Virginia sees spike in abortions due to influx of out-of-state patients
Virginia was among the states that saw a substantial increase last year in the number of abortions provided.
That's according to a new report from the Guttmacher Institute, a research organization that advocates for access to reproductive care including abortion. The increase is likely due to an influx in patients from states with new or more restrictive abortion bans.
Virginia saw 5,500 more clinician-provided abortions in 2024 than the year before, a 16% increase. That's an outlier compared to the national trend, where there was just a 0.4% increase in states without total bans.
'There was an 86% increase in the number of patients traveling from out of state to Virginia for abortion care between 2023 and 2024, and we think that the Florida ban is likely playing a big role here,' said Guttmacher senior research associate Isabel DoCampo .
Most states without total abortion bans saw small changes to the number of abortions performed between 2023 and 2024. Arizona, California, Kansas, Ohio and Virginia, states that did not change their abortion legislation in the past two years, saw substantial increases. Virginia saw the most significant increase, outpaced nationwide only by Wisconsin, which restored abortion services in the latter half of 2023.
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Virginia is the last state in the Southeast without a ban on abortions after six or 12 weeks of pregnancy — Florida, which previously allowed abortions up to 15 weeks, enacted a six-week ban that took effect May 1, 2024.
'Virginia is the second-closest state for Florida patients to access abortion, and it's the closest place without a waiting period to access abortion,' DoCampo said. 'It's also likely that people in the Southeast who would have traveled for care to Florida are now going to Virginia instead.'
That maps with findings from the Virginia League for Planned Parenthood, which operates clinics in Virginia Beach, Hampton and Richmond.
'Before the Dobbs decision in 2022, the amount of out-of-state patients was 2 to 3% of our entire patient population,' said Planned Parenthood spokesperson Rae Pickett, referencing the Supreme Court decision that stripped away the nation's constitutional protections for abortion . 'After the Dobbs decision, that increased very quickly to 15%. So that was a very large jump. Then, after the six-week abortion ban went into effect in Florida, our numbers went from 15 to 25 to 30% and have stayed there for that period of time.'
Virginia permits abortions during the first and second trimester, or during the third trimester if three physicians agree the pregnancy will lead to the woman's death or substantially harm her health.
VLPP increased same-day and telehealth appointment availability in anticipation of the Florida, as well as the use of patient navigators, who help patients coordinate travel. The Planned Parenthood affiliate operates a virtual clinic via telehealth, but people seeking an abortion pill for up to 11 weeks after their last period must be physically located in Virginia at the time of their appointment, and the medication is mailed to a Virginia address.
'I think the Virginia case shows us that an abortion ban in one place has a dramatic impact on the abortion care infrastructure in other parts of the country,' DoCampo said.
The Virginia Society for Human Life, an anti-abortion advocacy group, described the report as tragic.
'The new numbers suggest a deeply alarming trend,' said Olivia Gans Turner, president of VSHL, in a statement.
Virginia's constitution does not expressly prohibit or protect abortion. That could change: the General Assembly voted this session along party lines to advance a constitutional amendment that would enshrine a right to abortion in the state constitution. If the legislature passes that same resolution next year, the amendment will appear on the ballot for public referendum in 2026.
The state constitutional amendment process excludes input from the governor, but both the Republican and Democrat candidates for governor have taken positions on the issue. Lt. Gov. Winsome Earle Sears, the Republican nominee, spoke at Virginia's March for Life earlier this month.
'All those who are for abortion are already born,' she said. 'We stand for life, and how can it ever be wrong to stand for life?'
Former U.S. Rep. Abigail Spanberger previously voted in Congress in favor of codifying the abortion protections offered in Roe v. Wade.
'Virginia is the last bastion in the South when it comes to protecting reproductive freedom — and the consequences of this reality on women and families are clear,' she said in a statement. 'In the aftermath of the Supreme Court overturning Roe v. Wade, families across the Commonwealth continue to worry that extreme politicians and judges will rip away their right to privacy, jeopardize their safety, and leave their families without access to medical care.'
