(Editor’s note: This piece originally stated that International Community Health Services (ICHS) mostly serves “mainly serve Asian American, Native Hawaiian and Pacific Islander communities,” when in fact they serve a wider diversity of groups, which speak 70 languages. The error has been corrected.)
On July 4th, 2025, President Donald J. Trump signed into law H.R. 1, a budget reconciliation bill that is also known as the “One Big Beautiful Bill Act.” H.R. 1 makes permanent most of the tax cuts from Trump’s 2017 Tax Cuts and Jobs Act, including expanded tax deductions and estate tax reductions that primarily benefit the wealthy. It also increases the budget for border security, defense, and fossil fuel-based energy production, which will partially be paid for by restrictions to government-sponsored healthcare and nutrition programs, namely by imposing work requirements. Recipients need to prove that they are working, engaging in community service, going to school, or receiving work training for at least 80 hours per month. More frequent eligibility checks will also take place, where recipients will need to file paperwork to renew their eligibility every six months.
For some of the most vulnerable populations in Seattle’s Chinatown-International District, the more stringent requirements of the bill spells trouble.
How did we get here?
In 2024, Trump ran on a platform that was broadly anti-immigration, anti-federal spending, and pro-tax cuts for the wealthy. As of time of this writing, Trump has created 170 executive orders instituting far-reaching changes that made good on his platform. Trump at times also places meaningful pressure on Congressional Republicans to pass legislation; between February and July 2025, he did the same with the Big Beautiful Bill.
On July 1st, the bill narrowly passed the Senate in a 51-to-50 vote, with Vice President JD Vance placing the tie-breaking vote. The House approved the bill on a 218-to-214 vote on July 3rd, setting the stage for Trump to sign the bill into law on July 4th. The bill was touted to help middle-class households and small businesses. However, when working on budget reconciliation, safety net programs such as Supplemental Nutrition Assistance Program (SNAP) and Medicaid were among the federal programs that were imposed additional restrictions through eligibility requirements. Such programs provide government-sponsored resources for low-income and disabled citizens.
Washington State and the City of Seattle responds
In response to fears and reports that federal spending on Medicaid will be restricted, Senator Maria Cantwell released a snapshot earlier this year in February 2025, which discussed the possible implications of the bill in Washington State. She estimated that the One Big Beautiful Bill would exacerbate Washington State’s budget deficit, impose additional pressure on the state’s healthcare system, and put hundreds of thousands of Washingtonians at risk of losing their coverage.
On July 3rd, 2025, Ingrid Ulrey, CEO of the state marketplace for purchasing health insurance, the Washington Health Benefit Exchange, issued a statement in response to the passage of H.R.1.
Ulrey commented: “At a time when we’ve made substantial progress on reducing the uninsured rate in our state, the changes in the bill will impact the availability and affordability of health coverage, making Washingtonians sicker, will make our health care delivery system weaker, and create ripple effects that will be felt for decades.”
At the same time, she reaffirmed their commitment to their clients, and stressed that the Washington Health Benefit Exchange will be ready for open enrollment, which starts on November 1st.
Since March 2025, Seattle City Council has convened the Select Committee on Federal Administration and Policy Changes, chaired by Councilmember Alexis Mercedes Rinck. On July 18, 2025, the select committee convened to speak about H.R. 1. Councilmembers expressed concern over the most vulnerable community members, including the unhoused population, and possible security challenges that H.R. 1 could lead to when services for mental health, substance use prevention, and intervention services are restricted.
Possible effects on Chinatown-International District residents
Similarly, local and community agencies are gearing up to meet the challenges thrust upon the neighborhoods they serve, including in the Chinatown-International District (C-ID)—which has historically been home to marginalized residents who have experienced underfunding, systemic racism, and lack of opportunities.
According to an August 2023 neighborhood snapshot by the Seattle Department of Neighborhoods, almost 30% of C-ID’s residents live below the poverty level (vs. 10% citywide). C-ID has a median household income of $39,171 (vs. $105,391 citywide); 95% of residents are in renter households (vs. 55% citywide); and 43% are speakers of a non-English language (vs. 22% citywide). In short, C-ID is home to those who are extremely vulnerable to the tightening of social safety net programs.
The Seattle Chinatown International District Preservation and Development Authority (SCIDpda) has a mission to preserve, promote, and develop the C-ID as a vibrant community and unique ethnic neighborhood. They manage 13 buildings in and around the C-ID, which includes 555 units of affordable housing.
“We’ve heard through our Resident Services and building staff that at least two families have shared they’ve been affected by the Medicaid and Medicare cuts and have lost their coverage,” said Jade Yan, SCIDpda Resident Services Manager. “Given that more than half of the residents living in SCIDpda-managed buildings are low-income—at or below 30% of the Area Median Income—it’s likely that many others we haven’t heard from will also be impacted. Many low-income households depend on programs like Medicaid, Medicare, and SNAP which will be slashed.”
For G de Castro, Deputy Director of the Asian Counseling Referral Service (ACRS), “these cuts could be a matter of life or death,” and could deepen existing disparities, especially “for immigrant and refugee communities—many of whom already face language barriers, limited transportation, and systemic inequities. This directly undermines decades of trust built by community-based organizations like ACRS.”
