West Virginia hospital organizations are expressing deep concern about the potential effects of the “Big Beautiful Bill” under consideration in the U.S. Senate.
Several analysts have concluded that rural hospitals, including around seven in West Virginia, could be endangered by the financial effects of the legislation.
This is a big week for consideration of the big reconciliation bill as Senate leaders continue to aim for a Fourth of July deadline for passage.
The “One Big Beautiful Bill” advances many of President Trump’s top priorities, including extending the 2017 tax cuts enacted in his first term and expanding border enforcement while going ahead with deep cuts to Medicaid, SNAP and other federal programs.
The nonpartisan Congressional Budget Office’s latest cost estimate concludes that the bill would reduce federal Medicaid spending by $793 billion and increase the number of people without health insurance by 10.9 million, because of changes to Medicaid and the Affordable Care Act.
The West Virginia Hospital Association, which represents 72 members, outlined concerns this month in a letter to Senators Shelley Moore Capito and Jim Justice, both Republicans from West Virginia. The hospital association expressed “strong opposition” to provisions released by the Senate Finance Committee.
The hospital association wrote:
“We appreciate President Trump’s and Congress’ efforts to address the nation’s deficit, but our fear is that, without careful consideration, cuts to Medicaid will not only result in thousands of West Virginian’s losing health insurance coverage, but the cuts could also result in hospitals being forced to reduce services or, worse, they might be forced to close, leaving communities without timely access to quality care.”
The hospital association specifically questioned federal proposals to change provider taxes for Medicaid expansion states like West Virginia and a change of supplemental payments for Medicaid-expansion states. The changes are technical, but could still amount to a devastating wallop, according to the hospital association.
“Please oppose the Senate language, as it would negatively impact rural providers in West Virginia disproportionately and others across the country,” the association wrote in the letter signed by Jim Kaufman, chief executive of the West Virginia Hospital Association.
The Medicaid provisions have been a sticking point in the Senate, where some members of the Republican majority have warned against the proposed changes — in particular, Senator Josh Hawley of Missouri. “It’s wrong,” Hawley has said.
Democrats in the U.S. Senate recently commissioned a report from the Sheps Center for Health Services Research at the University of North Carolina showing that Alabama, Kentucky, Louisiana, and West Virginia are among states that could suffer the most hospital losses.
The conclusion took into account the number of hospitals that were in the top 10% Medicaid payer mix of rural hospitals across the country or the hospital has experienced three consecutive years of negative total margin.
The combination of factors means the rural hospitals face greater risk of being forced to stop providing some services, converting or closing.
A letter summarizing the findings shows that more than 300 rural hospitals across the country could be at risk, including seven in West Virginia.
Those are Logan Regional Medical Center, Welch Community Hospital, Broaddus Hospital Association in Philippi, Minnie Hamilton Health Care Center in Grantsville, Grafton City Hospital, Montgomery General Hospital and Jackson General Hospital in Ripley.
That’s in line with data from the Chartis Center for Rural Health provided by the West Virginia Rural Health Association.
Rich Sutphin, executive director of the rural health association, said the reconciliation bill as it stands “would be devastating to the rural health landscape across West Virginia. The work requirements and requirement for eligibility determinations every 6 months are particularly burdensome for enrollees and the state government.”
In a telephone interview, Sutphine said, “Most of our hospitals, especially in our critical access hospitals and rural hospitals are operating on negative margins already, and so if we add on that uncertainty of not having Medicaid paying for a large number of folks that could really put some of them as close to closing as possible or potentially closing them.”
When someone who has lost coverage shows up to a hospital emergency department, the hospital is required to treat them but may not get reimbursed for the services provided, he said. Treating more patients without healthcare coverage could deeply impair rural providers already operating on the margins, Sutphin said.
That could affect communities around West Virginia, Sutphin said.
“These hospitals are really economic drivers, and so if you look at — you know, Mason County has a rural hospital, and we’ve had a lot of economic development there. And that’s one factor. Companies aren’t going to want to locate to West Virginia if we don’t have a robust healthcare system,” he said.
“So if we have hospitals closing, that’s going to not only decrease the local economy because they’re often the largest employers with the best salaries but also decrease the opportunities for new businesses to come in.”
Sutphin urged senators Capito and Justice to consider these factors carefully.
“I think it’s important that the delegation reach out to their rural hospital leadership and understand exactly how this bill will impact their operations, especially in the seven that are listed as at immediate risk of closure because that will be really make or break for these communities,” he said.