Kate Seltzer, kate.seltzer@virginiamedia.com, (757)713-7881
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The Wyoming Hospital Upending the Logic of Private Equity
The Atlantic Daily, a newsletter that guides you through the biggest stories of the day, helps you discover new ideas, and recommends the best in culture. Sign up for it here. After years of trying to improve his hospital in Riverton, Wyoming—first as a doctor, then as a board member and volunteer activist—Roger Gose was ready to give up. Gose, a Texas native, had been in Wyoming since 1978, when he saw an ad in a medical journal looking for a small-town internist. Ever since he was a kid, he had wanted to be a community doctor, the kind who made house calls and treated his neighbors from birth into adulthood. He found his calling in Riverton, a town of 10,000 people in one of the state's poorer counties. For 35 years, he ran a private practice and worked shifts at Riverton Memorial Hospital, even serving for a time as the chief of medicine there. After retiring from his practice in 2012, he joined the hospital board, still eager to do whatever he could to help. 'You want to leave a place better than you found it,' he told me. And for a long time, he felt like he had. But that was before LifePoint Health, one of the biggest rural-hospital chains in the country, saw his hospital as a distressed asset in need of saving through a ruthless search for efficiencies, and before executives at Apollo Global Management, a private-equity firm whose headquarters looms above the Plaza Hotel in Midtown Manhattan, began calling the shots. That was before Gose realized that, in the private-equity world, hospitals were just another widget, a tool to make money and nothing more. In late 2018, Gose and a group of his neighbors decided that trying to save their hospital was futile. It had already lost its maternity ward, leaving pregnant people to drive nearly 30 miles to deliver a baby. Data from the Wyoming Department of Health show that the number of air-ambulance flights from the county where Riverton sits to hospitals elsewhere in the state rose from 155 in 2014 to 937 in 2019. By the time I spent several days with Gose and a dozen other Rivertonians in the spring of 2023, they didn't even have a hospital anymore, they told me; they had a 'Band-Aid station.' The only way to ensure that their town had a real hospital, they decided, was to build one themselves. The conventional wisdom about rural hospitals in the 21st century is that they are, in a word, screwed. Young people move away; older residents left behind need more expensive care and are less likely than urban and suburban residents to have private insurance, which is more lucrative for providers than Medicare and Medicaid. A 2018 report from the U.S. Government Accountability Office found that twice as many rural hospitals closed from 2013 to 2017 than in the five years prior, and the ones that remained were in much worse financial shape than their nonrural counterparts. Emergency funding during the coronavirus pandemic improved the financial health of rural hospitals, but after that funding dried up, many were left facing labor shortages and supply-chain problems that increased prices. House Republicans' proposed cuts to Medicaid could drive even more hospitals out of business, the American Hospital Association argued in a letter to congressional leaders this April. The ability to stave off closure has been the chief value proposition that private-equity firms offer to rural hospitals. In my reporting on private equity's growing dominance in health care, I heard versions of the story that LifePoint and Apollo told Riverton residents again and again: Without us, you will be left with no hospital at all. Yours is running out of money, and our ability to consolidate and find efficiencies across our ever-growing system is the only thing that can keep it alive. Your community is too small and poor to support an obstetrics department, or general surgery, or mental-health services, so you won't have those anymore, but isn't something better than nothing? Accepting that private equity is the only option for rural hospitals, though, requires accepting that rural Americans deserve less access to care than their urban and suburban counterparts, and that the care they do receive will be measurably worse. A landmark 2023 study found that in the three years after a private-equity acquisition, the rate of serious preventable medical complications increased significantly. (LifePoint hospitals were not included in the study, which focused on acquisitions made before 2018.) Patients were more likely to fall in the hospital and more likely to acquire infections at the site of a surgical incision. The number of central-line infections, which often result from improper insertion or cleaning, rose 38 percent. Though the study didn't delve into the reasons for the increases, the implication was clear: Focusing on short-term profits was leading to cost cutting that could be dangerous for patients. In Riverton, the hospital's owner was cutting costs aggressively, while also raising prices. In 2014, LifePoint formally merged the hospital with one in wealthier Lander, a town 25 miles away, and renamed them SageWest Riverton and SageWest Lander. In 2017, the year before Apollo bought LifePoint, researchers examined hospital data for 14 individual Wyoming facilities and found that SageWest charged the highest relative prices; data from 2020 show that SageWest maintained the largest price disparity of any general hospital in the state after the Apollo acquisition. (LifePoint referred questions about the Riverton and Lander hospitals to SageWest; SageWest leaders did not respond to several requests for comment.) At the same time, the Riverton hospital was shrinking. In quick succession, SageWest suspended its obstetrics services, closed its inpatient mental-health unit, and shrunk