ACRS is a local nonprofit organization that offers a broad array of behavioral health programs, human services and civic engagement activities for Asian and Native Hawaiian/Pacific Islanders and other communities in King County and beyond.
“Cutting essential programs like SNAP, which support food security for low-income households, will likely increase demand at local food banks, including the one operated by ACRS in Seattle’s Chinatown-International District,” said de Castro. “Cuts to Medicaid-funded services also threaten culturally and linguistically appropriate care—something mainstream systems rarely offer. For many, ACRS is one of the few trusted places they can turn to. Losing access could mean falling through the cracks entirely.”
H.R. 1 may also contradict an older bill–namely the Health Center Consolidation Act of 1996, which is also known as Section 330 of the Public Health Service Act. The act mandates the establishment of Federally Qualified Health Centers (FQHCs), which are community-based healthcare organizations that are legally obligated to make primary health services available and accessible to the community, while ensuring that no patient will be denied health care services due to an individual’s inability to pay for such services.
“It will be interesting to find out how the contractual obligations to see all people regardless of their ability to pay play out with this Big Beautiful Bill,” noted Seattle Indian Health Board (SIHB) President and CEO Esther Lucero noted.
SIHB is one such FQHC that has three locations around Seattle, including one located at Weller St. in the International District. While they specialize in the care of Seattle’s Urban Indian population, they also provide health and human services to all patients, as mandated by the federal funding they receive. Indeed, 58% of total patients served at SIHB in 2024 are with Apple Health, which is what Medicaid is called in Washington State.
Another FQHC that services C-ID is the International Community Health Services (ICHS). With deep roots in the Asian Pacific Islander community, ICHS has since its inception grown to be a regional health care provider that offers culturally and linguistically appropriate health services in more than 70 languages.
ICHS CEO Kelli Nomura, shared concerns about their patients: “When social safety nets are weakened, our patients are often the first to feel the impact and the last to recover. This bill disproportionately harms communities that have already been marginalized and are historically underinvested in. The promise of economic relief simply doesn’t reach those who already live on the margins.”
“We’re particularly concerned about immigrant elders, limited-English speakers, and families with mixed immigration statuses,” Nomura continued. “They are often the most hesitant to seek help, the most affected by policy changes, and the least resourced to navigate complicated systems. We also worry about young people whose families rely on Medicaid for routine and behavioral health care, as well as our patients who receive nutrition and housing support that are now in jeopardy.”
That the Big Beautiful Bill will fund Immigration and Customs Enforcement (ICE) has added additional stress to C-ID residents. In an article for the Washington State Standard, Stan Shikuma of the liberatory Japanese-American organization Tsuru for Solidarity noted that–in the first half of 2025 alone–1,342 migrants have been boarded on so-called “ICE Air” deportation flights in Boeing Field after being transferred from the Northwest ICE Processing Center in Tacoma. This sum is already more than the total number of deportees in all of 2024. Locally, ICE has targeted Southeast Asian refugees and immigrants–including Tuan Thanh Phan, a Vietnam War refugee whom the federal government attempted to deport to South Sudan–a place he has no connections to.
“It also sends a chilling message to immigrant communities: that their health and safety are less valued than surveillance and enforcement,” Nomura shared. “Being targeted by our government triggers traumatic responses for many of our patients. Some of them survived violence and brutality of corrupt regimes before immigrating here.”
The work goes on
Even with increased pressure from these federal-level changes, Lucero, Nomura, and de Castro are adamant that their work has to go on.
“We are actively assessing both the immediate and long-term financial impacts to our services and programs, which directly affect community members’ ability to access care,” de Castro shared, regarding the ACRS. “We’re engaging in advocacy with elected officials at the local, state, and federal levels to ensure they understand the harmful consequences this bill would have on our most vulnerable communities. Like many service providers, we are also seeking alternative sources of funding to help fill the gap.”
Nomura shared that ICHS’s operations remain stable and that there are no immediate changes for their patients, due to the fact that their leadership has been preparing for the passage of the bill for months. Yet she comments, “Make no mistake: continued disinvestment in safety-net programs puts pressure on community health centers to do more with less.”
“Many folks who receive Medicaid are already working, but the paperwork becomes so cumbersome, and they’re making it a requirement to be deemed re-eligible every six months instead of annually. That creates a barrier to folks accessing care,” said Lucero, regarding the ways in which SIHB are helping clients navigate the Medicaid work requirements. One of the things we are doing is actually enhancing our ability to provide case management services to help people with that paperwork.”
The Community must stand together
SIHB, ACRS, and ICHS encourage community members to continue accessing their services and seek help with paperwork challenges. They also encourage the community to advocate for themselves and for their community health centers.
“It’s important for folks to continue to call their legislators, because this actually doesn’t go into effect, I believe, until 2026,” said Lucero.
Adrian Alarilla, PhD, is a program evaluator, writer, researcher, and filmmaker. Born and raised in the Philippines, he is currently based south of in Seattle, and has a PhD in History from the University of Hawaiʻi at Mānoa. Besides contributing to the International Examiner, he is an associate with Alaska-based consulting firm Stellar Group, and has worked with Tribal, governmental, and nongovernmental agencies in Alaska, Hawaiʻi, and the Pacific Islands.
