Vashon Health Systems Prepares for Federal Budget Cuts

Vashon Health Systems Prepares for Federal Budget Cuts

M Hasan    6:42 AM   

The Impact of Federal Funding Cuts on Vashon’s Health Care System

Vashon’s health care system, already under significant strain, is now facing additional challenges as federal funding cuts take effect next year. These changes are expected to disrupt a wide range of services, from clinics to long-term care, and have far-reaching effects on the island community.

The Cuts in Detail

The One Big Beautiful Bill Act has rolled back several provisions of the Affordable Care Act (ACA) and Medicaid. Enhanced ACA premium subsidies are set to expire in 2026, while some Medicaid eligibility will be restricted in 2027. As of press time, Congress was nearing a potential government shutdown, with Democrats and Republicans at odds over health care funding. Democrats, who need Senate support, are pushing for extensions of ACA subsidies and changes to Medicaid cuts.

The Congressional Budget Office predicts that these cuts could result in 17 million Americans losing medical coverage over the next decade. In Washington state, 14 hospitals are at risk of closure due to shrinking Medicaid reimbursements. Safety net programs, including those for substance abuse and mental health, could face severe cuts, reducing help for families dealing with serious mental illness.

State-Level Responses

Washington’s Medicaid program, Apple Health, has some capacity to shield residents from national health care shocks. However, the federal government will cut their spending on $11 million annually from Washington’s family planning healthcare. Apple Health has stated its commitment to funding critical services with state resources, but it cannot fully insulate residents from coverage losses. Over 620,000 Washingtonians will face loss or delay of Medicaid coverage due to changing federal eligibility requirements.

Local Expert Perspectives

On Vashon, members of the Medical Reserve Corps are raising concerns and organizing a community response. Wendy Noble, a member of the Medical Reserve Corps and a Vashon Health Care District commissioner, warned that the cuts could be catastrophic. She emphasized that Medicaid supports not only low-income populations but also long-term care facilities, children, and disabled residents. Rural hospital systems, already fragile, depend on Medicaid to stay afloat and recruit physicians.

John Osborn, another member of the Vashon Medical Reserve Corps, echoed this urgency. He and Noble are helping to organize a medical conference on November 22, aimed at creating a roadmap for navigating the cuts. Osborn highlighted the importance of building relationships and strengthening teams to protect vulnerable individuals.

Specific Organizations Affected

Vashon Youth & Family Services

For Vashon Youth & Family Services, Medicaid makes up about 45% of its budget. Executive Director Jeni Johnson noted that expansion plans for disability-focused youth groups have been paused, with resources redirected to at-risk youth counseling. The uncertainty surrounding federal funding makes planning difficult, and the full impact remains unclear.

Sea Mar Community Health Clinic

Sea Mar Community Health Care Centers, one of the state’s largest providers, gets 65% of its revenue from Medicaid. While only 15% of Sea Mar patients on Vashon use Medicaid, administrators expect an increase in uninsured patients. The clinic will continue to offer its sliding fee scale but anticipates a rise in uncompensated care.

Vashon DOVE Project

DOVE, which supports survivors of domestic violence and provides mental health care, faces a challenging environment. New grant rules proposed by the U.S. Department of Commerce could require grantees to frame domestic violence strictly as a criminal issue, which contradicts DOVE’s approach. Executive Director Heidi Jackson criticized this shift, emphasizing the power control dynamic at the heart of abuse.

Vashon Natural Medicine

Vashon Natural Medicine (VNM), an independent primary care clinic, relies solely on federal funding through Medicare Advantage plans. Owner Kelly Wright expressed concern over inadequate reimbursements but remains confident in the clinic’s resilience. The clinic is developing a sliding fee scale for the newly uninsured and urging patients to schedule preventive care before year-end.

Neighborcare Health

Neighborcare Health runs the clinic at Vashon High School. While it has not yet seen federal cuts, administrators anticipate tighter budgets as state and local partners absorb federal losses. New Medicaid rules, such as work requirements and re-certification every six months, could disrupt care for patients.

