Like many other hospitals, Three Rivers Hospital is facing fallout from the passage of the “One Big Beautiful Bill” and its cuts to Medicaid, the federally funded insurance program. The Central Washington hospital has already seen the effects of President Trump’s policies.
The hospital in Brewster, a city in rural north-central Washington, has had a notable drop in patient visits during times when the hospital is usually busy. Officials attribute the drop to increased actions by U.S. Immigration and Customs Enforcement. The city is in a major agricultural area and has a sizable Latino population.
“People are afraid to get care,” said Jennifer Best, the hospital’s business development coordinator. “We’ve been working to reassure people, explain our process and [state that] we haven’t had a visit from ICE and we’re not aware of any hospitals that have.”
Now the hospital has to figure out how to navigate yet another Trump policy: Earlier this month, he signed the bill, also known as House Resolution 1, which is expected to cut Medicaid by $911 billion. The cuts would be implemented over the next decade.
Nearly a third of Three Rivers Hospital’s patients are enrolled in Medicaid.
With such a large percentage of Medicaid patients, it was not surprising to officials that Three Rivers Hospital showed up on a list of rural hospitals in Washington state deemed at risk of closure. Democratic U.S. Senators included the list in a letter written in early June asking Trump and Republican leaders to reconsider the cuts.
For now, Best said, the hospital has no immediate plans to cut services or shut down. But hundreds of thousands of Washingtonians could lose their health insurance, and hospitals dependent on Medicaid reimbursements may need to cut services.
The first priority is to figure out exactly what the cuts entail and what impacts might follow, said Jacqueline Barton True, vice president of advocacy and rural health at the Washington State Hospital Association.
They won’t have long to decide what to do next: The initial round of cuts will come in 2027 and 2028, said Barton True, and hospitals don’t want to shut down services. “We’re going to do everything to preserve [health care] access for communities, but it’s going to be a challenge,” she said.
Lower reimbursements, more uninsured patients
The Trump cuts will roll back a planned increase in Medicaid reimbursement rates – the amount of money hospitals receive for providing health care services to Medicaid patients. Over the past few years, the reimbursement rates had increased from 50 to 80 or 85 cents for every dollar of the cost of care, thanks to the assessment to hospitals that are used to trigger additional federal dollars. Those dollars then go back to the hospitals to help cover Medicaid-funded services. In 2028, these payments will be capped until 2035, when reimbursement rates are scheduled to go back to around 50%.
Hospitals, though, have an obligation to treat uninsured patients and patients on Medicaid regardless of the rate, which means the declining reimbursements could become financially unsustainable, leading to staffing cuts or closures.
The cuts would also mean fewer people are covered under Medicaid – or any insurance program.
The policy would require low-income residents to furnish proof every six months that they are working, volunteering or going to school for 80 hours a month. For many people on Medicaid, said Barton True, navigating the process of meeting this requirement will not be possible.
That means more Washingtonians will end up uninsured, or may defer care until a condition is acute and requires emergency care – care that will need to be subsidized by hospitals.
Julia Barcott, a registered nurse for Astria Toppenish Hospital in the lower Yakima Valley and former vice-president of the Washington State Nurses Association board, remembers working in emergency departments prior to the Affordable Care Act. There were often multi-hour waits, she said, and the issues were often more acute because the patient was uninsured and hadn’t gotten preventive care.
“What does that say about us as a nation when the most vulnerable don’t have health care?” Barcott said. “It’s a bigger divide of the ‘have’ and ‘have-nots.’”
What’s next for hospitals
In Washington, 14 hospitals were included on the list of at-risk hospitals, nine of them in the 4th Congressional District in Central Washington. In total, the list includes 338 hospitals nationwide.
Washington hospitals on the list: Astria Sunnyside Hospital, Sunnyside; Astria Toppenish Hospital, Toppenish; Samaritan Hospital, Moses Lake; Summit Pacific Medical Center, Elma; Odessa Memorial Hospital, Odessa; Coulee Medical Center, Grand Coulee; Providence St. Joseph’s Hospital, Chewelah; Prosser Memorial Health, Prosser; Klickitat Valley Health, Goldendale; Othello Community Hospital, Othello; Three Rivers Hospital, Brewster; Forks Community Hospital, Forks; Mid-Valley Hospital, Omak and Mason General Hospital, Shelton.
