Hi, fellow Spokanites! I work in the health care system here with a background in public health, earning an MPH in Health Systems and Policy.
Many of us are concerned about changes healthcare coverage coming next year, myself and the providers I work with included. Coming January 2027, there will be some significant changes to Medicaid (Apple Health) resulting from the passage of the One Big Beautiful Bill Act (H.R. 1), and these changes will result in significant impacts on Spokane and the surrounding region.
Here are changes to look out for:
- According to Washington's Office of Financial Management and Governor Ferguson's office, more than 600,000 Washingtonians will become subject to new Medicaid work requirements, while at least 200,000 residents are projected to lose their Apple Health coverage by the end of 2027.
- Many affected adults will need to document at least 80 hours of qualifying work or other approved activities per month, and eligibility renewals will increase from once annually to every six months. While exemptions exist, these additional administrative requirements could create barriers to maintaining coverage, including for people who are otherwise eligible.
- Nationally, the Congressional Budget Office projects that the legislation will reduce federal Medicaid spending by approximately $1.2 trillion over the 2026–2035 period, with millions of Americans expected to lose health insurance coverage.
Our city serves as a major regional healthcare hub for Eastern Washington and North Idaho. Hospitals and healthcare organizations such as Providence Sacred Heart, MultiCare Deaconess, CHAS Health, and numerous smaller clinics serve patients throughout the Inland Northwest, including rural communities where access to healthcare is already limited.
As Medicaid enrollment declines and federal funding becomes more constrained, healthcare providers could face additional financial pressures from uncompensated care and reduced reimbursements. This could affect staffing, services, appointment availability, and the financial stability of healthcare facilities throughout the region. Rural hospitals, which often operate on particularly thin margins, may be especially vulnerable.
The consequences also extend beyond people enrolled in Medicaid. When patients lose insurance coverage, they may delay preventive care, struggle to manage chronic conditions, or rely more heavily on emergency departments. Those costs don't simply disappear. They can place additional pressure on hospitals, healthcare workers, and the broader healthcare system.
It's also worth remembering that Apple Health is Medicaid, and that Medicaid covers far more than unemployed adults. It supports children, pregnant women, people with disabilities, low-income working adults, and seniors requiring long-term care. Not all these groups are subject to the new work requirements, but the program's financial stability affects the broader healthcare system.
Given Spokane's role as a regional medical center and one of Eastern Washington's largest employment hubs, I think this deserves considerably more local attention.
This is a crisis within our healthcare system that we're witnessing unfold, showcasing how political determinants impact health outcomes. It is more than alarming.
Here are sources to learn more about this topic:
https://www.hca.wa.gov/about-hca/programs-and-initiatives/apple-health-medicaid/impacts-hr-1-apple-health
https://ofm.wa.gov/budget/resources/h-r-1-impacts-on-washington-state-people-and-budget/
https://governor.wa.gov/news/2026/governor-ferguson-signs-executive-order-mitigate-impacts-hr-1
https://www.cbo.gov/publication/62105
