Holston Valley Medical Center is one of the flagship hospitals of Ballad Health, a 20-hospital system in northeastern Tennessee and southwestern Virginia that is the only option for hospital care in a large swath of Appalachia. (Brett Kelman/KFF Health News)
As Congress debates funding changes to Medicaid that could negatively impact rural hospitals and patients’ access to care, hospital associations in Virginia and 13 other states sent a joint letter to U.S. Sen. Majority Leader John Thune, R-South Dakota, warning of the potential risks to health care access for people who need it the most.
US Senate launches debate on GOP mega-bill, but passage still not assured
Provider assessment rates and state-directed payment programs are at risk — two funding mechanisms that are critical to hospital operation in Virginia and that determine how hospitals chip into the state’s expanded Medicaid coverage. The Virginia Hospital and Healthcare Association estimated each program could take a $2 billion hit, if the proposal is fully implemented.
The measure ignited fresh controversy in recent days, as hospitals warned against adjusting the assessment rates from 6% to 3.5%. Over the weekend, members of U.S. Senate began floor debate on the bill, which key Republican senators like Josh Hawley, R-Missouri, had said they would not vote to advance because of the assessments adjustment proposal and the damage it could do to rural hospitals in their states.
Late Saturday, Hawley and all but two other GOP senators voted to advance a new version of the bill that included a $25 billion stabilization fund for rural hospitals from 2028 to 2032. Critics, however, still caution that fund will not fill the financial gaps as states lose portions of federal funding through the Medicaid cuts.
In a call with reporters on Thursday, U.S. Sen. Mark Warner, D-Virginia said he doesn’t plan to vote for the bill as it stands. The week prior his Senate colleague, Democrat Tim Kaine said the same. As the bill proceeds to what is called a vote-a-rama, Senate Democrats have remained in opposition to the bill.
The possible Medicaid changes are part of an overall budget package that President Donald Trump dubbed the “one big beautiful bill” and has pressured Congress to send to his desk by July 4. While there is still more time for deliberations before the Senate votes whether to send the bill to Trump and he potentially signs the Medicaid changes into law, hospital associations warned in their letter that if he does, vulnerable, already-cash-strapped hospitals would struggle to keep their doors open or need to cut the services they offer.
“Stable funding is vital not only for serving Medicaid beneficiaries but also for providing care to all patients, including the uninsured, those with commercial insurance, and our seniors and disabled patients on Medicare,” the associations wrote, representing hospitals in North Carolina, Tennessee and West Virginia, Arizona, Georgia, Iowa, Kentucky, Louisiana, Missouri, Nebraska, Oklahoma, South Carolina, and Pennsylvania. “Severe cuts to Medicaid inevitably would lead to cuts in healthcare services for all Americans.”
The hospital funding mechanisms aren’t the only Medicaid changes that Congress is considering.
A version of the bill that passed the U.S. House of Representatives includes work requirements to access Medicaid. Though most Medicaid recipients do work, some use Medicaid while they are unable to work due to disabilities or illness. Such is the case for Richmond-area resident Aida Pacheco’s daughter who is out of work while she battles cancer.
Still, the twice-a-year-proof of employment required by that version of the bill could make it challenging for eligible people to stay on Medicaid and overwhelm some government employees with additional work, Warner said.
He referred to the bill as “budget gimmickery” riddled with “poison pills,” from Medicaid changes to cuts to the Supplemental Nutrition Assistance Program benefits — which could place additional cost burdens on local and state governments. Twenty-three governors have sent a letter to Congress on that matter recently, which Virginia Gov. Glenn Youngkin didn’t sign.
Meanwhile, some of Virginia’s federal lawmakers would like to see the president sign the House version of the bill.
Last week Virginia’s 1st District congressman Rob Wittman, R-Westmoreland, joined a letter in opposition to the Senate draft that reiterated support for the House version of the bill.
“The House’s approach reflects a more pragmatic and compassionate standard, and we urge that it be retained in the final bill,” they wrote. “Protecting Medicaid is essential for the vulnerable constituents we were elected to represent. Therefore, we cannot support a final bill that threatens access to coverage or jeopardizes the stability of our hospitals and providers.”
After the House’s version of the bill passed by a single vote, Democrats blasted Wittman for his support of it, which could affect about 250,000 Virginians. Wittman asserts eligible Medicaid recipients will not lose coverage and has noted his personal connection to the program. Medicaid coverage allowed his birth mother to continue her pregnancy and his parents to eventually adopt him, he said.
“I know firsthand what access to care means for families like mine,” Wittman said in a recent statement.
Back to the drawing board?
Amid all the pushback to the Medicaid tweaks in the bill, the Senate’s parliamentarian set Republican’s plans back in a Thursday ruling that found several measures didn’t comply with the federal reconciliation process. Lawmakers then spent the weekend reworking the bill. Though Republicans didn’t back down on their sought changes to the hospital provider taxes in Medicaid, they agreed for the cuts to be delayed and incremental.
What happens to Medicaid in Virginia if massive federal bill to slash billions becomes law?
As an adviser to the chamber, Thune has said lawmakers won’t challenge the parliamentarian’s ruling, which included other reforms they’ve sought, like reducing federal funds to states that use their own tax dollars to provide Medicaid coverage to immigrants and a bar on patients tapping into Medicaid for gender-affirming care.
Thune told Politico late last week that Republicans may not get “everything that we want” on the provider tax, but that he hopes his party can salvage “most of the reforms.”
Warner said he hopes Republican congresspeople will be “willing to go back to the drawing board and actually work with both parties.”
For now, he thinks it will be “a bumpy next couple of days, but this is a bad bill for America. It’s a bad bill for Virginia.”
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Author: Charlotte Rene Woods
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