Federal cuts to public health system and Harborview Medical Center

King County Councilmember Teresa Mosqueda

Presenters at the King County Board of Health on Thursday outlined in stark detail sweeping federal cuts to the county’s public health system and to Harborview Medical Center due to the impacts of federal House Resolution 1 (HR1). 

The first major coverage losses go into effect in two weeks, when lawful permanent residents lose Medicaid coverage, followed by major enrollment changes and reimbursement cuts starting in 2027. 

Representatives from the County Executive’s federal team, Harborview Medical Center, and Public Health – Seattle & King County detailed the expected coverage loss for upwards of 215,000 residents in King County alone, and the loss of tens of millions of dollars to the county’s public health system and county hospital.

The expected federal cuts compound existing revenue shortfalls projected at Harborview and Public Health – for which two revenue tools were already passed by the State Legislature to provide additional taxing authority to King County after outcry about the projected deficit even prior to HR1. 

On Thursday, Board of Health Chair Teresa Mosqueda noted the need for the council to activate the revenue tools granted by the state Legislature to invest in the King County-owned Harborview Medical Center and the public health clinics and services:

• HR 2442: Approximately $45.8 million could be generated annually for public health investments with councilmanic passage of the five-cent property tax authorized for King County by the state legislature earlier this year. 
• SB 2348: An additional $45.8 million could be generated annually for Harborview Medical Center by fully implementing the taxing authority, another five cents, within the authority granted by the state legislature in 2024. 
• Further, the council could release $31 million set aside for Harborview’s Medicaid cut responses from the amount already collected from this taxing pool to help respond, in part, to the expected impact of HR1.

Devastating impacts in King County alone include:

Beginning October 1, an estimated 4,000 lawfully present residents in King County will lose federally funded Medicaid eligibility starting October 1st—this population includes refugees, people granted asylum, and survivors of human trafficking. 

Beginning Jan. 2027, new federal work requirements and more frequent eligibility checks will affect an Apple Health coverage group that includes about 215,000 King County residents. Many will remain eligible, but the additional requirements and paperwork are expected to cause some people to lose coverage. 

Beginning Jan. 2028, reductions to Medicaid directed payments that help hospitals cover the cost of care will begin taking effect. Harborview currently receives more than $260 million annually in supplemental Medicaid payments and projects that funding will decline to roughly zero over the following decade.

HR1 is expected to dismantle healthcare coverage to pre-Affordable Care Act (ACA) levels. The ACA reduced uninsured patients at Harborview to 4%, and due to HR1 their uninsured population served is expected to climb back to 13%. The hospital projects $120 million in enrollment-related losses in the first full year of HR1 alone. 

Harborview leaders told the Board that patients who lose insurance do not stop needing care. They are more likely to delay treatment and arrive sicker and with more complex needs, while Harborview receives less funding to provide that care.

Sommer Kleweno-Walley, CEO, Harborview Medical Center said during Thursday’s BOH hearing, “one incorrect thing that people think is this is only going to impact marginalized individuals, individuals who are vulnerable. That is not true. When hospitals, health systems and clinics close programs - because they can’t afford to keep the doors open anymore - they don’t close them just for Medicaid or just for underinsured or uninsured. When programs close, those programs close for everybody. 

"We shouldn’t think this is a problem for just those who are most vulnerable, this is a problem for all Washingtonians and particularly for those in King County.”

Mark Ritacco, Senior Policy Advisor at Manatt noted, “people who lose access to Medicaid, who lose access to behavioral healthcare don’t simply get better on their own, they end up showing up for county services more often than they would otherwise.”

Mosqueda concluded, “the state cannot fill this gap, and King County cannot fill it alone, but that does not mean we are powerless. We know these cuts are coming. We have these revenue tools at our disposal to invest in the safety net that is Harborview and our public health clinics - the time to act is now.”