Hospitals in the Fredericksburg area could lose part of their annual revenue — and the local unhoused population could also be dramatically impacted — by Medicaid cuts as a result of the president’s recently approved One Big Beautiful Bill, local health care and community officials said recently.
While the exact nature of any changes remains somewhat unclear, there are clear negatives attached to the legislation, according to leaders with Mary Washington Healthcare, Micah Ecumenical Ministries and the Virginia Hospital & Healthcare Association.
The White House has said that the bill, which President Donald Trump signed into law July 4, will, among other things, lower taxes and protect Medicaid.
But those who work with Medicaid and its recipients take issue with the latter claim.
“The cuts passed by Congress will have widespread negative impact on the health of Virginians and all Americans,” Dr. Christopher Newman, president and CEO of Mary Washington Healthcare, which operates Mary Washington and Stafford Hospitals, said in a statement to the Free Press. “Health systems like ours will have to absorb more of the cost of providing uncompensated care, and we are still evaluating what the bill will mean to Mary Washington Healthcare and what changes we will need to make because of it.”
A spokesman for HCA Healthcare, which runs the Spotsylvania Regional Medical Center, referred questions to the Virginia Hospital & Healthcare Association, which has been monitoring the Medicaid issue closely.
As the Big Beautiful Bill was being debated in Congress, the state hospital association issued a statement warning that cuts would be severe and “jeopardize the stability and survival of hospitals, pose real harm to access to care for hundreds of thousands of Virginians, and significantly weaken our economy and employment.”
The new regulations approved “would cost Virginia hospitals more than $2 billion annually in essential funding that helps them sustain their operations, employ people in communities across the Commonwealth and care for people in their moment of need.”
“The effect of that financial impact would be devastating to hospitals,” the statement said. “It is likely that several hospitals, including those serving rural parts of Virginia, could end up closing in that scenario. Others may have to cut services or reduce employment, which would limit patient access to care.”
A total of 16 million Americans will lose their health insurance by 2034 under the cuts to Medicaid and the Affordable Care Act, the nonpartisan Congressional Budget Office has said. Of those, 302,608 are Virginia residents, according to Democrats on Congress’ Joint Economic Committee.
In Virginia’s 7th Congressional District, which includes the Fredericksburg area, the loss figure would be 25,489, according to the same committee.
Beyond the human cost, revenue also stands to be lost for health care providers.
As part of the Big Beautiful Bill, hospitals in the Fredericksburg area could lose 17.1 percent to 23.6 percent of their net revenue, money that comes from the deal to expand Medicaid in the Old Dominion, said Julian Walker, vice president of communications for the Virginia Hospital & Healthcare Association. He couldn’t speak to exact numbers for each facility, however.
When hospitals lose money, Walker said, that can hurt the greater economy because of their broad impact in communities.
“Hospitals are some of the largest employers in communities across Virginia,” he said. “Hospitals generate $62 billion in positive economic impact for the Commonwealth and employ more than 140,000 people, and that’s just direct jobs.”
There are also indirect jobs, including vendors whose businesses hospitals support, Walker said.
Damage from Medicaid cuts also may be seen in the Fredericksburg area’s unhoused population, said Meghann Cotter, executive director of Micah Ecumenical Ministries.
“Medicaid is a huge resource for today’s homeless population to access treatment and care that preserves quality of life and stabilizes them in housing,” Cotter wrote in an email.
What people don’t always realize, she wrote, is that before Medicaid was expanded in Virginia in 2018, less than 30 percent of unhoused neighbors had insurance, which meant the Moss Free Clinic or hospital emergency rooms were the only places they could turn to for care.
After Medicaid expansion, though, more than 90 percent of the unhoused have some form of insurance, Cotter wrote.
“It’s easily been a game-changer as far as how people can access primary care, mental health treatment, substance abuse services and other kinds of care,” she wrote.
In Virginia, observers are concerned that those who received benefits as a result of Medicaid expansion could lose coverage through what’s known as a “trigger law.” Language in the legislation suggests that if the extra federal funding the state gets from the federal government to pay for an expanded number of Medicaid recipients gets slashed, those who got coverage as part of the expansion would lose it, according to Georgetown University’s Center for Children and Families.
If the expanded coverage goes away, the doors shut for some very vulnerable people, Cotter wrote: 78 percent of those on the street have a disability, living on the street takes years off of people’s lives, and the region no longer has a dedicated free clinic with the closing of the Moss operation. Dr. Theron Stinar, however, CEO of the Fredericksburg Christian Health Center, has announced that his organization will attempt to help a portion of the “hundreds of uninsured patients” that will need care in Moss’ absence.
Requirements to work to receive Medicaid could pre-emptively end eligibility for many unhoused people, even if states do not roll back expansion. Living conditions for people on the street make it nearly impossible to meet work requirements and submit documentation that keeps benefits active, Cotter wrote.
“We are hoping perhaps there will be exemptions for people experiencing homelessness, but the impacts are still steep for marginalized groups,” she wrote.
Research also shows that communities often spend millions more on enforcement than they would have if they provided the benefit without work requirements, Cotter wrote.
Could those at risk of losing benefits look to the next Virginia governor for help? One of the two major-party candidates for the office addressed the issue when she was in downtown Fredericksburg last month.
Former 7th District Rep. Abigail Spanberger, the Democratic nominee, said she is having conversations with state legislators about how they’re viewing things and “looking at how we can make sure that, come January, we’re moving very quickly to ensure that as few people as possible get pushed off of Medicaid.” January is when the Virginia General Assembly convenes its regular sessions each year.
Her opponent in November’s election, GOP nominee Winsome Earle-Sears, the state’s lieutenant governor, addressed the issue earlier this month.
In a July 11 YouTube video from the Virginia Democrats, Earle-Sears said congressional committees “have already formed” to address issues of Americans losing medical insurance, and that Virginia is “ready and able” to help any state resident who can’t access health care.
“And so I would say to Virginia,” said Earle-Sears, “‘Don’t panic. Things are being worked out.'”
Free Press managing editor Joey LoMonaco contributed to this story. Meghann Cotter is a member of the Free Press journalism advisory committee.
