The people who do health care in this state are getting increasingly agitated about the weather coming out of the nation’s capital.

It’s shaping up as “a perfect storm,” warned Ingrid Ulrey, the head of the Washington Health Benefit Exchange, on Tuesday.

Ulrey and others have been forecasting for weeks that the One Big Beautiful Bill Act, the Orwellian-named Republican tax cut plan, is going to savage medical coverage in Washington state.

Earlier in June, they announced new estimates that the bill would cut more than 400,000 Washingtonians off medical coverage. It would also slice an estimated $6 billion in federal support to the state. These are colossal cuts — the largest to the health system ever proposed. But that message was largely ignored.

Now they say it could also drive out half the customers who currently get help buying private insurance plans under the Affordable Care Act, aka Obamacare.

All told, about 20% of the 2.2 million Washington residents who either get Medicaid coverage or buy Obamacare policies “will lose health insurance” if the bill is passed, the state predicts.

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In the 30-slide presentation on all this, officials included some alarming background that cast the One Big Beautiful Bill Act in an especially craven light.

It turns out that some of the huge corporations that stand to reap windfalls from the tax-cut side of the bill also employ the most workers who depend on the health and welfare subsidies.

At the top of this dubious list: Amazon.

“Amazon accounts for the single largest number of Medicaid enrollees of any employer in the state,” reads a state legislative analysis of the data circulated last week. The company has more than 3,000 workers with 5,000 dependents enrolled in the state’s medical program for the poor, costing around $30 million annually in taxpayer dollars.

In second is Walmart, with 7,400 local workers and dependents on Medicaid, costing about $28 million annually.

I remember when Walmart began to first make the news for having so much of its workforce on public assistance.

Twenty years ago, I interviewed the head of the old Brown & Cole grocery chain in the Northwest, which provided health coverage for all its employees. He blasted Walmart as “a form of social pollution,” arguing it was shifting its costs onto the public and accelerating a race to the bottom. As if on cue, later that year the Brown & Cole chain declared bankruptcy.

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We have progressed in some ways, but in others scarcely at all. Since 2019, the number of Walmart workers on Medicaid is up 19%, the state analysis shows. The number of Amazon workers on Medicaid has tripled.

The good news is these workers at least have some insurance. Twenty years ago, up to 25% of Walmart workers simply went without.

Other big firms that currently depend the most on taxpayer help for medical coverage include Safeway and Albertsons grocery stores, McDonald’s, Kroger, DoorDash and Uber. The firms named in this story have more than 40,000 Medicaid enrollees combined, according to the state.

Some of the companies note that they have a lot of seasonal and part-time workers. To qualify for Medicaid, a single person generally can’t make more than $21,600 a year, while the head of a four-person household can’t make more than $44,000, about $21 per hour if working full-time.

But the report notes that more than half the Amazon and Walmart workers on Medicaid have been continuously employed at the companies for more than a year.

When this issue was raised a few years ago, then presidential candidate Bernie Sanders decried it as “morally obscene. … U.S. taxpayers should not be forced to subsidize some of the largest and most profitable corporations in America.”

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Sanders introduced a bill to get the biggest firms to pay for some of their own workers’ subsidies, but it went nowhere. Amazon, for instance, booked $59.2 billion in profits last year. Paying back the Medicaid costs used for its own workers in Washington state would have consumed just 0.05% of that.

Anyway, what’s happening now in Congress is a trip back in time. The One Big Beautiful Bill Act would lock in huge tax cuts for Amazon and other companies, while slashing health payments to the states and stripping 16 million Americans off Medicaid and the Affordable Care Act.

Why aren’t Amazon or any of the other firms speaking out against this, given how many of their lower-paid employees depend on subsidized health care? Yes, that could entail accepting a smaller tax cut … and I think I just answered my question.

So long as we have an employer-based insurance system, the Fortune 500 firms at a minimum ought to actually provide the insurance. If not, then step up to help pay for a system that does. Lobbying for tax cuts as part of the same bill that guts the health system is like a double betrayal of responsibility.

It’s distressing that with all the work and debate these past decades toward the dream of universal health care, it’s not just stalled out. We’re about to lurch backward — back to the Walmart days.