Vulnerable people and rural hospitals: The system-wide impacts of potential Medicaid cuts

Nearly 2 million people in Washington depend on Apple Health, the state’s Medicaid Program, while over 1.4 million people use the Oregon Health Plan, according to each respective health authority. Based on data from the Keizer Family Foundation, the federal government will bankroll 50% of Washington’s total traditional Medicaid spending this fiscal year, compared to 59% in Oregon.

The Oregon Health Plan also covers more than half of children under the age of 17, one being Wylie George.

“I don’t think anybody’s going to understand what it’s like to need help like this unless they go through it themselves,” said Wylie’s mom, Tiffany George. “It’s a life-changing circumstance, and just because you need help doesn’t mean you don’t belong.”

Wylie was just four pounds at birth, and after contracting a viral infection 15 months later, she started losing her hair and developed anemia. Tiffany and her husband, Jason, eventually learned that Wylie has a rare genetic disorder called CLPB (caseinolytic peptidase B) deficiency with just dozens of diagnosed cases worldwide. Essentially, Wylie has a shortage of infection-fighting white blood cells, leaving her vulnerable to sickness alongside many other conditions.

“I feel like her soul just didn’t integrate into her physical body,” said Tiffany. Wylie has lots of charisma, she’s “very spicy, adventurous and fun,” as Tiffany described, but she also uses a wheelchair to move around, eats through a plastic gastrointestinal tube and doesn’t speak in sentences at 6 years old.

Beginning in March 2020, Wylie was hospitalized at least 10 times over the next three years, recovering from different infections and ailments. She worked with occupational and speech therapists and still sees a physical therapist twice a week to improve her motor skills. Every evening, she’s injected with a medication to boost her immune system that costs $9,000 a month.

“Who could pay for that?” Tiffany said.

In 2015, she and Jason founded their own business, Future Folk Supply Co., and have relied on Medicaid since. Jason crafts custom metal furniture and design elements in his Parkdale shop while Tiffany concocts candles and sprays from their home on the Heights, always on-call in case Wylie’s instructional assistant sees something concerning at school. 

“There’s no amount of time that we can put into work and earn the money to actually pay for all the things that we need for her,” said Tiffany. Because Wylie has emergencies so often and requires around-the-clock help, maintaining the full-time schedule necessary to be eligible for employer-sponsored insurance isn’t feasible.

Medicaid has completely covered Wylie’s care, even a therapist and chiropractor for Tiffany, which has helped her parent a child with disabilities. Growing up in Texas, she remembered how people called single Black moms on Medicaid “welfare queens” during the Reagan era, one example of the shame and stigma she said our country associates with social programs, a lifeline for many.

“It doesn’t matter if you’re making $5 million or if you’re just going to school and smiling at people, that’s what your ability is — there’s value in both,” Tiffany said. “I’m just praying that we make it to 25 [years old] — or to 20, or to 15, or to 10.”

Regardless of race or class, she believes that everyone deserves health care and hopes that Wylie, with continued support, can lead a somewhat independent life.

Reductions in federal Medicaid spending may cause Wylie, along with thousands of people in Oregon and Washington, to lose critical coverage. The impact on individuals is hard to overstate, but the systemwide effect on rural hospitals means this potential policy change extends much farther than Medicaid beneficiaries themselves.

“It’s going to cut services that are available,” said Rep. Maxine Dexter of Oregon’s 3rd Congressional District. “That hurts everyone in our community.”

“Medicaid coverage helps ensure that not only rural community health centers but also rural hospitals stay open because we see, in our communities, far more uninsured patients than urban areas do,” said Jennifer Griffith, the CEO of One Community Health in Hood River. “Medicaid, I think, is even more important in our rural and frontier communities.”

One Community Health serves about 30,000 people. Medicaid recipients make up roughly 44% of that population and account for 65% of the nonprofit’s annual revenue. All health care facilities have fixed costs like employee salaries and utility bills, so if fewer people seek help because they’re uninsured, places like One Community Health will have to shed services.

Providence Hood River and Skyline Hospital in White Salmon weren’t immediately available for comment, but across Oregon, Providence sees nearly 172,000 Medicaid patients annually. At Adventist Health Columbia Gorge in The Dalles, Medicaid makes up about 30% of the total patient population while Medicare, which primarily covers people older than 65, insures 50%.

“Reductions in Medicaid support would cause lasting harm to our nation’s most vulnerable populations — including children, veterans, individuals with chronic conditions, seniors in nursing homes and working-class families,” said Adventist Administrator Jayme Thompson over email. “As we monitor how this administration approaches Medicare and Medicaid funding, our commitment to this community remains unwavering.”

Dexter reported she wasn’t privy to how the House Energy and Commerce Committee plans to cut $880 billion over the next 10 years, and Rep. Cliff Bentz of Oregon’s 2nd Congressional District did not respond to a request for comment. In an interview with Oregon Public Broadcasting, however, Bentz noted the committee may implement a work requirement for adults on Medicaid.

The Congressional Budget Office analyzed a similar 2023 proposal and found that work requirements would reduce federal Medicaid spending and lower the national debt, but also increase the number of uninsured people and have no change on overall employment. That’s because nearly two-thirds of adults on Medicaid were working while the remaining enrollees couldn’t because of illness or disability, caregiving responsibilities or due to school attendance, according to 2023 data from the Kaiser Family Foundation.

In an op-ed published by the Yakima Herald-Republic, Rep. Dan Newhouse, who serves Washington’s 4^th Congressional District, highlighted a report from the Government Accountability Office that outlined $31 billion worth of improper Medicaid payments over the last fiscal year.

Neither Bentz nor Newhouse were able to have an on-the-record conversation with Columbia Gorge News. 

“I do not and will not support denying any eligible Americans access to services like Medicaid, Medicare and SNAP [or food stamps],” wrote Newhouse. “What is important in maintaining the integrity of these vital programs is that we identify and eliminate waste and abuse that has bloated federal spending beyond what is sustainable.”

Griffith acknowledged that waste exists within Medicaid, but that remediating the issue shouldn’t come at the expense of people’s health care.

“We are literally taking money from poor and working families to pay for tax breaks for the ultra-wealthy,” said Dexter. The reconciliation bill would also extend Trump’s 2017 tax policy that disproportionately benefited corporations and high-income households,  according to the nonpartisan Center on Budget and Policy Priorities.