Broader Implications

Thunderbird Treatment Center and Seattle Indian Health Board (SIHB) are also affected. Construction of the Thunderbird Treatment Center is ahead of schedule, supported by diverse funding streams. However, the Urban Indian Health Institute, part of SIHB, faces greater risks from federal health funding cuts. Esther Lucero, President of the Health Board, warned that public health work like harm reduction and prevention is at stake.

These changes highlight the broader implications of federal funding cuts on public health systems, with consequences that ripple through communities. As the situation unfolds, cooperation, creativity, and advocacy will be essential to protect vulnerable populations.

Health Insurers Seek 20% Premium Increase in Texas under ACA

Health Insurers Seek 20% Premium Increase in Texas under ACA

M Hasan    5:00 PM   

Rising Premiums and Uncertain Future for Texas ACA Market

Health insurance companies in Texas have submitted proposals for an average 24% increase in premiums for Affordable Care Act (ACA) plans in 2026. This significant rise could destabilize the marketplace, potentially leading to more individuals opting for less or no coverage. The proposed hikes are far steeper than the 3.8% average increase seen last year, marking a major shift in the health insurance landscape.

The data from KFF indicates that this could be the largest rate hike since 2018, when premiums increased by 35%. That year, insurers considered Congress' attempts to repeal the ACA and President Donald Trump's executive order ending subsidies for low-income individuals. Since then, premium increases have remained relatively modest, with no more than a 4% rise in any given year.

Growth of the ACA Marketplace in Texas

Despite these challenges, the ACA has seen substantial growth in Texas. Nearly 4 million Texans enrolled in ACA plans for 2025, a record high in a state with the nation’s highest uninsured rate. Enrollment has tripled since 2020, largely due to expanded tax credits that helped lower monthly premiums for many users.

This expansion has had a measurable impact on health care trends in Texas. Enrollment grew from 1.3 million in 2021 to nearly 4 million in 2025. The average post-subsidy monthly premium paid by Texans dropped from $136 in 2018 to $50 in 2024. While the uninsured rate remains the highest in the country, it has decreased from 23% in 2012 to 16.3% in 2023.

The ACA marketplace in Texas now offers more options than ever. The number of insurers operating in the individual marketplace has increased from eight in 2020 to 15 today. This competition has led to more choices for consumers, with 114 counties now offering at least four insurance options. Only seven counties, all near the Oklahoma border, still have just one insurer.

Challenges Ahead: Expiring Tax Credits and Rising Costs

However, these gains may be at risk due to the expiration of key tax credits at the end of the year. Insurers have cited rising medical costs and increased use of health services as reasons for their proposed rate hikes. Blake Hutson, vice president of public affairs at the Texas Association of Health Plans, described the situation as a "perfect storm" involving increasing medical costs, the loss of tax credits, and a less healthy risk pool.

The premium tax credits, expanded through the American Rescue Plan Act and the Inflation Reduction Act, currently benefit 83% of Texans who purchase coverage through the ACA. These credits are based on income and help reduce monthly premiums. However, they will expire at the end of 2025, making those earning over $62,600 ineligible for subsidies. This change could significantly impact those earning under 150% of the federal poverty level, who currently pay little or nothing for coverage.

KFF projects that premiums for those using ACA tax credits could rise by an average of 115% or $456 per year. Insurance brokers like Michelle McLaren warn that this could lead to higher uninsured rates and a contraction of the ACA marketplace, particularly affecting rural areas, lower-income individuals, and the elderly.

Impact on Major Insurers

Several major insurers have already submitted rate requests for 2026. BlueCrossBlueShield, the largest insurer in Texas, is asking for an average 39% increase in individual plan premiums. United Healthcare is requesting a 23% average increase, while Celtic Insurance Company and Superior HealthPlan are proposing 41% and 36% increases, respectively.

These hikes are driven by factors such as rising medical costs, increased use of services, and the expiration of tax credits. For example, United Healthcare explicitly cited the loss of enhanced tax credits in its filing. The company also noted higher provider reimbursement rates and the use of expensive new technologies.

The Risk of a Shrinking Marketplace

Analysts worry that if subsidies expire, healthier individuals may drop their coverage, leaving a sicker and more expensive risk pool. This could lead to further premium increases and potentially force some insurers to exit the market, as happened in 2016 when premiums rose sharply and several insurers left Texas.