other basic services. By 2022, the last year for which Centers for Medicare and Medicaid Services data are available, SageWest employed 227 people across its two campuses, nearly 40 percent fewer than before the Riverton-Lander merger. According to Gose, the number of physicians based in Riverton had dwindled from 20-something to just seven. If they were going to build a new hospital, Gose and his neighbors first needed to know whether it could theoretically be financially viable. By 2018, they had formed a nonprofit, Riverton Medical District, and one of the board members, Vivian Watkins—the former head of commercial lending for U.S. Bank's 14 branches across Wyoming, and the kind of person who can't leave the grocery store without stopping four times to ask about someone's kids or their neighborhood drama—began cold-calling hospital CEOs across Wyoming, looking for advice on where to start. One told her that she should go straight to Stroudwater Associates, a Maine-based consultancy with a specialty in rural-health-care finances. The Riverton nonprofit was not Stroudwater Associates' typical client. The company's chairman, Eric Shell, and his team usually work directly with rural hospitals, or occasionally with a larger chain looking for system-wide strategic planning. Gose, Watkins, and their allies didn't have a hospital, didn't have concrete plans for a hospital, didn't even have any money for a hospital. Still, Shell was intrigued by the brazenness of what they were dreaming up. After nearly 30 years working with rural hospitals, Shell believed that rural hospitals could survive, but that too few hospital executives think creatively about solutions. Over and over, he's seen cuts damage a hospital's business further: 'You win the battle, but you lose the war,' he told me. Instead of cutting costs by 'doing more with less' (to use the corporate jargon for layoffs and overworking employees), making rural hospitals run in the 21st century means increasing profits by expanding a hospital's business. One of Shell's go-to examples is Mahaska Health in Oskaloosa, Iowa, a nonprofit hospital in a city slightly bigger than Riverton. When the pandemic hit in 2020, hospitals across the country were overwhelmed with critically ill COVID patients, but also saw a decline in other types of cases. The result was a huge, unexpected loss of revenue for many hospitals, and a correspondingly huge number of layoffs: 1.4 million health-care workers lost their jobs in April 2020 alone. At Mahaska, though, CEO Kevin DeRonde—a former NFL linebacker—ran in the opposite direction: He hired many of the providers who had been laid off from other area hospitals, Shell said. His hospital took a short-term financial hit, but DeRonde wagered that patient volume would recover once the worst of the pandemic eased up. The bet paid off. After the drop in 2020, the number of non-COVID patients skyrocketed. Now many hospitals were understaffed, but not Mahaska. The hospital hadn't been doing well even before the pandemic, losing more than $5 million in 2017. By 2023, it made $7.5 million in net income, according to Shell and Mahaska Health officials. Growth, though, is more difficult at hospitals owned by private-equity firms, because of the need to keep shareholders happy through quick returns. 'When I look at what they're doing in Lander and Riverton, I shake my head and say, 'That's not the way I'd be running the company,'' Shell told me. 'But I'm not running the company, and they're driven by an external force. If they're not beating the market rate of compensation for their investors, their investors are going to walk.' Shell agreed to conduct a feasibility study for Riverton Medical District, and Stroudwater spent months digging into every aspect of Riverton's economy, population, and existing health-care options. Just 44 percent of Medicare recipients in the area who needed hospital treatment got it at either Riverton or its sister hospital, leaving an opening for a new hospital to quickly capture market share. The presence of the Wind River Reservation, which surrounds Riverton, boosted the financial case: The Eastern Shoshone and Northern Arapaho Tribes, which share the reservation, both provide private insurance to their members. In June 2019, Shell's firm handed over its report. Its takeaway: The area had the ability to 'support a financially viable rural health system with a range of medical, surgical, and specialty services.' The Riverton Medical District team had the answer they wanted, from a company with real bona fides in the rural health-care world. Gose and Watkins were jubilant. They were going to build a hospital—if they could find the money, that is. Friends and neighbors had banded together to cover the $150,000 Stroudwater study, but a whole new hospital was going to cost tens of millions. Shell didn't think they could pull it off. He told them so outright. He's an accountant, which means always assuming the worst. He couldn't fathom why a bank or a government would give Riverton Medical District a loan, considering the competition risk. The group, though, was unanimous: Shell's fears weren't going to stop them. They were the ones who lived there; they were the ones who, in Gose's words, felt an obligation to leave Riverton better than they found it. After months of looking into every other source of funding they could think of, Riverton Medical District turned to what the group considered the 'lender of last resort'—the U.S. Department of Agriculture, the primary government funder of projects affecting rural Americans. A community hospital in an underserved rural area fit the portfolio, which could qualify Riverton Medical District for low-interest loans. Applying for government money, however, required navigating government bureaucracy. In an email exchange that stretched over months, the USDA rural-development regional director for Wyoming, Lorraine Werner, was encouraging