By TJ MARTINELL | THE CENTER SQUARE
Washington state’s Medicaid spending has quintupled, or increased five times over, since the 2013-15 biennium, according to an analysis by The Center Square.
Along with that increased spending, the number of those on Medicaid has climbed, though some health care experts note that despite this increased spending Washington continues to undercompensate medical providers who treat Medicaid patients.
In the 2013-15 operating budget, Washington state spent $7.85 billion on Medicaid. Spending was evenly split between the federal government and the state. As part of the Medicaid expansion, the federal government offered to cover 100% of the expansion costs for the first three years, then decrease it on a sliding scale to 90%.
Washington state was planning to spend $42 billion on Medicaid in the 2025-27 biennium, with $26 billion coming from the feds. However, with President Donald Trump’s One Big Beautiful Act seeking to reduce both funding and the number of people on Medicaid in Washington state, some healthcare experts warn that Washington taxpayers can expect to hear calls for more taxes to cover the lost funding.
“Taxpayers are going to start hearing why we need to increase the tax revenue because of that bill passing,” Washington Policy Center Healthcare Center Director Elizabeth New told The Center Square.”
However, she added that “the bottom line is people who are traditional Medicaid recipients are not in danger here,” arguing that the program was in need of reform. According to a 2014 report by WPC Senior Fellow Roger Stark, Washington’s Medicaid program was expanded by the state Legislature through “a one-line budget gimmick,” after the U.S. Supreme Court ruled in 2012 that states could voluntarily choose whether to do so under the Affordable Care Act. Prior to that, Medicaid provided health insurance for families with children that earned less than 133% of the Federal Poverty Level, for long-term care patients, and the disabled. The expansion included any adult who earns less than 138% of the FPL.
“The 2015 Legislature must again face the long-term impact of what the Medicaid expansion means for the people of our state,” Stark wrote in 2014.
In 2013, there was an estimated 1.3 million people enrolled in Washington’s Medicaid program, known as Apple Health. According to the Washington Health Care Authority, there were 2.17 million residents enrolled in Apple Health as of January 2022. Nearly half of all births in Washington state in 2020 were covered by Apple Health. As of 2023, the uninsured rate was 4.8%.
As a result of the Apple Health expansion, New said that “you had these inflated numbers of people who didn’t even need care. That added hundreds of thousands of able-bodied adults to the Medicaid rolls.”
She added that the suspension of Medicaid eligibility redetermination during COVID “kept enrollment artificially high. The safety net is too wide. Eligibility goes out to people in need and not in need, and we’re not doing a state recovery the way we could be.”
In an email, she wrote that “there is a valid argument to be made that even if able-bodied expansion enrollees lose coverage because they don’t meet community-participation or redetermination requirements, they could simply use ER services when needing care. That will bring pain to hospitals and cost-shifting to commercial payers. BUT I hope the reforms help shaves down the expansion group, ending Medicaid for those with other insurance options through work or on the subsidized exchange, etc., and reserving taxpayer-financed care for those without other health insurance options.”
According to the Washington Health Care Authority, between 200,000 and 320,000 Washington residents are projected to lose Medicaid coverage, while the state is estimated to lose billions in funding at a time when it already faces a fiscal crisis by 2027 despite the largest tax increase in state history and record revenue levels.
House Health Care & Wellness Committee Chair Rep. Dan Bronoske, D-Lakewood, wrote in an email to The Center Square regarding the One Big Beautiful Bill Act that “I believe that health care outcomes will be worse for the people of Washington as a direct result of this piece of legislation. The state of Washington is projected to lose billions in federal funding between 2025-2034.”
“The entire state Legislature will have to collectively determine how to control the damage to AppleHealth/Medicaid and the people who will be negatively impacted by the changes made by the federal government,” he wrote further. “Let me be clear, I believe every single one of us will feel these impacts, not just the people covered under Apple Health and the expansion.”
