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Medicaid Cuts Would Hurt WA Rural Nursing Homes, Hospitals

Nurses in rural Washington could be disproportionately hurt by repeal of the Affordable Care Act, compared with those who work in urban areas. (janeyhenning/Flickr)
Nurses in rural Washington could be disproportionately hurt by repeal of the Affordable Care Act, compared with those who work in urban areas. (janeyhenning/Flickr)
January 13, 2017

BELLINGHAM, Wash. - As debate in the nation's capital continues over repealing the Affordable Care Act and ending Medicaid expansion, rural Washington is bracing for the effects of repeal.

Rural counties face a different set of health-care challenges than do urban areas, and could be disproportionately hurt by repeal. There are fewer facilities for rural residents who need care, and operational budgets for hospitals often are lower.

If the ACA is repealed, said Sherilyn Hughes, who works at a nursing home in Bellingham, her patients will feel the cutback.

"I definitely worry about our residents," she said. "If they lose their insurance or they have less access to care, what would happen to them? If they would be in facilities that are poorer staffed with less-trained people, if they would end up in assisted-living facilities, or places where they're by themselves."

According to a report by the Center on Budget and Policy Priorities, if the ACA is repealed, 775,000 fewer people in Washington state would have health insurance in 2019. President-elect Donald Trump has said a repeal would come with a "simultaneous replacement" plan, but no details have been released.

Repeal also would affect states' budgets. The same report estimated that Washington state would lose slightly more than $3 billion in 2019, which is likely to fall heavily on rural hospitals. Another study, published in Health Affairs, said rural hospitals have seen greater increases in Medicaid revenue than have urban hospitals under the ACA.

Belinda Hewett, a home nursing aide in Richland, said she worries that, if fewer patients are able to afford care, it means job cutbacks for nurses, as well.

"It'd cut our hours back for me and my co-workers," she said, "and then we'd have to go look for a second job to just make our income to pay our rent and the bills, and the stuff that we have."

Repeal could affect Hughes in another way. She has asthma and uses an inhaled steroid twice a day. Hughes said the medication is expensive and wonders how she would pay if she were dropped from her insurance.

"Through the Medicaid expansion, I get those paid for, so I'm able to continue to go to work. I'm able to pay to go college," she said. "I would not know what I would do if I lost my insurance. There's no way that I could afford to pay for the insurance plan that my employer offers."

The CBPP report is online at, and the study in Health Affairs is at

Eric Tegethoff, Public News Service - WA