Health systems get loud about current and anticipated insurance drop-offs, stunted funding pathways
Virginia’s state and federal Democratic lawmakers have issued many full-throated rebukes of the drastic health care impacts imposed by the One Big Beautiful Bill Act over the past year, but hospital chains have been more reserved about their concerns.
But that’s changing, as the reality of reduced federal funding and spiking insurance costs has set in for facilities statewide.
“There has been just a lot of quiescence,” said Virginia political analyst Bob Holsworth. “But clearly, it’s getting closer to the point where it’s going to hit home.”
Sentara owns 12 hospitals throughout Virginia and northeast North Carolina. The hospital chain hosted a roundtable discussion on the 16th anniversary of the Affordable Care Act this week.
There, one of the hospital chain’s representatives — alongside U.S. Rep. Bobby Scott, D-Newport News, Virginia’s Health and Human Resources Secretary Marvin Figueroa and Hampton Roads health providers — aired the challenges professionals and patients are facing, posed by the quickly shifting health care landscape.
Sentara vice president of government relations Andy Stephenson said the health system is “getting hit on all sides.”
“This is a big issue for not just all of us in this room, but for all our friends, families and neighbors,” he added.
The comments come as tens of thousands of Virginians have already dropped their health insurance due to spiked premiums, after Congress failed to renew ACA subsidies and as forthcoming changes to Medicaid and hospital funding mechanisms loom on the horizon.
In a follow up interview on Thursday, Stephenson said Sentara’s status as a nonprofit hospital means it also reinvests its profits to “safety net” community partners, like other nonprofits or free clinics. That collaboration may be at stake, as hospitals like Sentara take financial hits.
As risks to care grow, hospitals speak up
Though Virginia’s health systems were part of a multi-state joint letter to members of Congress in June opposing versions of the reconciliation bill, U.S. Sen. Mark Warner, D-Viriginia, and Virginia House Speaker Don Scott, D-Portsmouth, suggested some hospitals had been otherwise silent on the public front.
“They’re trying to bury their heads in the sand. They want to lobby me and the Speaker for help behind closed doors, but don’t want to go out and be transparent with their community,” Warner said at a health care event in Franklin last September.
He’d originally asked to host it at Southampton Community Hospital — one of six hospitals in Virginia considered vulnerable to the health care changes, but the event ended up hosted a few miles away instead.
Bon Secours, which owns Southampton, did not comment directly at the time. The Virginia Hospital and Healthcare Association, which represents health systems in the state, reiterated the joint letter to Congress and said its chains have been in touch with lawmakers.
Sentara’s chief administrative officer Aubrey Layne said hospitals have kept open lines to lawmakers over the past year, but acknowledged that Sentara has become “more purposeful lately about getting the public to understand.”
Despite the reconciliation bill passing last year, the changes to Medicaid and hospital funding mechanisms don’t take effect until early next year and 2028, respectively. Layne said Sentara has been deliberative about how to best translate that to the masses.
From presenting to regional chambers of commerce to hosting the recent roundtable, “we’ve been trying to get the message out that if you have commercial insurance and think ‘well, I’m not impacted by this’ — of course you will be,” he said.
Southwest Virginia and Tennessee-anchored Ballad Health was an early communicator and granted The Mercury a tour of Lee County Community Hospital, another of the six on the national vulnerability list, weeks after the reconciliation bill passed.
The hospital chain’s Chief Operating Officer Eric Deaton called the changes “pretty scary” for hospitals with high percentages of Medicaid patients.
He predicted Ballad could lose around $25 million in the first year the reconciliation bill’s hospital funding changes take effect. Hospitals with a footprint in rural areas, like Ballad, can be less profitable and be forced to make it all work on slimmer margins.
That work is “a calling” for some physicians and hospitals, Deaton said, but that doesn’t erase the strains.
“We’re very concerned, and we’re really focused on, ‘what can we do to work with our legislators in the future?’” he said.
Other hospital systems have weighed in, as well.
VCU Health and HCA participated in a forum with Richmond’s Chamber of Commerce to press for the renewal of the ACA subsidies. In a press release, Augusta Health cited the One Big Beautiful Bill Act as a factor in the closure of three clinics.
Centra referenced “reductions in federal health care funding” in a press release announcing that it was ending labor-and-delivery services at its Farmville hospital — making a regional maternal health desert a little drier.
Warner thinks all of it is “a positive step.”
“What we’re seeing in Virginia is not unique,” he said. “Health systems across the country, particularly in rural and underserved areas, are sounding the alarm about the strain caused by Medicaid cuts and higher uninsured rates.”
Health care access tops voters’ list of concerns
Over the past year, Democratic lawmakers have emphasized that preventative care reduces emergency room visits, noting that uninsured patients are more likely to put off care until emergencies arise.
Prolonged uncompensated care can lead to private insurance spikes over time, Warner has said. This means that, while some who’ve relied on ACA insurance and some who rely on Medicaid may be the first to feel the strain from the federal shifts, paying for their care could eventually fall to taxpayers.
KFF polling found that Democrats have a 13-point advantage over Republicans when it comes to health care access and affordability issues.
Across political affiliations, two-thirds of respondents say they worry about being able to afford health care, ranking higher than utilities, food, groceries, housing and gas. Fifty-five percent said their health care costs have gone up in the past year and 56% say they expect it to become even less affordable in the coming year.
“When we asked specifically about the economy, ‘what is it about the economy that worries you?’ we saw that health care concerns were the case across partisanship — this is the first time we’ve really seen this,” said Shannon Schumacher, a senior policy analyst with KFF.
The government shutdown triggered by Congress’ prolonged debate over renewing ACA subsidies shone “a spotlight,” on ACA marketplaces and health insurance as a whole, Schumacher said.
With state lawmakers in Virginia and other states sorting out how to cushion the blow in pending state budgets, providers and patients are inching closer to further insurance drop offs.
Almost all respondents said health care costs has the ability to impact their votes, Schumacher said, but it resonated most strongly among Democrats and independent voters.
Though spiking gas prices due to America’s unexpected war with Iran are a pressing issue, Schumacher suspects future polling could continue to indicate health care worries are paramount for ballot casters.