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Richmond Times Dispatch: With healthcare, Virginia has been dealt a bad hand
July 30 marks the 61st anniversary of Medicaid and Medicare, arguably the biggest turning point in the history of the social safety net. Millions of older Americans and people with low incomes had health insurance for the first time. Millions more who had bare-bones insurance, covering only hospitalization, could now afford to see doctors for routine care that could keep them out of the hospital. Decades later, the Affordable Care Act (ACA) became law in 2010 to expand health insurance coverage through Medicaid and subsidized private insurance because coverage had become unaffordable or unavailable for millions of working-age adults.
Yet last year, President Trump and Republicans in Congress made major cuts to Medicaid and the ACA to help pay for huge tax cuts to help pay for tax cuts that disproportionately benefit high-income households and corporations. Virginia and other states have started to cope with the damage, but there are no good options at the state level — just some that are less bad than others.
Like termites in the basement, the damage from these cuts will accumulate over time. The Congressional Budget Office (CBO) has projected that 16 million Americans will lose health insurance by 2034. A year ago, the nonpartisan Kaiser Family Foundation estimated that 260,000 to 430,000 of them would come from Virginia. Governor Spanberger is now saying those numbers will be “monumentally worse.”
Even though Virginia’s unemployment rate is higher than a year ago, Medicaid enrollment has decreased by 125,000 people, according to Virginia DMAS enrollment reports. That’s not normal. So far, more than 30,000 Virginians have dropped ACA Marketplace coverage in 2026; more will do so as the higher premiums become too burdensome. These premiums could easily rise by more than 10% next year, according to an analysis of preliminary rate filings in 16 states and D.C.
Nationwide, recent cuts to health insurance also threaten hundreds of hospitals, clinics and nursing homes that rely on Medicaid and the ACA Marketplaces for reimbursement, according to Hospital Crisis Watch. More than one-third of Virginia’s rural hospitals are at risk of closing, according to the General Assembly’s Joint Commission on Health Care. Three clinics in western Virginia have closed, along with a labor and delivery unit at a Farmville hospital. Closures like these eliminate jobs and limit access to medical care for everyone.
Virginia’s budget for 2026-2028 includes $350 million to cope with Medicaid cuts and $150 million to help Virginians afford ACA Marketplace coverage. That’s 500 million dollars that could have been spent on affordable housing, childcare, special education, job training or any number of pressing needs. But that painful trade-off was required because of Trump’s tax cuts. The richest 1% of Virginians, for example, will each owe almost $80,000 less in income taxes this year, according to the Commonwealth Institute.
State officials realize that $500 million won’t be enough to mitigate all the damage to healthcare. The governor and state agencies are currently brainstorming with providers to find other remedies. Good luck to all. The list of bad options is long and depressing.
For instance, Virginia could reduce reimbursements to doctors and hospitals. Problem: Medicaid already pays less than Medicare and much less than private insurance, and further cuts might cause providers to accept fewer Medicaid patients.
Virginia could cut back on optional services covered by Medicaid. Problem: these include prescription drugs, dental care for adults, physical therapy and many other types of care that most of us would call essential.
Or Virginia could protect kids and senior citizens at the expense of working-age adults on Medicaid and the ACA Marketplace. Problem: Adults get sick or injured, too, and being uninsured will lead to worse health outcomes and more expensive care later, which someone (for example, hospitals, clinics) will have to pay for, according to a Kaiser Family Foundation brief.
Virginia could raise taxes generally or only on affluent people who are receiving the biggest tax cuts. Problem: Politically, Democrats would have to play Scrooge right after Republicans got to play Santa Claus.
Finally, Governor Spanberger and the Democratic legislature could do as little as possible, showing Virginians how much it hurts when Republicans control the White House and Congress. Problem: Scoring political points will come at the expense of vulnerable people who need immediate help.
Instead of celebrating the anniversary of Medicaid and Medicare, I will sympathize with state officials who are trying to minimize damage from changes that most Americans, Democrat and Republican, opposed in 2025. I will feel bad for local caseworkers who must explain to vulnerable people why their health insurance has been taken away. If we want better options in Virginia, then we need people in the nation’s capital who will reverse those cuts.