but exacting. Every time Werner needed more documents, including a third-party audit that cost an additional $50,000, the group would scramble to get them to her. Then she would ask for even more. It took Riverton Medical District more than a year to have its application accepted—not for funding, just for consideration. Yet somehow, Riverton residents never seemed to grow tired of what looked to many outsiders like a quixotic scheme. To house the hospital, the Eastern Shoshone Tribe agreed to sell eight acres on the north end of town and donated four more acres outright. People kept handing over money, frequently $5 or $10 at a time. Finally, after an application process that took nearly two years, USDA announced its ruling. The federal government agreed that a new hospital in Riverton could be financially viable, committing to fund the lion's share of the costs—more than $37 million. It was the largest USDA rural-development loan ever awarded in the state of Wyoming. The money would fund a hospital offering every routine service Rivertonians had lost. It would have 13 inpatient beds, a full surgical department, two labor-and-delivery rooms, two rooms equipped for intensive care, and space for physical and speech therapy. It would be staffed to perform surgery and deliver babies 24 hours a day. And the building would be designed to accommodate future growth, with the potential to add 11 new patient rooms, additional surgery space, and more parking, board members told me. In its report, USDA was more bullish than Shell and Stroudwater had been; the agency's official assessment of the project barely referenced the threat of competition from the existing hospitals. Citing numbers provided by the Riverton Medical District board, USDA found that the hospital could break even with just 30 percent market share, far less than SageWest's 44 percent. The Riverton Medical District project, evaluators wrote, had generated a remarkable level of local support; the agency noted donations from individuals and businesses that added up to more than $1 million, and more than 200 letters of support. Several of the letters said that without a new hospital, they would move out of Riverton. Multiple business owners wrote that the lack of a fully functioning hospital left them unable to recruit and retain workers. Most of the USDA report was written in bureaucracy-speak, but at one point the author slipped into first person: 'The applicant started a true grassroots movement to bring back essential services to the community and has exhibited a level of community support, both monetarily and otherwise, that is unseen in my experience.' In December 2024, just before the soil froze for the season, work crews broke ground on Riverton's new community hospital. In early June, 400 people turned out for a community celebration, cheering for state-government officials and Riverton Medical District board members and signing a beam that will be installed into the new facility. Building a new, locally owned hospital isn't a scalable way to help every community where hospitals owned by private-equity firms are providing less health care. The particular combination of ingredients in Riverton Medical District's recipe baked into something resembling a miracle. But to Gose's mind, following Riverton's example doesn't require building a community hospital in every rural county in the country. What it requires is people with knowledge of, and investment in, one specific community making decisions for that community—the exact opposite of the private-equity ethos of consolidation at all costs. 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Big Data Can Make America Healthier. How to Do It Right
Credit - Ezra Bailey—Getty Images Big data can help make Americans healthier, and the Trump Administration has stated—in its recently released Make America Healthy Again report and elsewhere—that building a national big-data platform is one of its primary goals. As scientists who use large data sets to study health, we're excited about its potential and the willingness of the federal government to invest in it, particularly since big data has been underutilized in the U.S. compared with other developed countries—and since the number of ways it can be used grows nearly daily. It's a huge opportunity. But there are lots of concerns when assembling sensitive health data and combining it with other sensitive data, like credit scores, tax records, employment, educational records, and more. Some of those concerns with the Administration's plans have already surfaced. The Administration's first goal of assembling big data to studying autism has left some worried that if used inappropriately, such data could lead to harm, rather than help, for those with autism. Others worry that big data could be used to perform and justify shoddy research that supports predetermined conclusions without adhering to rigorous scientific methods—a concern reinforced by the discovery that the Make America Healthy Again report cited non-existent sources to support its claims. So how can we reap the benefits of big data while minimizing its risks? Here are some guiding principles: The health care system already possesses health data on millions of Americans. Medical records are now almost always digitized, permitting doctors' notes, medical imaging, laboratory tests, insurance claims, and more to be linked (in theory) across doctors' offices, hospitals, nursing homes, and any other place people receive care. 