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The expertise, experience, and perspective of physicians and physician assistants practicing in Washington is crucial to helping to inform our advocacy on your behalf. And, it's often crucial in helping to inform legislators' decision-making on policy being debated at the state and federal levels.

Setting the Record Straight on Impact of Medicaid Cuts on Washington State and Washingtonians

A public messaging campaign to correct the record on the impact of Medicaid program cuts on patient care.

The U.S. Senate is currently considering massive changes to the Medicaid program that would have a severe impact on patient care in Washington state. Nationwide, the current Congressional proposal passed by the U.S. House of Representatives, would impose $715 billion in cuts to health care and result in more than 13.7 million Medicaid and Affordable Care Act enrollees losing coverage.

These proposed changes would have severe consequences for Washington state, intensifying our existing budget challenges and destabilizing the health care system—particularly in rural areas where Medicaid is a significant source of insurance coverage.

Physician reimbursement in the Medicaid system already falls short of the cost of care, and further reductions or limitations on payments would deprive frontline physicians of critical resources, reduce access to care, and worsen health outcomes across our communities.

The reality behind Medicaid policies under consideration

Impose work requirements as a Medicaid-eligibility criteria

Congress has proposed a work requirement as a new condition of Medicaid eligibility for adults, making coverage contingent on working 80 hours a month.

What they say: Supporters say this is merely “requiring able-bodied people to work.”

What it means: Work requirements will mean thousands of lower-income Washingtonians will lose coverage, effectively reducing the Affordable Care Acts Medicaid expansion. Enrollees often lose their coverage not because they fail to comply with the work requirement, but rather due to the ongoing need to submit paperwork and documentation to the state. Importantly: Work requirements used in other states have added cost and did not improve rates of employment.

Let’s drill down:

• Medicaid enrollees work: Most Apple Health clients already work (or are the dependents of a working adult).
• Adults will lose coverage: More than 620,000 adults would be at risk of losing or delaying coverage due to administrative red tape. Assuming similar experience from other states, an estimated 138,000 Washington adults will lose Medicaid coverage.
• Work requirements are ineffective: States that experimented with work requirements spent more money on implementing and enforcing requirements than they saved, and employment levels did not increase.

Reduce the federal match rate for certain populations

Congress has proposed reducing a state’s federal match by 10% for the adult expansion population if the state provides comprehensive insurance coverage to non-citizens.

What they say: Supporters say this is merely “taking illegal immigrants off the insurance rolls.”

What it means: Everyone needs health care. This provision will potentially result in thousands of people in our state being disenrolled from Medicaid coverage, which means once preventable or treatable conditions deteriorate, and care is provided in higher cost emergency departments.

Let’s drill down:

• Non-citizens are not eligible for federally funded Medicaid or federal subsidies on the exchange and often have no other options to receive insurance.
• Washington’s program that covers undocumented residents is funded out of the state budget, yet this policy would punish Washington state by reducing federal Medicaid matching dollars for the entire adult population.
• People losing health coverage leads to more emergency department visits, more uncompensated care, higher costs for everyone else, and fewer resources for treating doctors, nurses, and hospitals.
• A 10% reduction in federal match would reduce annual funding for Washington by $460 million.

Reduce the use of state directed payments and provider taxes

Congress has proposed $200 billion in Medicaid provider tax cuts recently passed by the U.S. House of Representatives.

What they say: Supporters say this is merely “tackling fraud and abuse.”

What it means: This provision would represent a major reversal from long-standing financing agreements between states and the federal government. In Washington state, current provider taxes support access to care in hospitals, nursing homes, and for ambulance services. And the WSMA’s Medicaid Access Program legislation relies on the establishment of a new provider tax on insurance carriers to increase Medicaid reimbursement. If this provision is enacted, it would result in a $2 billion loss to Washington state and prohibit the establishment of the Medicaid Access Program. Following a tough legislative session where lawmakers struggled to fill a $15 billion budget hole with new taxes and cuts, it’s far from clear how our state budget could survive such a hit. Suffice to say, choices will be limited to painful decisions: raising taxes, cutting Medicaid physician and provider payments, or reducing coverage for vulnerable Medicaid patients. 

Let’s drill down:

• Provider taxes allow states to direct expenditures to advance local health system needs.
• Certain “provider taxes” can be used to return revenue to providers in the form of higher reimbursement rates, such as the assessment at the heart of WSMA priority Medicaid Access Program in House Bill 1392.
• Provider taxes and related state-directed payments account for $2.36 billion in annual federal investments in the state’s delivery system, including safety net and rural hospitals, emergency transport, primary care, mental and behavioral health, maternity services and birthing centers, skilled nursing facilities, and home health.

Require payment of cost-sharing

Congress has proposed requiring certain adults in the Medicaid system to pay cost-sharing of up to $35 for many services.

What they say: Supporters say this is giving Medicaid patients “skin in the game.”

What it means: Cost-sharing requirements add to the financial burden of lower-income Washingtonians and create a significant barrier to care.

Let’s drill down:

• Cost sharing forces out-of-pocket spending for individuals who may be earning as little as $16,000 per year.
• These individuals, many of whom are chronically ill or disabled, will forgo care and end up hospitalized, driving up costs.
• Physicians are rarely able to collect such payments from patients, which will further financially burden already struggling physician practices.

