaska. Her “yes” vote effectively ensured its passage, despite her own admission that it was, in her words, an “agonizing” decision. “I worked my butt off to make sure that Alaskans were not going to be penalized, and we’re not going to be harmed” she said.
But realistically, Alaskans will not be isolated from the consequences of this legislation. Sen. Murkowski’s vote and rationale suggest a misunderstanding of just how interconnected our region’s health care infrastructure is.
When Alaskans need the most advanced trauma or burn care, they are often transferred to Harborview Medical Center in Seattle — a public hospital and the only Level 1 trauma and burn center serving the entire Pacific Northwest, including Alaska, Idaho and Montana. The strain that this bill will put on funding for Washington’s health care system will affect access to care for the entire region. There is no state-level border when it comes to saving lives or needing highly specialized care.
In the end, health care workers will be the ones navigating overcrowded emergency rooms, hospital/clinic closures and patients arriving sicker because they delayed care due to cost. We will be the ones trying to find treatment options that don’t bankrupt families, because lawmakers who voted for this bill won’t be there when those impossible decisions must be made.
And let’s be clear: Many of those lawmakers who called us “heroes” during the pandemic now dismiss our pleas for help. They expect us to stay silent and carry on. We must firmly reject this assumption by elevating our stories to convey the real impact of this harmful legislation.
The public’s trust in the nursing profession may run deep, but trust alone doesn’t fund trauma care, maternal health or behavioral health services. It doesn’t replace the trillions in federal dollars stripped from our health care system. Nurses are trusted because we speak truth to power, which is what we must do now to protect our patients
When the fallout of H.R. 1 begins — when hospitals close, patients suffer, and costs rise — patients and nurses must remind our communities of who is responsible, particularly before the next election. We must hold our elected officials accountable through nonviolent protest, sharing our stories and exercising our right to vote. Nurses are committed to caring for our patients to the best of our ability, but we also recognize a duty to advocate for the systems that sustain their lives.