Researchers at the Cecil G. Sheps Center for Health Services Research at the University of North Carolina compiled the list using hospital financial data. Not every hospital in danger of closing is on it, state hospital officials said. And not every hospital that made the list is planning to close or cut services.
In a news release, Othello Community Hospital, which is on the list, said that while the hospital is dealing with a “challenging financial landscape” and evaluating the impact of Medicaid cuts, it has no immediate plans to adjust services or shutter.
Best of Three Rivers Hospital also said layoffs, shutting down services or closing the hospital are last resorts and the hospital would not pursue them without exhausting other options.
In recent years, Three Rivers has prioritized increasing patient volume in areas such as transitional care, surgery and open-wound treatment. The hospital also plans to pursue a bond through a voter initiative that would pay for additional renovations.
To save money, the hospital might not fill vacant positions or could pause plans for new equipment and capital improvements.
Also, to address the loss of Medicaid coverage, the hospital has a financial counselor who can advise patients on options to cover costs under charity care or discounts.
'People need to know’
While the Medicaid cuts are moving forward, hospital officials and community organizers are continuing to engage with residents and encourage them to speak out about the importance of Medicaid in their community.
In Yakima, a group of advocacy organizations under a collaborative called “Between the Ridges: Alliance for the Common Good” will hold a forum on July 30 featuring a panel of health care workers.
There are still those who don’t fully realize cuts will be happening, said Barcott of Astria Toppenish Hospital, an organizer of the upcoming forum. Others don’t realize that Apple Health is Washington state’s version of Medicaid, she said, or are in a panic because there has been so much confusion about the cuts.
“I think we’re going to have to make sure we educate [people] as [cuts] begin to happen,” she said. “Nobody really knows exactly what’s going to happen.”
Barcott said residents need to be informed and hold lawmakers accountable for their votes. “People need to know [who] did or didn’t vote [for the “Big Beautiful Bill”],” she said.
Most of Washington’s Congressional delegation voted against the bill. The state’s two Republicans in Congress — U.S. Reps. Dan Newhouse (R-US-04) and Michael Baumgartner (R-US-05) — did vote for the bill.
In response to criticism for voting for a bill that includes excessive cuts to Medicaid, Newhouse took note of the bill’s inclusion of what he called an “unprecedented” $50 billion fund aimed at helping rural hospitals.
“I have received commitments from the [Center of Medicare & Medicaid Services] administrator that these funds will benefit rural hospitals in Central Washington,” Newhouse said.
Newhouse also said he would take steps to prevent hospital closures and advocate for rural health grants for providers in Central Washington.
Recently, Newhouse introduced a bill to provide Critical Access status to Astria Toppenish Hospital, which is on the list of hospitals deemed at risk of closure and has already reduced care, including its labor and delivery department. The Center of Medicare & Medicaid Services issues the status to hospitals in rural and underserved communities. Newhouse said he hoped the status would improve the hospital’s financial standing.
Newhouse maintains that his vote for the bill was necessary to eliminate “waste,” “abuse” and “fraud” in the Medicaid program and ensure that the people using the program need it, specifically “preventing illegal immigrants from receiving taxpayer-funded benefits.”
At Three Rivers, Best hasn’t seen any evidence of this. She noted specifically that undocumented immigrants are not eligible for Medicaid.
The political narrative that the program suffers from waste and fraud runs counter to what she and others witness daily.
Researchers at the Georgetown University McCourt School of Public Policy have noted undocumented immigrants do receive benefits through state-funded programs. But the cuts would impact Medicaid access for U.S. citizens, including funding for state Medicaid expansion.
“It will be interesting to see as things move forward what the savings are and if it’s helping at all or it’s making things harder for patients to get the care they need,” Best said.
Mai Hoang
Mai Hoang
Cascade PBS Staff
