With President Donald Trump’s self-imposed July 4 deadline fast approaching, Washington Gov. Bob Ferguson harshly criticized the proposed GOP-backed “Big Beautiful Bill” on Thursday, warning it could gut Medicaid and devastate rural health care access across the state.
Speaking in the Tri-Cities, Ferguson’s remarks came shortly after U.S. Senate Parliamentarian Elizabeth MacDonough ruled that several proposed Medicaid cuts in the bill — particularly those affecting immigrant eligibility and gender-affirming care — violate Senate rules. Specifically, she found that the provisions breach the Byrd Rule, which requires reconciliation legislation to directly impact federal spending, not serve ideological aims.
“These proposed cuts are cruel and would harm tens of thousands of Washingtonians just to fund tax breaks for the ultra-wealthy,” Ferguson said. “Republicans are pushing nearly $1 trillion in Medicaid cuts over the next decade — the largest in U.S. history.”
The proposed bill includes sweeping federal spending reductions, but the Congressional Budget Office (CBO) still estimates it would increase the national debt by about $3 trillion over 10 years. Among the cuts were changes to the Medicaid provider tax cap, bans on gender-transition surgery coverage, and new work and residency eligibility requirements — all now in limbo following the parliamentarian’s ruling.
Republicans could revise the bill to comply with Senate rules and still pass it through reconciliation before July 4, but any changes must also win approval in the House, leaving little time.
Ferguson warned that Washington’s Medicaid program, Apple Health, which currently covers nearly 2 million residents, could see 200,000 people lose coverage under the GOP plan. Nationwide, CBO estimates 7.8 million Americans would lose Medicaid by 2034.
“In Washington alone, Medicaid spending totals $21 billion annually — $13 billion of that comes from the federal government,” said Ferguson. “If this bill passes, we could see up to $3 billion in cuts. That’s a direct threat to our hospitals, especially in rural areas.”
He pointed to CBO estimates showing that 4.8 million of the projected coverage losses nationwide would be among low-income, childless adults who don’t meet new 80-hour monthly work requirements. Another 1.4 million would lose coverage due to immigration status, while others are flagged for duplicate enrollments or overlapping Medicare coverage.
Even some Washington Republicans have expressed concern. In a letter signed by 23 GOP state lawmakers, they warned Congress that the cuts could destabilize local health care infrastructure, especially in areas where Medicaid helps keep hospitals, clinics, and nursing homes afloat.
“Hospital closures don’t just affect Medicaid patients,” Ferguson said. “If your local hospital shuts down, you lose emergency care, maternity services, cancer treatment — even if you have private insurance.”
The National Rural Health Association estimates that rural hospitals would lose 21% of their Medicaid revenue under the bill. In Washington, where 25% of rural hospital reimbursements come from Medicaid, 18 hospitals are already at risk of closure, with seven considered in “immediate danger.”
“One-third of rural hospitals nationwide could close,” Ferguson warned. “This isn’t hypothetical. We’re talking about real communities losing access to critical care.”
Despite the parliamentarian’s ruling blocking some of the most controversial cuts, Ferguson cautioned that Republicans may still try to push them through in revised form before the holiday deadline.
“Thursday’s ruling might have given us a temporary reprieve,” Ferguson said, “but make no mistake — these efforts to slash health care for vulnerable Americans aren’t going away. We must stay vigilant.”