The average monthly premium for Texans with ACA coverage after subsidies is $57, while the benchmark silver plan costs around $489. Federal law requires insurers to spend at least 80% of premiums on medical costs and quality improvement efforts. If this ratio falls below 80%, rebates must be issued to enrollees.

Looking Ahead

With open enrollment approaching, time is running out to address these concerns. While Congress could extend the tax credits, the window for action is narrowing. As the ACA marketplace faces these challenges, the future of affordable health care in Texas remains uncertain.

The Real Story Behind Resident Doctors' Pay Before the 5-Day NHS Strike

The Real Story Behind Resident Doctors' Pay Before the 5-Day NHS Strike

M Hasan    7:08 AM   

The NHS Doctors' Pay Dispute: A Clash of Statistics and Priorities

The ongoing dispute between the British Medical Association (BMA) and the UK government over resident doctors’ pay has sparked significant controversy, with both sides using different statistical measures to justify their positions. As a result, the debate has become increasingly complex, raising questions about the accuracy of the data being used and the potential impact on the National Health Service (NHS).

Resident doctors, who are also known as junior doctors, have announced a five-day strike starting this Friday, demanding salary increases that could reach up to £20,000. They argue that these hikes are necessary due to what they describe as "pay erosion" over the past 17 years. According to the BMA, this erosion amounts to more than a 29% reduction in real terms. However, the government claims that resident doctors have already received an average pay rise of 28.9% over the last three years, including a 5.4% increase this year—making it the largest in the public sector.

The BMA’s stance is that the current pay levels do not reflect the true cost of living for doctors, particularly given the high student loan debt many face upon entering the profession. The union uses the Retail Price Index (RPI) to calculate this erosion, which they argue better reflects the everyday expenses of working people. However, the Nuffield Trust, an independent health policy think tank, found that when measured against the Consumer Price Index (CPI), the pay gap is much smaller—only 4.7% below inflation since 2008. This discrepancy highlights the importance of the inflation measure used in such calculations.

The government has criticized the use of RPI, pointing out that it was downgraded as an official national measure in 2013 due to its tendency to overstate inflation. Instead, CPI and CPIH (which includes housing costs) are now considered more accurate. Despite this, the BMA continues to defend its use of RPI, arguing that it is more relevant to the daily lives of doctors. For instance, RPI is used to set student loan repayments, car taxes, and train fare caps—factors that significantly affect the financial burden of medical professionals.

Health Secretary Wes Streeting has condemned the strikes as "shockingly irresponsible," insisting that the government will not compromise on pay. He emphasized that resources are finite and that decisions must be made with the interests of all NHS staff in mind. Streeting also pointed out that resident doctors have already received substantial pay increases under the current administration, including a 28.9% rise over three years.

Despite these efforts, the BMA remains unconvinced. In September, members voted overwhelmingly in favor of further strike action after rejecting a proposed pay deal from the government. The latest offer included a 4% uplift plus £750 in additional payments, resulting in an average pay increase of 5.4%. However, this was not enough to prevent another round of industrial action, with nearly 90% of those who voted supporting the walkout.

The consequences of the strikes are expected to be severe. A report by the Policy Exchange think-tank warned that up to 250,000 appointments could be canceled or postponed this month, costing the NHS approximately £87 million in staffing cover. Charities have also expressed concern, warning that the disruptions could lead to "significant distress, pain, and worsening health for patients."

In addition to the financial impact, there are serious safety concerns. Previous strikes by junior doctors have been linked to at least five patient deaths, according to an audit. NHS leaders have warned that the upcoming five-day walkout could put even more lives at risk.

As the debate continues, the question of how to fairly assess pay increases remains unresolved. Different inflation measures can paint vastly different pictures of real-term changes in wages, making it essential to consider multiple perspectives. The Nuffield Trust's Lucina Rolewicz emphasized the need to look at a range of baseline years and inflation measures to gain a more complete understanding of the situation.

Ultimately, the dispute underscores the challenges of balancing the needs of medical professionals with the broader responsibilities of the NHS. While the BMA argues that fair pay is crucial for retaining talent and ensuring quality care, the government maintains that resources must be allocated wisely across the entire healthcare system. The outcome of this conflict will likely have far-reaching implications for both the NHS and the wider public.