With Trump's HR1 Medicaid cuts underway, Mosqueda to propose revenue to support county public health clinics, Harborview Medical Center

October 28, 2026

With President Trump's sweeping Medicaid cuts now taking effect due to HR1, and far more cuts to coverage and care on the way, King County Councilmember Teresa Mosqueda on Wednesday described possible budget revenue tools that would generate revenue for the county's public health clinics and Harborview Medical Center – brining in a total of around $90 million a year.

Speaking at the Council's Budget & Fiscal Management Committee meeting Wednesday morning, Mosqueda described the ability for the Council to use two revenue tools authorized by the Washington State Legislature to invest in its health care safety net via public health clinics and Harborview Medical Center, the county-owned hospital. Mosqueda described the impact federal cuts are already having with increased uncompensated care, closure of clinics and hospitals around the county, and cautioned that the impact will be far worse next year when an estimated 215,000 King County residents will begin to lose Apple Health/Medicaid coverage as onerous and duplicative verification requirements adopted in HR1 come into effect. Less health coverage means less reimbursement for clinics and hospital, less staff and fewer programs, thus longer wait times, delayed care and death.

"We cannot undo the damage and cruelty of the Trump administration, and local government cannot replace every federal dollar we're losing; but we are not powerless,” Mosqueda said. “The state legislature gave us two revenue tools for the county hospital and public health clinic fiscal cliffs which have only been exacerbated by HR1. We have an opportunity — and a responsibility — to act now before the county health clinics and hospital runs into the red and people’s care is denied. The consequences become even greater if we wait to act." 

Mosqueda said she intends to bring forward legislation for two separate property tax measures. Together, they could generate upwards of $90 million a year, based on preliminary estimates. Other counties have already stepped in with new revenue for public health clinics and hospitals: LA County and Santa Clara Counties approved sales tax measures which expire in 5 years to address substantial revenue losses due to reduced healthcare coverage for residents, increasing demand for County services, placing pressure on hospitals, clinics, and public health programs and services.

Public health clinics: A new levy authorized by the Legislature could generate an estimated $45 million annually to support the operation, maintenance, and capital needs of county public health clinics. The funding can be used for fixed or mobile, publicly operated site for the provision of public health and other related services including, but not limited to: primary, dental, and reproductive health care; treatment, control, and prevention of communicable diseases, substance use disorder, and other health conditions; maternal, infant, child, and family health and nutrition; behavioral health care; assistance with health plan enrollment; and access and referrals to other community services. This revenue tool was authorized in 2026 via House Bill 2442.

Harborview Medical Center: Expanding the County's existing hospital levy could generate an additional $45 million in annual revenue for the operation, maintenance, and capital expenses of the hospital, and any outpatient clinics operated by the hospital, and for the payment of principal and interest on bonds. This revenue tool was authorized in 2024 via House Bill 2348.

Both would require Council approval as part of the budget process in the upcoming month. Mosqueda plans to formally introduce these revenue amendments for Council’s consideration in the coming weeks as the County continues its supplemental budget deliberations.

Watch Mosqueda’s full comments from Wednesday’s Budget and Fiscal Management meeting here.

QUOTES FROM PUBLIC COMMENT:

Estela Ortega, Executive Director, El Centro de la Raza: “Federal Medicaid cuts and coverage losses are expected to significantly increase the number of uninsured residents, placing unprecedented financial pressure on Harborview Medical Center and our public health clinics. Acting now will help preserve access to critical healthcare services, prevent deeper fiscal challenges, and protect the health and well-being of our most vulnerable community members before this crisis worsens.”

Karen Estevenin, Executive Director, PROTEC17: “Right now, our union is talking to all sorts of municipalities and agencies that are facing impossible choices and deficits. But few of them, if any, have what [the Councilmembers] have in front of [them] right now, which is a tool in hand to act before this crisis hits, and the ability to keep thousands of people from falling off the cliff. [This Council] has the means to protect people who are counting on you, and I urge [them] to use it.”

Jessica Hauffe, Director of Government Affairs, Washington State Nurses Association: “These clinics are the foundation of our public health and [King County] constituents in being healthy. This funding shortfall issue for the [Public Health] clinics has been going on for years; the community and the employees of King County Public Health need and deserve a plan of action to resolve the issues starting now – not a year from now. They need to know the Council is in the fight with them, and that they, too, are a priority.”

Lee Che P. Leong, Senior Policy Advocate, Northwest Health Law Advocates: “We support Councilmember Mosqueda’s call to leverage every available tool to respond to this crisis, including levy authority. We need every level of government to act and agree that the county should use every tool at its disposal, as soon as possible – the damage to our communities and to individuals has already begun. Early estimates suggest that roughly 50,000 people have already lost their coverage statewide this year. We urge [the Council] to support King County values and mitigate the harms of federal attacks on the health of our communities.”

FURTHER BACKGROUND:

The proposed revenue investments come as King County begins experiencing the effects of H.R. 1, the federal budget law signed by President Trump in July 2025. An estimated 4,000 county residents, including refugees and people granted asylum, lost eligibility for federally funded Medicaid on Oct 1.

Beginning in January, new work requirements and more frequent eligibility checks will affect a Medicaid coverage group that includes approximately 215,000 King County residents, putting some at risk of losing health insurance.

The financial consequences for Harborview are substantial. Harborview's charity care rate share has already risen from 1.4% just one year ago to now more than 5% this month, increasing pressure on a hospital that provides care regardless of patients' ability to pay.

Public Health – Seattle & King County faces serious financial challenges of its own. Updated forecasts project a $97 million operating shortfall in 2028–2029, with the department's available fund balance expected to be nearly depleted by the end of 2029. These existing financial challenges are separate from, but compounded by, the federal Medicaid changes.

The consequences extend throughout King County. In 2025, Public Health clinical programs served approximately 41,500 residents across all nine Council districts, while the department's WIC program served another 34,800 clients, with some overlap between the groups. The department's services include primary care, reproductive health care, disease prevention, nutrition assistance, and other essential care. Reimbursement for care offered through public health clinics and services totaled more than $31 million in 2025 – funding that is now at risk with HR1.