It’s time to let all Washingtonians know what is at stake

Right now, the most important way the physician community can help oppose these draconian Medicaid cuts is to educate the public via your local paper, op-eds, letters to the editor and on social media.

Physicians and practitioners are trusted voices—we must leverage that trust to tell the public what these cuts mean to Washington state and Washingtonians.

Your perspective is important for establishing the extent of local impact on access to care. Sharing your support with local media is an excellent way to reach legislators as well as the public to help educate them on these issues.

• Letters to the editor (200 words) – Submitting a letter to the editor is an excellent way to put a face to the problem. Your letter can be in response to a local story run in the media outlet, although that’s not required.
• Opinion/editorial (600 words) – Submitting an op-ed to the media outlet that serves your community is an ideal way to reach both your local legislators and community. Try to lead with a real-life patient story to help humanize the impact on patients.
• Tips to reporters – Contacting a reporter, introducing yourself, and telling your story can help to educate them on complex issues. Be polite and respectful, and remember that, while a story may not be forthcoming, your goal is to serve as a source of information—the reporter may then call on you in the future.

Sample op-ed or letter to the editor

The following editable text can be used as the basis of an opinion piece or letter to the editor, or excerpted and used for social media. While a bit long for a letter to the editor, it can be edited as you see fit to meet the requirements of your local media outlet. For help submitting your opinion piece or letter to the editor, contact WSMA Director of Communications Graham Short at gfs@wsma.org.

349 words

I am a physician serving our shared community. I see firsthand the vital role Medicaid plays in ensuring access to care for many in our community. I am deeply concerned with the proposed Medicaid cuts currently under consideration in Congress—and just as troubled by the reasons given for these cuts.

Legislators say they are “requiring able-bodied people to work.” Most Washingtonians on Medicaid already work or are the dependents of a working adult. Work requirements mean many thousands of hard-working adults lose coverage, not because they fail to comply, but because of the ongoing need to submit paperwork and documentation to the state. Work requirements add cost and do not improve rates of employment, as seen by other states that have tried.

Legislators say they are “tackling fraud and abuse” by cutting provider taxes and state payments. This is false. In Washington state, current provider taxes support access to care in hospitals, nursing homes, and ambulance services. This provision would mean a devastating $2 billion loss to Washington state and more reductions in coverage for patients.

And on it goes. Legislators say cost-sharing give patients “skin in the game,” when it adds to the financial burden of lower-income Washingtonians and creates barriers to care. Legislators say they are merely “taking illegal immigrants off the insurance rolls.” Everyone needs health care. With this provision, thousands of people in Washington will lose coverage, forgo care, and end up in our ERs.

This last point is important, and one I implore your readers to consider: these dramatic Medicaid cuts impact us all. When patients lose Medicaid coverage, they will not seek regular care and will instead line up in their emergency room, which puts the cost of their care on us all.

Despite the justifications given by legislators, simply cutting Medicaid is not going to take away our responsibilities to the aged, those with disabilities and mental health needs, children, and the poor. I urge you to oppose any budget measures that would weaken Medicaid and instead work toward preserving and improving health care access for those who need it most.

For assistance, contact WSMA Director of Communications Graham Short at gfs@wsma.org.

Sample social media posts with accompanying graphics

The following posts and graphics may be used on any and all social media accounts. You may use the posts as is or you may edit them, to honor the house of medicine’s partnership on this issue.

Follow the WSMA on X (formerly Twitter), Facebook, and LinkedIn, and consider tagging us in your posts so we can like and share them:

On X: @WSMA_update

On Facebook and LinkedIn: @Washington State Medical Association

Sample post #1 with image

For physicians and health care professionals, patient care is priority No. 1. Work requirements as a condition of #Medicaid eligibility don’t work, cost money, and will cause already working adults to lose coverage. #CompassionNotCuts #YourCareIsatOurCore.

Sample post #2 with image

Compassion is at the heart of patient care. If undocumented residents lose #Medicaid coverage, preventable conditions go untreated. Let’s focus on #CompassionNotCuts. #YourCareIsatOurCore.

Sample post #3 with image

#Medicaid provider taxes are not “waste, fraud, or abuse.” They fund access to care in hospitals, nursing homes, ambulance services, physician reimbursement, and more. #CompassionNotCuts. #YourCareIsatOurCore. 

Sample post #4 with image

Washingtonians deserve access to care when and where they need it. #Medicaid cost-sharing creates barriers to care and is not the right solution for Washington state. #CompassionNotCuts. #YourCareIsatOurCore 

Banner graphic for email newsletters or websites

Help Protect Medicaid. Join Our National Texting Campaign.

Medicaid is under threat. You can help protect it one text at a time.

The WSMA has joined the Protect Our Healthcare Coalition in launching a nationwide peer-to-peer texting campaign to oppose federal Medicaid cuts—and we need volunteers.

Using a secure platform called RumbleUp, you’ll be able to send prewritten, personalized messages directly to voters in key congressional districts. These messages will go out on behalf of local doctors and health care professionals urging recipients to call their members of Congress and demand they oppose Medicaid cuts. All texts are sent through RumbleUp’s secure platform. Your personal phone number or messaging service is never used to contact voters.

How to volunteer for the texting campaign: Watch this 90-second welcome video, then review full instructions on how to join the text program as a volunteer. Contact the volunteer coordinators directly at info@protectourhealthcare.org with any questions or concerns. Thank you for volunteering.

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