"We will not survive standing alone"

DAYTON - In June, flyers from a west-side political action committee landed in the mailboxes of residents in the Columbia County Hospital District. In the flyers, the committee charged the GOP U.S. House of Representatives and Rep. Michael Baumgartner(R) with harming health care access for millions of people after H.R.1, known as "The One Big Beautiful Bill Act," became law on July 4, 2025. 

Columbia County Hospital District CEO Shane McGuire offered his thoughts, noting that healthcare is a complex industry with ever-evolving legislation and oversight, which adds to operational challenges.

"This happens regardless of which party controls the state and federal government," he said.

A case in point was when rural counties saw the largest drop in health insurance coverage after the Republican-controlled Congress failed to extend the Affordable Care Act subsidies. The loss of ACA subsidies led to steep price hikes for some customers, with young and lower-income residents most likely to drop coverage.

In Washington, Garfield County had the largest loss in coverage, with 30.8 percent, and Columbia County lost 13.5 percent.

"For these people, their healthcare needs did not go away; their healthcare coverage did," he said.

McGuire noted that people in rural areas already have higher mortality rates for heart disease, cancer, unintentional injuries, chronic lower respiratory disease, and stroke than do urban communities. These are predicted to increase as rural community members are set to lose health care coverage at higher rates than urban populations.

He said people enrolled in Apple Health, the state's Medicaid program, could be caught by surprise when H.R.1 rules take effect on January 1, 2027. The delay in the bill's 10-year implementation will likely create a disconnect between the legislation's passage and its consequences.

H.R.1 will affect those covered through ACA Medicaid Expansion programs, which  provided more people with access to the healthcare program. As the law is implemented, people who are eligible for Medicaid must prove they can meet the 80 hours-per-month work, community service, or school attendance requirements, and they must do so once every six months. 

McGuire said even people with qualifying disabilities, like those on dialysis with kidney failure, will have to prove they are too sick to work by uploading documentation through complex state-run portals.

"Medicaid enrollees in our community already struggle with navigating the signup websites. Forgetting to attest to the work requirements means disenrollment and loss of coverage," he said. "Their care needs won't go away, but the ability to pay for them will."

This will create an inherent risk for CCHS and other healthcare organizations, as it increases uncompensated care. 

The federal Rural Health Transformation Program is part of the H.R.1 budget reconciliation bill. It provides $50 billion in nationwide funding to improve rural health care. Each state will share $25 billion for rural healthcare over the next five years, and the remaining $25 billion will be distributed over the last five years of the H.R.1 bill implementation. 

McGuire said the RHTP funding will not address the shortfall. Those funds can't be used to hire staff, increase the building values, or offset lost revenue. They are strictly for transformative or sustainability projects that improve the efficiency of health care. 

On Monday, June 29, the Associated Press reported that 25 states, including Washington State, and the District of Columbia are suing the Trump administration over its recent guidance on new Medicaid work requirements.

Washington state Democrats considered legislation to address healthcare budget shortfalls, including a business tax on companies with over 100 employees to help fund coverage for their workers enrolled in Apple Health. 

Other possible legislation leans on nonprofit health carriers to fund the state's premium assistance program for people covered through the Washington Health Benefit Exchange.

Another proposal, backed by Governor Bob Ferguson, is rolling back a business and occupation tax break for some insurers, netting $56 million in the current budget for healthcare. 

In February, "Forbes" magazine published data from a Medicare & Medicaid Services cost report that listed 22 of 84 Washington state hospitals as financially at risk, including Dayton General Hospital. 

McGuire said operating margins for rural hospitals are "razor thin."

"There is no slack in the system to absorb additional revenue cuts without cutting services," he said. "Any cuts made will directly impact patient care, and all patients will be impacted by Medicaid cuts".

"We will not survive standing alone," he added.

CCHD is relying on trusted partnerships with Rural Collaborative and the Washington State Hospital Association for support and direction.

McGuire said CCHD administrators are taking steps to shore up existing programs and services wherever possible.

"We continue to make improvements an inch at a time," he said. "This makes me hopeful and willing to fight for rural healthcare."

McGuire wants people to know it's in the best interest of both political parties to have healthy constituents and that a bipartisan effort is needed to change outcomes over time.