What happens to Medicaid in Virginia if massive federal bill to slash billions becomes law?

Yahoo

23-05-2025

Medicaid sign at U.S. Senate Democrats' press conference on Feb. 19, 2025. (Photo by Shauneen Miranda/States Newsroom)
This week, Republicans in the U.S. House of Delegates advanced a mega bundle of bills designed to shave billions from the federal budget, which Democrats and advocates have said will take resources from the nation's most vulnerable citizens and hinder social safety nets. Virginia's congressional delegation was split along partisan lines on the measure, which cleared the House by one vote and is now up for consideration in the U.S. Senate.
The 1,116-page package contains 11 total bills and is championed by President Donald Trump, and supported by Virginia's Republican federal lawmakers including U.S. Reps. Rob Wittman, Jen Kiggans, John McGuire, Ben Cline and Morgan Griffith. The legislation aims to extend 2017 tax cuts from Trump's first term at a cost of $3.8 trillion, trim $880 billion from the federal deficit and boost defense and border security spending by cutting several federal social aid programs or incentive packages.
The measure calls for a $625 billion cut to Medicaid over the next decade, which the state's Democratic federal legislators — including U.S. Reps. Jennifer McClellan, Bobby Scott, Suhas Subramanyam, Euguene Vindman, Don Beyer and deceased Congressman Gerry Connolly, who died days before the vote — have cautioned and voted against.
Medicaid is a federal program that helps states provide health insurance coverage to low-income people or people with disabilities. The newly-passed measure would impose work requirements on those who receive it and reduce Medicaid funding to states that choose to use the program for undocumented immigrants. Virginia has specific guidelines for which legal immigrants can qualify for Medicaid and state legislators have considered creating work requirements for Medicaid enrollees in the commonwealth in the past.
As federal funding and systems dwindle, states are left to decide how and whether to make up the difference.
While it's unclear exactly what toll the federal measure's cuts would take in the state if it passes, the U.S. Congress Joint Economic Committee estimates 161,614 Virginians could lose Medicaid coverage. Meanwhile, some citizens, like Central Virginia residents Aida Pacheco and Andrew Daughtry, are voicing opposition to the work requirements.
Pacheco's daughter is currently unable to work while undergoing breast cancer treatment that Medicaid helps her cover, she said. Daughtry, a construction worker unable to work temporarily after an injury, has used Medicaid because he did not have employer-provided health insurance and now is out of work temporarily due to an injury that needs surgery and physical therapy.
Pacheco and Daughtry joined U.S. Rep. Jennifer McClellan, D-Richmond, on a recent press call, where McClellan said the proposed overhauls to Medicaid could cost taxpayers more money in the long run. Uninsured people are inclined to only seek emergency medical care, rather than preventative care. Because emergency rooms are federally required to treat all patients, care for uninsured patients who cannot pay could become a shared financial burden on taxpayers.
'When you kick people off of their health insurance, that raises the cost for everybody else,' McClellan said.
In contrast, Virginia's Republican representatives have celebrated the proposed changes, framing them as a big step towards fiscal responsibility and a better use of the country's resources.
U.S. Rep. Morgan Griffith, R-Salem, told The Mercury before the bill cleared the House that his GOP colleagues 'proved the other party wrong' by not making 'massive, significant cuts to Medicaid.'
McClellan, Virginia Democrats warn of dire impact to state if proposed Medicaid cuts materialize
And though the projected $625 billion in cuts indeed qualify as 'massive,' the federal funding tool that allocates Medicaid money to states called the Federal Medical Assistance Percentage (FMAP) has not changed. Should the bill pass the Senate and be signed by Trump, many beneficiaries would remain covered, though changes like the work requirements could affect some Medicaid recipients. It's a detail of the bill that many Republicans, including U.S. Rep. Rob Wittman, R-Westmoreland, have pointed out.
Wittman also framed the bill's work requirements as 'community engagement requirements for able-bodied adults without dependents' in a Thursday statement and emphasized that pregnant women, seniors, and people with disabilities would still be covered.
