BELLINGHAM, Wash. - As debate in the nation's capital continues over repealing the Affordable Care Act and ending Medicaid expansion, rural Washington is bracing for the effects of repeal.

Rural counties face a different set of health-care challenges than do urban areas, and could be disproportionately hurt by repeal. There are fewer facilities for rural residents who need care, and operational budgets for hospitals often are lower.

If the ACA is repealed, said Sherilyn Hughes, who works at a nursing home in Bellingham, her patients will feel the cutback.

"I definitely worry about our residents," she said. "If they lose their insurance or they have less access to care, what would happen to them? If they would be in facilities that are poorer staffed with less-trained people, if they would end up in assisted-living facilities, or places where they're by themselves."

According to a report by the Center on Budget and Policy Priorities, if the ACA is repealed, 775,000 fewer people in Washington state would have health insurance in 2019. President-elect Donald Trump has said a repeal would come with a "simultaneous replacement" plan, but no details have been released.

Repeal also would affect states' budgets. The same report estimated that Washington state would lose slightly more than $3 billion in 2019, which is likely to fall heavily on rural hospitals. Another study, published in Health Affairs, said rural hospitals have seen greater increases in Medicaid revenue than have urban hospitals under the ACA.

Belinda Hewett, a home nursing aide in Richland, said she worries that, if fewer patients are able to afford care, it means job cutbacks for nurses, as well.

"It'd cut our hours back for me and my co-workers," she said, "and then we'd have to go look for a second job to just make our income to pay our rent and the bills, and the stuff that we have."

Repeal could affect Hughes in another way. She has asthma and uses an inhaled steroid twice a day. Hughes said the medication is expensive and wonders how she would pay if she were dropped from her insurance.

"Through the Medicaid expansion, I get those paid for, so I'm able to continue to go to work. I'm able to pay to go college," she said. "I would not know what I would do if I lost my insurance. There's no way that I could afford to pay for the insurance plan that my employer offers."

The CBPP report is online at cbpp.org, and the study in Health Affairs is at content.healthaffairs.org.


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A case before the U.S. Supreme Court could have implications for the country's growing labor movement. Justices will hear oral arguments in Starbucks versus McKinney today to determine if the bar should be raised for the National Labor Relations Board when it seeks to impose court-ordered injunctions on companies.

David Groves, communications director with the Washington State Labor Council, said the Supreme Court could further undermine the power of the NLRB, the independent federal agency that protects employees' rights.

"We already have weak labor laws in this country that have such minor penalties for breaking union organizing laws that companies routinely do it, and this is another opportunity for them to weaken labor laws even further," he argued.

The case involves Starbucks' firing of seven employees in Memphis during their union campaign in 2021. The coffee company says it rehired the workers and denies wrongdoing. If the justices rule in favor of Starbucks, it could make it harder for the NLRB to seek court orders.

Groves said the law states that workers have a right to organize unions in their workplace without coercion or retaliation from their employers.

"That's all fine and good but if the penalty's not significant enough, then they'll just go ahead and break that law and consider it the cost of doing business if they have to pay a fine two years down the road," he explained.

Groves said his and other labor organizations support the passage of the Protecting the Right to Organize or PRO Act in Congress, which would strengthen labor laws, including providing greater authority to the NLRB.


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The U.S. House has approved a measure to expand the Child Tax Credit. It would help 16 million children from low-income families in Indiana and nationwide. Despite bipartisan support, the bill is stalled in the Senate. Advocates praise the credit's pivotal role in combating child poverty, pointing to its effectiveness in the past, and especially during the pandemic, when it was broadly expanded.

Candace Baker, an Indianapolis mother of 4, said the previous tax-credit expansion worked for her family, and she wants it reinstated.

"Having a child, and I had to get on some government-assistance programs. My grandmother never did because she just didn't want that stigma over her, but I utilized those services when I had a child. I didn't want to either, but I'm like, I need this support," she explained.

Congress approved expanding the Child Tax Credit in 2021. However, the expansion has expired, leaving families without vital assistance. As the Senate deliberates, pressure mounts on lawmakers to prioritize the needs of struggling families and secure passage. Opponents believe taxpayers who don't work should not be eligible. Some Republicans also contend the provision may incentivize parents to leave the workforce.

Families reeling from the pandemic received between $300 and $360 per month per child from the expanded tax credit. It lifted 3.7 million children from poverty. Baker currently works for a food bank in Indianapolis where she says she is able to help neighbors in need and give back to the community.

"Being able to be a voice for those who have no voice - that is my motto. Even though where you start, you don't have to stay there. So, that is my biggest motto that I stand on: You may start here, you may be on government assistance, you may be in poverty, but that does not have to be your end game," she said.

Families who benefited from the increased aid were more than twice as likely to pay their overdue rent during the initial stages of the pandemic. The Child Tax Credit did not pass in time for this year's tax deadline, and its prospects for the future are uncertain.


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Washington joins a handful of states to do away with mandatory meetings for employees on political or religious matters.

Sometimes known as captive audience meetings, the gatherings were seen as a way for employers to give their opinions on subjects like unionization, and held potential consequences for employees who didn't attend. Lawmakers passed a bill this session allowing workers to skip the meetings without repercussions.

Sen. Karen Keiser, D-Des Moines, a sponsor of the bill, said we live in a divided society where emotions run high on political topics.

"This bill simply protects employees to have a real choice on whether or not to attend a meeting called by their boss to be told about some political or religious issue," Keiser explained.

Keiser pointed out the legislation is nonpartisan. For instance, employers could not force employees to attend anti-union meetings, but also could not force them to attend a meeting about the importance of reproductive rights. The bill takes effect June 6.

Keiser noted the bill likely got across the finish line this session because of the uptick in union organizing and support for labor. She added there are widely known stories of Starbucks managers, for example, requiring employees to attend anti-union meetings while the employees organized the workplace.

"Employees have been forced to attend meetings to listen to the boss or the employer basically tell them why they shouldn't join a union," Keiser observed.

Washington is the sixth state to pass a law prohibiting attendance at captive audience meetings. Connecticut, Maine, Minnesota and New York have passed similar laws in recent years. Oregon passed a law allowing workers to skip such meetings without repercussions in 2010.


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