The One Big Beautiful Bill Act (H.R. 1 in the 119th Congress), passed by the House of Representatives in May 2025, would significantly impact healthcare coverage in Washington State, potentially making it one of the most affected states in the nation. According to Congressional Budget Office (CBO) estimates, Washington faces particularly severe consequences due to its robust Medicaid expansion under the Affordable Care Act[1].
Nationally, the CBO projects that 13.7 million more Americans will become uninsured by 2034 due to the bill’s provisions combined with the expiration of enhanced ACA premium tax credits[4][5]. Given Washington’s current uninsured rate of 4.7% in 2022—an all-time low—and the state’s heavy reliance on federal Medicaid funding, Washington residents would likely experience a substantial increase in the uninsured rate.
Washington State could experience a dramatic 25% decrease in Medicaid enrollment, representing one of the steepest declines nationally[1]. With current Medicaid/CHIP enrollment at approximately 1.84 million Washingtonians as of October 2024[2], this translates to roughly 460,000 residents losing Medicaid coverage. The state would also face a 15% reduction in federal Medicaid funding, among the highest cuts in the country[1].
The bill introduces several provisions that would disproportionately affect Washington residents. Work requirements for able-bodied Medicaid expansion adults, requiring 80 hours per month of work, volunteering, or school attendance, would be implemented beginning in 2026[3]. Additionally, the legislation mandates more frequent eligibility redeterminations every six months rather than annually for expansion populations, creating additional administrative barriers[3][1].
The legislation would effectively reverse much of the coverage gains Washington achieved through aggressive Medicaid expansion and robust implementation of ACA marketplace provisions, potentially pushing the state’s uninsured population back toward pre-ACA levels.
What can you do to help change this trend? Check out Health Care for All Washington and join the effort to make universal health care real in Washington!
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- https://www.kff.org/medicaid/issue-brief/allocating-cbos-estimates-of-federal-medicaid-spending-reductions-and-enrollment-loss-across-the-states/
- https://www.healthinsurance.org/medicaid/washington/
- https://www.sheppardhealthlaw.com/2025/05/articles/federal-healthcare-legislation/house-passed-budget-bill-the-one-big-beautiful-bill-act-includes-major-changes-to-medicaid/
- https://www.kff.org/uninsured/
- https://www.kff.org/policy-watch/how-will-the-2025-budget-reconciliation-affect-the-aca-medicaid-and-the-uninsured-rate/
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