'I've fought to protect and preserve Medicaid for Virginia's most vulnerable, and this bill does just that,' he said. He added that the bill 'strengthens the integrity of the program, saves taxpayers billions, and ensures care is available for those who truly rely on it.'
In April, he'd also co-signed a letter to Republican U.S. House leadership cautioning the legislative body not to cut too much from the program.
Likewise, U.S. Rep. Jen Kiggans, R-Virignia Beach, characterized the bill as a way to strengthen, not destroy, Medicaid.
Kiggans said in a statement on X that she voted in favor of the measure because it 'puts people first by protecting Medicaid for vulnerable families, delivering tax relief and child care credits to working Virginians, investing in our servicemembers and shipbuilders, and cutting wasteful federal spending.'
As Kiggans represents Virginia's 2nd Congressional District, anchored in Virginia Beach, she and her predecessors from both parties have been considered vulnerable incumbents in elections. The district has oscillated between partisan control over the years, placing its representatives under heightened scrutiny for votes they take.
Though the 1st Congressional District has been historically Republican-leaning, its absorption in redistricting of blue or politically purple Richmond suburbs has made it an opportunity for Democrats to try to flip. This spring, some constituents hosted a town hall and invited Wittman to hear their concerns about the federal cuts, but he didn't show up.
Wittman constituents host town hall in his absence to address immigration, federal funding concerns
Though congressional elections aren't until next year, the impact of their votes concerning Medicaid remain to be seen.
In the meantime, an analysis by the nonpartisan Congressional Budget Office shows that about 10.3 million people nationwide would lose access to Medicaid or the Children's Health Insurance Program, with 7.6 million people becoming uninsured during that 10-year budget window.
The 'Big Beautiful Bill,' as Trump has called it, is not yet law. It still must pass the Senate chamber before he can sign it.
Some GOP senators are calling for a rewrite of it to address a range of concerns to include the bill's projected impact on federal debt, the phaseout of clean energy incentives and notably, the reforms to Medicaid. A key sticking point from Senate conservatives is concern that the bill doesn't do enough to cut future deficits.
With some Medicaid recipients already standing to lose access as the bill has so-far advanced, further changes to the in-progress bill — like addressing the FMAP — could put about 630,000 more people in health insurance limbo.
This is because when lawmakers were compromising to expand Medicaid in 2018, they settled on trigger language that would upend the expansion if the FMAP were adjusted.
Virginia's private hospitals have financially supported the state's Medicaid expansion since 2018, and are closely monitoring federal developments.
Julian Walker, a spokesperson for the Virginia Hospitals and Healthcare Association, said that the organization is glad Virignia's congressional delegation across both aisles has been listening to its feedback and is appreciative that the FMAP was not altered in the current draft of the bill.
Walker said earlier this year that hospitals have been 'proud' to help sustain Virginia's Medicaid expansion, but acknowledged uncertainty about what lies ahead.
State lawmakers are monitoring the situation too.
Del. Mark Sickles, D-Fairfax, suspects the legislature would need to go into a special session if the Medicaid expansion were undone but he also believes that congressional actions could wrap up in time for the 2026 Virginia General Assembly session.
'It could turn out we know everything we need to know by the time our regular session starts,' he said.
Or, he added, if Congress takes too long and has to pass continuing resolutions, they could still be sorting through final details of their proposal as Virginia's legislature begins meeting early next year.
As chair of the House of Delegates' Health and Human Services committee and vice-chair of its Appropriations committee, Sickles is watching Congress closely.
'We need to see what they actually do,' he said.
He echoed McClellan's warnings about the potential financial burden to Virginia taxpayers if people unenrolled from Medicaid are forced to seek more care from emergency rooms.
'In the end, the savings that (Republicans are) claiming are going to come from fewer enrollees in Medicaid, the cost of their health care does not go away,' Sickles said. 'There is no free lunch if you're not enrolled in Medicaid.'SUPPORT: YOU MAKE OUR WORK POSSIBLE