Since the Big Beautiful Bill passed last summer, cuts to Medicare and Medicaid have impacted hospitals and patients across the country.

Today, multimedia journalist Kevin Teeter explores how rural hospitals in Washington are bracing for the latest rounds of cuts that hit this October and are coming on January 1st.

-Three Rivers Hospital in Brewster covers the largest land area of any hospital district in Washington.

About 2500 square miles in the state's Okanogan region.

More than two thirds of their patients are on Medicaid or Medicare.

Starting in October, some immigrants, refugees and asylum seekers were no longer eligible for Medicaid, and starting on January 1st, many Medicaid recipients will need to show that they are working, volunteering or in school at least 80 hours a month.

Plus, they will need to reapply every six months.

-Once the changes hit next year, although we're not quite sure how it's going to affect us, we know there's going to be folks that are no longer eligible for Medicaid, and we need to be able to respond to that and help them to maintain the coverage.

-Three Rivers says they've already had to take on more bad debt and charity care since H.R.1 passed in 2025, and rural health transformation funding hasn't made up for the losses.

They've also seen some Medicare Advantage plans offered by private insurers leave the region.

The hospital says they're more worried than ever that the newest cuts could force a worst case scenario, cutting services or even closing the hospital.

-We don't have a magic ball, crystal ball, and so we don't know of all of the struggles that we will have moving forward, but we just know that we have a strong team here, and we know that we can get through tough times.

-For Cascade PBS, I'm Kevin Teeter.

-Next time, we'll explain how individual health care enrollment has changed at the Washington Health Benefit Exchange.

I'm Paris Jackson.

Thanks for watching The Newsfeed.