On July 4, the One Big Beautiful Bill (OBBB) became law, bringing many changes to healthcare systems across the country over the next several years. At Skagit Regional Health (SRH), we are working hard to understand how these changes will affect our patients, families and neighbors.

No Major Changes in 2025, But Challenges Ahead

Right now, we don’t expect any major changes in 2025. But starting in 2027, the law will begin restricting access to Medicaid by implementing work requirements, twice yearly redeterminations and stricter eligibility. This will result in fewer patients having insurance coverage. Additional restrictions to subsidized Affordable Care Act exchange premiums and reductions in amount of Medicaid financed by the Federal government will phase in between 2027 and 2035. Apple Health is how 17% of our patients get their care. It’s also a key part of how we keep our hospital running. Losing this support could make it harder for many people in our community to stay insured and get the care they need.

How Will This Affect Washington State?

The OBBB includes:

• Cuts to Medicaid funding for Washington state—up to $36 billion over 10 years
• New work and eligibility requirements for Medicaid patients starting in 2027
• Retroactive Medicaid eligibility is reduced from 90 to 30 days for medically necessary care
• Reduced subsidies for people buying insurance on the marketplace, which could make it too expensive for some families
• Higher health insurance premiums as insurers and providers absorb the financial shock
• Loss of insurance coverage resulting in increased medical debt for patients.

These changes could mean nearly 500,000 Washingtonians losing their Apple Health coverage. Another 150,000 may no longer be able to afford their insurance. This would push Washington’s uninsured rate back into double digits, undoing 12 years of progress through the Affordable Care Act.

What This Means for Our Hospital and Community

When funding drops so significantly, hospitals healthcare systems will often have to make hard choices. This could lead to:

• Longer wait times for care, regardless of insurance status
• Fewer local services, meaning more travel for patients
• A rise in the number of people going without care.

For rural patients who need to transfer to a larger hospital, it could also mean longer waits for higher-level care.

Our Commitment to You

At SRH, we are deeply committed to serving our community and keeping healthcare close to home. We are still studying all the details of this new law and will work with our board to plan how best to respond. Our goal is to protect care for our patients, especially in tough times.

What Can You Do?

Stay informed about these changes and talk to your lawmakers about the importance of supporting rural healthcare. Together, we can work to protect access to care for all. Here are some additional resources to keep you informed on this evolving topic:

Kaiser Family Foundation

American Hospital Association

Washington State Hospital Association