Providence Swedish, one of Everett's largest private employers, is already cutting programs as federal Medicaid changes threaten Washington hospitals with $5.8 billion in losses by 2033.

A report released Tuesday, Oct. 20, by U.S. Sen. Maria Cantwell's office projects the losses will strain hospitals statewide, leading to longer emergency room waits, potential clinic closures and staff reductions, according to The Seattle Times.

The data was compiled by the Washington State Hospital Association and the Washington Association for Community Health.

Providence Swedish employs 2,393 workers in Snohomish County, making it one of the county's top private employers, according to the Economic Alliance of Snohomish County. The system has already cited expected Medicaid losses as the reason behind cutting family medicine residency slots. Providence Swedish announced in April that it would merge its two largest family medicine residencies and reduce resident positions from 69 to 51 over four years, The Seattle Times reported in July.

The cuts stem from House Resolution 1 (HR 1), the federal spending bill that restructures Medicaid eligibility and funding. The first changes took effect at the beginning of October, pushing about 11,000 lawful immigrants in Washington off Apple Health, the state's Medicaid program. Nearly 2 million lower-income state residents are enrolled in Apple Health.

New work requirements take effect Jan. 1, 2027. Enrollees will need to prove every six months that they are working, volunteering or attending classes at least 80 hours per month, or show they qualify for an exemption.

About 200,000 more Washingtonians are expected to lose coverage by the end of 2027, according to updated state estimates. An online verification hub is expected to preserve insurance for roughly 400,000 of the 600,000 enrollees subject to the new requirements.

The revenue losses are projected to grow each year, starting at $339 million statewide in 2027 and reaching $1 billion per year in the 2030s, the Washington State Standard reported.

Northwest Washington faces some of the steepest cuts. The 2nd Congressional District, which includes Snohomish County, ranks among the top three districts statewide for projected Medicaid losses, according to the Washington State Standard.

Cassie Sauer, president and CEO of the Washington State Hospital Association, said in a statement that the cuts will reach beyond Medicaid patients.

"That means these cuts could affect your ability to access needed health care services, even if you have excellent health insurance," Sauer wrote.

The ripple effects are already visible. Harborview Medical Center CEO Sommer Kleweno Walley said at the Oct. 20 news conference that patients who lose coverage will skip primary care, then arrive at emergency rooms sicker and needing more expensive treatment, according to The Seattle Times.

Hospitals are required to treat ER patients regardless of insurance status, the Washington State Standard reported.

Separately, Providence has told United Health Care Medicare Advantage enrollees in the region that it will stop accepting those plans after Jan. 1, 2027, according to a column in The Everett Herald.

That change could force thousands of area seniors to switch plans or travel to other facilities.

No Providence-specific revenue loss figure for Everett has been made public. The Cantwell report does not break down losses by individual hospital system.