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Once linkages have been made, data can be anonymized so that those studying sensitive questions aren't privy to confidential information about specific individuals. In addition to governmental data, many other sources of data can provide insights into our health. For example, smartwatches not only have data on how our hearts are beating (e.g., they can identify abnormal heart rhythms like atrial fibrillation), but they can also identify subtle changes in mobility that might be predictive of early neuromuscular diseases like Parkinson's disease. Meanwhile, grocery stores have data on the foods we eat, and with increasing interest in how diet affects our lives, these data could be linked to detailed measures of health. Read More: Could the Shingles Vaccine Help Prevent Dementia? Similarly, social-media platforms possess data that can offer insights into changes in our mental health, and through large-scale analysis of online photos could even identify, in real time, early visible markers of disease. These are moonshots, of course, and whether we want to use data in this way is an open question. But the potential to improve health could be large. Creating a way for scientists to link outside data to existing government and health data—while responsibly maintaining individual anonymity after the linkage—could open many novel research opportunities. Keeping all of these data sources organized, secure, and accessible to scientists is a tall order. Researchers who use big data often dedicate substantial resources to finding the data they need, organizing it, and ensuring its accuracy; the better the database is maintained, the easier it is for researchers to actually perform their analyses. The secure online platform where Medicare and other government health care data are currently accessed has been described by researchers as 'tedious and prone to system errors' and in need of major improvements. Meanwhile, security concerns have led the government to stop letting researchers store the data on their own secure servers, the easiest and most cost-effective way to actually work with the data. Access to Medicare data by researchers has become prohibitively expensive, costing about $30,000 a year or more for a single user to work on one project using the online platform. Read More: Why We Can't Rely on Science Alone to Make Public Health Decisions Proposals to drastically cut medical research funding have been reported, and if passed, these research funding cuts will come at the cost of discoveries to improve health that will never be made. High-quality research of any kind requires investment, whether it's in a biology lab under a microscope or working with data on powerful computers. A new data platform is only as valuable as researchers' ability to access it in a functional and cost-effective way. Any roadmap to designing a national data platform that links together health care and other sensitive data must consider the many valid concerns about collecting data in the U.S., including privacy concerns and how data will be used. The Pew Research Center finds that large majorities of Americans say they are concerned about how the government uses data collected about them (71%), while also admitting that they have little to no understanding of what the government even does with such data (77%). Here are some strategies—in addition to many of the cybersecurity and privacy safeguards already in place—to both protect the data and help earn the public trust: Mistrust and unease with government data collection is readily traceable to historical abuse of Americans' data (as well as recent allegations of improper access), so it's not surprising that many are wary of the Trump Administration's plans. Ensuring data cannot be weaponized by the government against individuals is perhaps the single biggest barrier to creating a useful database, but it can be done. Those currently using federal health care data must already undergo training and comply with very high data-security standards. Misuse of the data—such as even attempting to figure out the identity of an anonymous individual in the data—or failure to protect patient privacy can lead to criminal penalties. A platform of sensitive data without well-delineated restrictions on who can use it and what they can use it for is a recipe for problems. Other ongoing efforts by the Administration to compile data under the vague goal of 'increasing government efficiency' have been met with pushback and lawsuits from organizations concerned about data being used against members of the public. Current use of federal health data also requires researchers to provide the government detailed plans to justify the use of specific data. This allows the government to ensure that no more data than is needed to answer the specific question is provided to researchers. Read More: Why Do Taxi Drivers Have a Lower Risk of Alzheimer's? Researchers must also obtain ethical approval from an Institutional Review Board prior to accessing and analyzing data, a second checkpoint. These boards, which exist in light of egregious failures of medical research ethics in the 20th century, help ensure that analyses are designed to minimize risk to patients—even if it is only their data, and not their bodies, at risk. Transparency into who is using this sensitive data and what exactly they are doing with it can engender trust between researchers and the American public. Just like researchers already do for clinical trials, those accessing the data platform should specify their plans in advance, and those plans should be easily and publicly available. Transparency around which data were accessed and what computer code was used to analyze it not only promotes trust, but such data- and code-sharing practices among researchers make it easier to appraise the quality of the work, identify mistakes, and root out misconduct. We can only assume that Americans' unease with governmental data use stems from knowledge that, as with all powerful tools, linked data has the potential to be used in potentially harmful ways. But when in the hands of qualified scientists using rigorous scientific methods and privacy safeguards, a robust real-world data platform like this could lead to new discoveries about how all of us can lead healthier lives. Contact us at letters@
