Comment: Cuts by ‘Big Ugly Bill’ still loom for our communities
Published 1:30 am Saturday, August 30, 2025
By Janet St. Clair, Megan Dunn, Brian Sullivan, Barry Buchanan and Jani Hitchen / For The Herald
On July 4, President Trump signed into law Public Law 119-21, commonly known by either the “Big Beautiful Bill” or the “Big Ugly Bill” depending on your point of view.
It officially has no short title as the senate version eliminated the title. It is well-known for sweeping changes to Medicaid, SNAP, clean energy cuts, and regressive tax reforms. An article by Jerry Cornfield in the Washington State Standard described that “GOP state senators in WA go to bat for Trump’s mega bill,” defending the cuts, describing concerns as “fear mongering” by Democrats.
Following publication, several local elected officials came together to discuss the importance of sharing the facts and data that demonstrate the overwhelming impact these federal changes will have on local communities, rural health care and hospitals, social determinants of health and the safety net that protects children, seniors, veterans and people with disabilities. Many of us are members with the National Association of Counties (NACo), a bipartisan national organization that unites over 40,000 elected officials to build “healthy, safe and vibrant counties across America.”
On July 14, NACo passed a bipartisan unanimous resolution to the American Counties Platform expressing concerns for the impacts of cuts to Medicaid and nutrition programs that would have devastating impacts on those who depend on these programs for health care, mental health treatment, disability services, senior care, and residential care for those with disabilities. Whatcom County Councilmember Barry Buchanan brought forward the resolution warning that, “cuts to all Medicaid programs would increase costs to individuals and health care systems.”
We were not the first bipartisan effort to oppose cuts to Medicaid. In December, the American Hospital Association sent a letter signed by 182 members of Congress opposing cuts to Medicaid, following up in May 2025 with a detailed letter describing the devastating impacts to 72 million Americans “including children and babies” if the threatened cuts were enacted. On June 12, members of the U.S. Senate sent a letter to the president, the Senate majority leader, and the speaker of the House decrying the threatened cuts that would “negatively impact hospitals, nursing homes, and other health care providers.” In that letter, they included a list of hospitals across the nation that will be at risk of closure. There were 14 in Washington state on the list. Commissioner Janet St. Clair observes, “these cuts will have significant, cascading effects impacting other hospitals across the state as they try to absorb patients, especially for specialty services, trauma centers, and neonatal intensive care units.”
Councilmember Buchanan notes that “without coverage, residents are more likely to delay care until medical issues become emergencies, leading to worse outcome and greater strain on local emergency departments.” Commissioner St. Clair reminds us that without the benefits of coverage with the Affordable Care Act, medical bankruptcy remains a critical issue in our economy, worsening with Medicaid cuts. Pierce County Council Chair Jani Hitchen shares that Washington health leaders warn that this law “jeopardizes the health care system for everyone.”
Thankfully, Washington state invests in Apple Health, a state Medicaid program that provides additional coverage to provide preventive care, behavioral health and many other health care services. This and other programs will now be challenged by the changes in Public Law 119-21 as the cascading impacts hit other health care programs and the state budget. Councilmember Hitchen highlights that access to preventive care and behavioral health will erode. Loss of continuous coverage and the added reporting hurdles disproportionately hit families with low incomes, reducing well-child visits, vaccination rates and access to treatment. Pierce County has already documented uneven school-based behavioral health access, with many services tied to Medicaid eligibility. Cuts amplify those gaps.
At the other end of the life journey, older adults and people with disabilities face reductions to long-term services and supports for behavioral health. Medicaid is the primary support for nursing homes and many home- and community-based services. Reductions will push these costs and responsibilities on to families, hospitals and safety net programs with no increase in revenue to support that shift. Snohomish County Treasurer Brian Sullivan noted, “Medicaid pays for over 60 percent of nursing home residents, meaning these cuts will hit baby Bboomers in nursing homes the hardest.” The Congressional Budget Office projects 10.3 million fewer people will have Medicaid or are Dual Eligible (Medicare/Medicaid) by 2034. If these are your family members, we advise to get a key made; they may be coming home.
Programs such as Meals on Wheels, SNAP, and the Commodity Supplemental Food Program for seniors are also facing cuts. Ironically, research has shown that SNAP not only reduces hunger and improves health, but it also boosts local economies acting “as a stabilizer for communities … helping families weather financial hardships. It prevents deeper poverty and homelessness by allowing families to use their limited resources on these necessities.” Snohomish Councilmember Megan Dunn expresses concern, “Our foodbanks are already seeing a year over year increase in the need for support for food insecurity.”
Finally, our law and justice systems will experience significant cost shifts back to county government as the federal government cuts Medicaid or constricts eligibility. Again, Councilmember Dunn notes, “When a person is housed in our jail, counties are responsible for medical care, and we bear the burden to pay for that care. Federal cuts will impact this system.” Many counties often have disproportionate budget expenditures to law and justice, often forced to cover mandated programs without revenue. If jail costs increase, it will impact the whole of law and justice, including our courts, prosecutor, public defense, and law enforcement, destabilizing this critical public safety element of local government. As Councilmember Hitchen notes, this cost shift will have far reaching impact from re-entry programs to recidivism risks tied to untreated substance use or mental health disorders.
While some Republican state leaders chose to use this new law for political grandstanding, the facts are clear. This law will hurt local communities and it will hurt Washingtonians. We must continue to fight back against the attacks on the most vulnerable in our communities. As Vice President Hubert Humphrey once said, “The moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy, and the handicapped.”
Janet St. Clair is an Island County Commissioner for District 3; Barry Buchanan is a Whatcom County Council Member At-Large; Jani Hitchen is a Pierce County Council Member for District 6; Megan Dunn is a Snohomish County Council Member for District 2; Brian Sullivan is Snohomish County Treasurer.
