Health care legislation update state and federal March 2025

Debra L. Glasser, M.D.

Olympia Wedding Photographer | Loewyn Behold Photography

Our Washington Legislature, in its frantic last five weeks, begins hearing state budget proposals this week. It is a heated and pressured time up on the hill dealing with a $12 billion budget shortfall.

Nonetheless, significant health care bills are moving through the legislative process. Democracy is functioning in Washington.

The budget reality is dictating what health care legislation will pass this session.

The bill I testified on, Senate Bill 5387, which would codify the Corporate Practice of Medicine, will not move forward this year due to its cost to institute into law.

Senate Bill 5387: A bill that protects the doctor/patient relationship | The JOLT News Organization, a 501(c)(3) Nonprofit

Still on deck are:

Health care pricing

Senate Bill 5083 and House Bill 1123 "Reference Pricing." The bills propose to set reasonable payment limits for public and school employee health plans. A total of 250,000 employees are eligible. Payment limits for hospitals would be set at twice the Medicare rate. For primary care and behavioral health, payment minimums would be set at one and a half times the Medicare rate.

Why is this legislation moving? Because it is expected to save the state $400 million.

Health care needs planning

One of many reasons our state is stymied in planning and preparing for our health care needs is because there is no data on who and what organizations are serving us and where.

Senate Bill 5561 and House Bill 1686 lay out a plan to implement a registry of health care providers, organizations and facilities across the state.

Cost transparency

Senate Bill 5493 would give our state Department of Health the authority to enforce federal price transparency rules for hospitals.

House Bill 1382 would prohibit insurers and health care organizations from withholding prices by claiming they are "proprietary." Price transparency would allow you and I to compare prices and decide where to obtain our care. Like price tags on groceries.

Medical debt protections

Senate Bill 5480 and House Bill 1632 protects medical debt from affecting one’s credit scores.

Senate Bill 5651 protects a basic amount of family savings from being garnished for medical debt thus preventing poverty. This bill will protect one-third of our state residents, 2.6 million who currently find themselves in this predicament.

Federal budget cuts and our state

I would be remiss not to mention how proposed U.S. congressional budget cuts to Medicaid of $880 billion over the next 10 years could affect healthcare in our state.

 How? Like a devasting Earthquake.  If you think that having private insurance will protect you, think again. This will impact everyone.

Putting $880 Billion in Potential Federal Medicaid Cuts in Context of State Budgets and Coverage | KFF

In our state alone, Medicaid insures nearly 2 million residents. That health care coverage not only provides access to health care for those insured, but it also provides funding for our health care system.  

Medicaid is funded by substantial federal subsidies to the states. Traditional Medicaid is 50% federally funded, Affordable Care Act plans 90%, including federal insurance premium tax breaks due to expire this year.  When Federal Medicaid funds are cut, the financial responsibility for the cost will fall on the states.

Hospitals are freaking out

Our hospitals are already struggling to survive and provide needed services while sorely short of resources on every level.

Hospitals cannot turn patients away. Losing Medicaid reimbursement will be further crippling. Unreimbursed care will break the back of our already strained hospital system.

Currently, hospitals rely on 30-50% of their reimbursement from Medicaid with children’s health care up to 75%. The children’s hospitals that provide lifesaving pediatric care will be devasted. About 50-70 % of children in our state are covered by Medicaid. 

As it is, our state has the lowest hospital bed-to-population ratio in the country. We have 1.6 beds per 1,000 people in contrast to the other Washington (D.C.), which has the highest at 4.89. We should be focused on expanding critical hospital access, not having to shrink it if these budget cuts are passed.

Locally, one of Providence St. Peter’s Hospital’s survival strategies has been to close or sell off less profitable services, such as physical therapy, home care, hospice, and skilled nursing facilities. When hospitals cut services to survive, it reduces access for everyone.

 Federally qualified health centers will suffer

Locally, Sea Mar and county clinics will lose reimbursement at best and need to close at worst. Many residents receive primary care, maternal care, vaccines, behavioral health, dental, and preventive services at these health centers.

Many of our 2 million residents on Medicaid risk losing coverage

Cuts will include reducing eligibility and increasing costs. Apple Health covers working lower-income people at affordable rates. Many will lose or drop their insurance. More people will be uninsured and when in crisis, will seek unreimbursed care.

Losing coverage does not reduce need: the opposite is true

Take away funding, take away health care, take away health. 

Prevention, maintaining population health has a cost

That upfront cost has been shown to reduce costs in the long run. Who in our government is looking at the long run?  

Preventing suicides takes psychiatric care, crisis centers, and a well-funded Veterans Administration. Those services have already been sharply curtailed by early Department of Government Efficiency mandates.

Preventing poor neonatal outcomes and infant mortality requires prenatal care. Without insurance, pregnant women will skip it and show up in labor in our overburdened emergency departments at higher risk for complications.

A pregnant woman looks worried while at a doctor's appointment.

Deposit Photos | @Pressmaster

Preventing cancer and saving lives requires screening. Treating diabetes and preventing poor outcomes requires wrap-around health care and medication.

Preventing infections, epidemics and pandemics requires public health measures, epidemiologists, science, worldwide cooperation, and vaccines.

 We are already in the midst of a measles outbreak, as a result of service reductions.

And the cuts have just begun.

Something’s wrong in Denmark (meaning there is an arithmetic thinking error somewhere)

The mathematics of deficits are elementary. Expenses surpass income.

If you or I are in debt, we get a second job and/or tighten our belts. When the debt is large, we do both.

When it comes to government, raising income means raising taxes. Proposing tax breaks in the face of huge budget deficits and instead proposing life-threatening and belt-tightening in the form of health care budget cuts is insane.

Creative solutions exist and need to be addressed with a focus on what is in the best interests of most of us. We the people, not the few.

All hands on deck

As a result of these budgetary pressures on healthcare, corporate and citizen advocacy interests blur and are coming together because these impending federal cuts will steal from every facet of health care. All hands are on deck working statewide and nationally because nothing less than our basic health care rights are on the line.

Engage in democracy, self-care and advocacy

My heart and life work is dedicated to helping to relieve suffering. What is happening to health care is heartbreaking to me.

In these times, we need to take care of ourselves and each other. To both keep the faith and act.

Action could be anything from self-care and advocacy to contacting our legislators, attending rallies, and participating in democracy in every way possible.

We are all in this together and I believe our actions can lead to solutions.

Debra L. Glasser, M.D. is a retired internal medicine physician in Olympia. Got a question for her? Write drdebra@theJOLTnews.com