Fourteen Washington state hospitals — plus four in Oregon including nearby Seaside Providence — are on a list of hospitals across the nation most at risk after recent moves by the Trump administration and congressional Republicans.

“Substantial cuts to Medicaid or Medicare payments could increase the number of unprofitable rural hospitals and elevate their risk of financial distress. In response, hospitals may be forced to reduce service lines, convert to a different type of health care facility, or close altogether,” according to a report from the authoritative Cecil G. Sheps Center for Health Services Research at the University of North Carolina.

In reality, most hospitals in the rural Pacific Northwest and elsewhere in the U.S. will come under greater strain as federal support for healthcare dwindles. The Sheps at-risk list was based on “one or both of two financial criteria: (1) the hospital is in the top 10% Medicaid payer mix of rural hospitals across the country, (2) the hospital has experienced three consecutive years of negative total margin.” Although facilities other than Seaside might not be in this degree of peril, nearly all are heavily reliant on Medicaid and Medicare patients. This is particularly true in retiree-heavy coastal counties.

Neither Ocean Beach Hospital or Willapa Harbor Hospital are on the Sheps “most-endangered” list. But both are highly dependent on Medicaid and Medicare reimbursements. The extent of damage to Pacific County healthcare will take the next several years to become fully apparent. But damage is certain.

The true extent of Medicaid cuts — which are partly in the form of adding more bureaucracy to discourage participation — are being concealed for now. The Trump-GOP legislation delays the harm until after the congressional election next year.

Mendacity is an underused but perfectly good word, perhaps most known to a few of us because it comes up so strongly in the play “Cat on a Hot Tin Roof,” in which a character says “Mendacity is a system that we live in” — fully immersed in lies and shady dealings. It is a perfect word for the attack on Medicaid, in which tax cuts for the ultra-wealthy will be partly paid for by taking healthcare from Americans least able to fight for it.

But while a significant fraction of Medicaid recipients will suffer first and most, we all will pay the price in the form of diminished hospitals with fewer and slower services, health workers forced relocate and cut back, and patients required to travel farther to find treatment.

We must all remember this mendacity when casting ballots next year and in 2028.