It would be easy to blame Republicans — especially the present White House occupant — for the steady atrophying of healthcare that’s readily accessible to Virginians in rural areas. You wouldn’t be wrong.
You wouldn’t be totally right either.
Policies put in place during President Donald Trump’s second term contribute substantially to the declining availability of medical care in the rural communities of the commonwealth — the same communities that are, by far, Trump’s strongest base of support.
One way to understand what’s happening is to look at the numbers.
A major culprit is $911 billion in cuts nationally to Medicaid over the next 10 years mandated by Trump’s “One Big Beautiful Bill Act” of 2025.
Those cuts will leave an additional 10 million Americans without health insurance in the next decade, according to the Kaiser Family Foundation.
In addition, more cuts may be on the horizon.
As the Mercury’s Charlotte Rene Woods reported Thursday, a new rule proposed by the Centers for Medicaid and Medicare Services could reduce Medicaid spending in Virginia by $31 billion in the next 10 years, according to an estimate by the Virginia Hospital and Healthcare Association.
Virginia hospitals predict $31B reduction in state’s Medicaid funding if proposed CMS rule passes
All of it will disproportionately hurt people outside of urban/suburban Virginia.
Rural residents rely more on Medicaid than metro dwellers. A 2023 nationwide analysis of county-level enrollment estimates in Medicaid or the Child Health Insurance Program by Georgetown University’s McCort School of Public Policy shows those programs cover 19% of adults but 38% of children in rural Virginia. That compares with 14% of adults and 33% of children in cities and suburbs.
By depriving people of coverage, the federal cuts will bloat an already large pool of patients unable to pay for medical services. Because people without coverage tend to forgo doctor visits for small ailments, they often turn up in emergency rooms when those problems become serious for treatment they can’t pay for.
That could crush small, rural community hospitals that serve older, more infirm populations with greater incidence of chronic and severe disease in disadvantaged cities or counties where tax bases struggle to help local hospitals on the cusp of insolvency.
Virginia, thankfully, has an advantage most southern states lack. We are among just four former Confederate states — along with Arkansas, Louisiana and North Carolina — that have expanded Medicaid coverage, providing Virginians a moderate buffer recipients in the 10 nonexpansion states lack.
An additional 300,000 Virginia adults received healthcare coverage in just eight months after Virginia expanded access to Medicaid in 2019, according to the Joint Legislative Audit and Review Commission, the General Assembly’s research arm.
In non-expansionist neighbor Tennessee, 14 rural hospitals have closed since 2012. In Virginia, just two — Pioneer Health Services of Patrick County and Norton’s Wellmont Mountain View Regional Hospital — have shut down since 2005, according to a recent Virginia Joint Commission on Health Care report. (Lee County Community Hospital closed in 2013 but reopened offering limited services eight years later.)
Virginia, however, is not immune. The JCHC analysis found that 13 of the commonwealth’s hospitals have a tenuous lease on life. Eight are considered “At risk” of closure while five are “At immediate risk.” It also found that another 12 hospitals are at risk of financial distress.
All of them serve rural communities.
Hospitals have dealt with tight or even negative operating margins by cutting services such as inpatient care, surgery and obstetrics. Residents in urgent need of those lost specialties face greater risk from longer travel to urban hospitals.
At the same time, other access points to medical services are also disappearing in areas where access to primary care was already severely limited. The Mercury reported earlier this month that eight federally funded health clinics based in southwestern Virginia public schools were closed.
Eight school-based health clinics close in Southwest Virginia as federal funding pressures mount
All of those clinics were in the westernmost corner of Virginia within the vast geographic footprint of the 9th Congressional District. It’s by far the state’s most reflexively Republican district.
(Remember the Democrats’ failed effort earlier this year to redraw the state’s 11 United States House districts so they could win up to 10 of them? The lone district they conceded to the GOP was the 9th.)
That puts the district’s seven-term Republican congressman, H. Morgan Griffith, on a hot seat of sorts. The Virginia Community Healthcare Association wrote to Griffith, imploring him to intervene to save the school clinics.
In a statement to the Mercury Friday, Griffith said Congress had been unaware of issues that had shuttered the eight clinics and that his office was conversing with the VCHA and Southwest Virginia Community Health Systems officials.
“I am in discussions with the House Committee on Energy and Commerce to see what can be done to help and mitigate these issues,” Griffith said.
Rural Virginia has been loyal to the GOP. Though Democrat Kamala Harris carried Virginia in the presidential election two years ago, Trump took 64% of the vote in rural localities. In 11 rural counties, Trump took 80% or more of the vote: all 11 are in Griffith’s 9th District.
Will the mounting rural healthcare access and affordability crisis put Griffith at risk in November’s midterms? No. Google “safe seat” and it’s likely to return Griffith’s photo alongside the definition.
But how long do people who live outside cities and their concentric rings of cookie-cutter subdivisions with their gleaming, modern hospitals and clinics put up with substandard access that endangers their lives before serious voters’ remorse sets in?
It might not be a problem — yet — for Griffith, but it’s plainly in the Democrats’ plan of attack to expand their 6-5 advantage in Virginia’s United States House delegation. Republicans in districts with narrower partisan margins will be vulnerable.
Democratic former Biden administration Transportation Secretary Pete Buttegieg said in an interview with the Mercury’s Markus Schmidt last week that healthcare and affordability are among the party’s most potent arguments for flipping rural, Republican-held congressional seats in Virginia.
“I think right now with everything that voters and their families are up against economically, there’s a very important opening,” the unsuccessful 2020 Democratic presidential hopeful and 2028 Democratic presidential prospect said.
Not that all the challenges facing rural hospitals can be fixed by Washington and Richmond. But Washington specifically aggravated this problem for rural people.
The Hippocratic Oath — the vow physicians take before they enter the practice of medicine — opens with the admonition “First, do no harm.” This Congress and this president have harmed Medicaid and those it serves.
In a little over four months, it will be up to voters to prescribe the course of treatment for that.
