Washington, a leader among states in expanding coverage to the uninsured, now struggles to maintain many of these advances due to spending growth constraints imposed by the I-601 ballot initiative, tax cuts, and revenue shortfalls. Budget problems threaten the ability of Medicaid and the Basic Health Plan to serve those losing employer sponsored coverage during an economic slowdown. Washington solved its 2001-2003 budget dilemma while avoiding dramatic health care spending cuts through expansion of the upper payment limit, or the "ProShare" program. There is a risk that the Centers for Medicare & Medicaid Services may not approve Washington's new ProShare arrangement, which would only exacerbate the state's budget problems. Regardless, ProShare represents a one-time fix, not a solution to the
state's health financing and other budget problems.