These proposals would:

Hurt low-income people enrolled in the Medicaid (Apple Health) expansion, by:

• Requiring more administrative hurdles, including eligibility checks every 6 months instead of yearly, and repeatedly proving they meet new “community engagement” work requirements.
• Imposing copays of up to $35 per service or item for people making over 100% of the federal poverty level.
• Limiting retroactive coverage to one month (instead of the three months allowed now, as has been the rule for decades).

Hurt immigrants and migrants, by: 

• Ending insurance coverage on the Exchange for people with Deferred Action for Childhood Arrivals (DACA).
• Limiting Medicare eligibility to citizens, green card holders, COFA migrants, and certain Cubans. Others, including asylums, refugees, and trafficking and domestic violence survivors, would be ineligible regardless of their lawfully present status or work history/payment of Medicare taxes.
• Prohibiting federal matching funds for immigrants’ Medicaid coverage during the 90-day reasonable opportunity period for proving an eligible immigration status.
• Ending Marketplace eligibility and access to premium tax credits for many lawfully present immigrants. The House Ways & Means Committee released an amendment on 5/12/25 that would disqualify all immigrants except green card holders and COFA migrants from obtaining Marketplace coverage. Moreover, it would strip lawfully residing and work-authorized immigrants of the Advance Premium Tax Credit.

Hurt older adults and people with disabilities, by:

• Repealing the Nursing Home Minimum Staffing rule.
• Delaying by a decade implementation of the rule to streamline Medicare Savings Program eligibility determination and enrollment.
• Reducing federal matching funds, which will likely force the state to cut “optional” programs many rely on, such as Home and Community-Based Long Term Care Services.

Hurt transgender people, by:

• Prohibiting Medicaid and CHIP coverage of gender-affirming care for minors.
• Prohibiting states from covering gender-affirming care as an Essential Health Benefit of plans sold to individuals & small businesses.

Hurt people buying insurance on the Exchange, by:

• Setting a shorter annual enrollment period (November 1 through December 15) and prohibiting special enrollment periods based on low income.
• Requiring more administrative hurdles, including increased income verification when tax data is unavailable or income changes by more than 10% and annual filing and reconciliation of Advanced Premium Tax Credits.
• Allowing insurers to require applicants to pay all past-due premiums before they are allowed to get new healthcare coverage.

Hurt Washington, by:

• Reducing the federal matching funds for the Medicaid expansion by 10% to punish the state for using its own funds to provide coverage for undocumented residents, resulting in a loss of $687.5 million annually – which will likely need to be made up by cuts to other services and programs. 
• Requiring the state to adopt, implement, and publicize a costly system to verify work/“community engagement” requirements, which have been shown to cause loss of coverage without increasing employment. 
• Prohibiting providers like Planned Parenthood from providing Medicaid services for 10 years, eliminating access to an important source of healthcare for many low-income Washingtonians. 
• Prohibiting the state from increasing or introducing new provider taxes as a way to fund the state’s share of Medicaid, thereby putting many more Apple Health services at risk.

Written By: Vanessa Saavedra, NoHLA Senior Attorney