By Cris M. Currie, Dennis Dellwo, and Shari McEvoy
The Spokesman-Review, May 31, 2026
While it’s no longer news that major federal cuts to Medicare and Washington’s Medicaid (Apple Health) have taken effect and will continue to take effect through 2027 and 2028, few realize their scope or impact.
Currently those people eligible for both programs face additional barriers enrolling in the Medicare Savings Program. Hospitals, especially rural hospitals, and skilled nursing facilities have seen their Medicaid payments slashed, and many are facing closure as a result. Medicaid payments for cancer screening and birth control have stopped. The pandemic era enhanced premium subsidies for ACA Exchange Plans have expired, causing premiums to more than double. Nearly 40,000 Washingtonians have already dropped their health coverage.
Starting in October, many legal immigrants and trafficking victims will no longer get Medicaid. Starting in January, Medicaid eligibility redetermination will be more frequent and difficult. Funding will decrease for states, such as Washington, that had expanded Medicaid coverage, forcing many to return to pre-expansion enrollment. Medicare funding will also be cut, making it even harder for seniors to find providers. In 2028, Medicaid patients will start having copays, and work requirements will be mandated.
All this means healthcare will become increasingly hard to access for low income people as providers stop accepting them due to lower or nonexistent reimbursements. This will likely result in further uncompensated emergency care that will drastically drive up private insurance premiums and employee health insurance deductions. State expenses will increase, since the state is responsible for approximately half the Medicaid funding for over 2 million residents, not to mention healthcare for about 138,000 state employees and about 220,000 retirees. Plus, Washington is still facing a $2.3 billion budget shortfall for the next biennium.
At this point, no relief is on the horizon for individuals, but there’s a way the state can dramatically cut healthcare expenses while improving quality at the same time. For years, most states have contracted with commercial insurance companies, aka managed care organizations, to administer their healthcare programs and, at least theoretically, accept the risks. Washington contracts with five companies that receive a proscriptive payment for each enrollee.
One of those MCOs is Coordinated Care, owned by Centene, the largest Medicaid MCO in the country. With some 98% of its health insurance revenue coming from taxpayers, Centene has faced numerous lawsuits, primarily for Medicaid overbilling and ghost networks, including a 2022 $19 million fraud settlement in Washington. In 2024 Centene made a mind-numbing $3.31 billion in net profit.
All of these companies operate with extremely high overhead comprising roughly 15 cents out of every premium dollar (Medicare’s is about 2 cents). This covers exorbitant executive salaries, gargantuan profits, extreme lobbying and advertising expenses, useless administrative requirements for providers, and an unbelievable bureaucracy to manage the complex applications, prior authorizations, premiums, copays, deductibles and coinsurance to guarantee the profits.
One of the worst practices of the MCOs nationwide is their excessive denial rate. The Office of Inspector General reported 1 in 8 prior authorizations were denied in 2019. Some companies had rates up to 25%, even in the absence of robust oversight by most states.
The real news is that MCOs are completely unnecessary. In 2012, Connecticut eliminated all of them because of their ever increasing costs, high denial rates, inadequate provider networks, lack of care coordination and their inability to prove that they were worth what the state was paying. Instead, Connecticut contracted with non-risk-bearing, far cheaper, administrative service organizations to handle the day-to-day administration. A 2025 report by the Physicians for a National Health Program explains how eliminating the middlemen saved the state billions of dollars in hospital, ER and administrative costs, while increasing provider participation and improving coordination with enhanced primary care.
A 2024 special report, as well as earlier studies, concluded that Connecticut’s MCOs neither saved money nor improved quality, and that stakeholders much preferred the ASO system.
PNHP predicts annual savings of between $750 million and $1.2 billion if Washington were to adopt a similar system. This could significantly blunt the effects of the federal cuts. But why stop with Medicaid? Why not create a single-payer system for all residents and save even more?
Health Care for All-Washington is working with legislators to help them become more knowledgeable about how Connecticut’s Medicaid model could benefit us. Of course, making the switch will involve significant resources, but we should not be deterred, given the substantial benefits.
Cris M. Currie is a retired registered nurse from Mead. Dennis Dellwo is a retired attorney from Spokane and former chair of the Washington House Health Care Committee. Shari McEvoy is a retired nurse practitioner from Spokane. All are members of the Health Care for All-Washington Policy Committee.
