Federal Impacts Test

INTRODUCTION: A BILL WITH FAR-REACHING CONSEQUENCES

With the July 4, 2025 signing of the federal reconciliation bill (H.R. 1), also known as the “One Big Beautiful Bill Act,” a series of policy changes will be implemented over the next five years that threaten to undermine the health and well-being of the American people. Implementation of this bill will include cuts to vital programs, causing millions of people to lose their health care coverage and access to food assistance, and will likely force the closure of hospitals, particularly in rural areas. 

Our Ongoing Analysis

Since last July, Children’s Alliance has been monitoring, researching, and analyzing the potential impacts of H.R. 1, sharing key updates through a series of blog posts. Building on that foundation, we are now releasing a new set of tools to make these changes easier to understand at a glance.  

What These Maps and Tools Show

We have created this collection of maps, along with summaries of key health policy changes and their implementation timelines, to illustrate how H.R. 1 is expected to affect critical health programs for Washingtonians, with a focus on Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and hospital access.  

Tracking Impacts Across Washington

These maps and our analysis of policy implementation will be updated regularly as we continue tracking how H.R. 1 affects each county and where those impacts are felt most. This tool is designed to help our partners, advocates, and policymakers better understand what’s ahead and prepare for the consequences of H.R. 1.  

How to Use This Resource

Below, we highlight key programs, outline the health policy changes from H.R. 1, and share additional resources to help all of us better understand what implementation will mean for our communities. These maps are interactive—you can hover over each one to see how families and children in Washington are affected, county by county. 

Transparency and Accountability 

We have also included sources and notes so you can see exactly where the data comes from and how each map was built. Our goal is to make this information not only accessible, but empowering, because when we understand the impact, we’re better equipped to stand up for the people who need these programs most.  

MEDICAID IMPACTS

Medicaid (Apple Health) and CHIP (the Children’s Health Insurance Program, called Apple Health for Kids in Washington)provide health care coverage to children and adults in households with low incomes, elderly individuals, and people living with disabilities. Medicaid and CHIP coverage provides comprehensive physical and behavioral health services, preventive care, coverage for prescription medications, and more.  H.R. 1 will significantly reduce federal Medicaid spending over the next decade and impose new work requirements that will make it harder for people to enroll in coverage and stay enrolled.  

These changes don’t just shift policy on paper. They create real barriers for families who rely on Medicaid for preventive care, chronic condition management, and basic stability.

Children Enrolled in Medicaid

This county-level map of Washington shows the percentage of children who were enrolled in Medicaid in each county in 2023.