On Tuesday, the US Senate passed its version of President Donald Trump’s “One Big Beautiful Bill” by a narrow 51–50 margin, with Vice President JD Vance casting the deciding vote after three Republicans — Sens. Susan Collins of Maine, Rand Paul of Kentucky and Thom Tillis of North Carolina — joined Democrats in voting against the bill.
The bill will cut roughly $1 trillion from Medicaid, according to a preliminary review done by the nonpartisan Congressional Budget Office. The House of Representatives on Thursday voted 218–214 to send it to Trump's desk for his signature, despite at least two Republican members of Virginia’s congressional delegation saying they opposed it.
Last week, US Reps. Rob Wittman (1st) and Jen Kiggans (2nd) signed a letter opposing an earlier version of the Senate’s legislation. The representatives urged the Senate to consider the reforms in the House’s version, which they say “strengthen the program’s ability to serve children, pregnant women, the elderly, and individuals with disabilities.”
VPM News reached out to Kiggans and Wittman after Tuesday’s Senate vote. Neither responded prior to publication.
Health care advocates in Virginia warn the cuts would reduce access to medical care across the commonwealth and could put half a dozen hospitals at risk of closure.
Republicans who have spoken out in support of the Senate’s bill say the cuts are meant to return Medicaid back to its original intent: protecting pregnant people, children and disabled adults.
In the decade after the Affordable Care Act went into effect — most of its provisions began in 2014 — Medicaid costs have nearly doubled. Senate Republicans propose using the savings from spending cuts on programs like Medicaid to offset a series of tax cuts and spending increases on the military and immigration enforcement.
Like the House version, the Senate’s bill proposes multiple changes to Medicaid including work requirements, copays for doctor’s visits and additional eligibility checks. But the Senate bill goes further than the House by lowering provider taxes incrementally from 6% to 3.5% by 2032, and capping the amount of money states can be reimbursed for treating Medicaid patients at a rate lower than the cost of service.
To offset the impact of the expected federal funding losses to states, the Senate added a rural health transformational fund — which allocates $25 billion for rural hospitals.
The reductions being considered to federal Medicaid spending could kick roughly 11.8 million Americans off their health insurance — including more than 300,000 Virginians, according to the CBO.
Julian Walker, Virginia Hospital and Healthcare Association spokesperson, said changing how these funding mechanisms work would have consequential impacts on the ability of hospitals across Virginia to maintain their current level of care.
“It would have devastating effects on hospital sustainability, on the availability of care in communities across Virginia. It very well could lead to hospital closures,” Walker said.
In a call with reporters last Thursday, Sen. Tim Kaine (D–Va.) expressed concerns about the legislation’s impact on people across the state: “The Medicaid cuts are one of the most glaring problems with the proposal.”
Both Kaine and Sen. Mark Warner (D–Va.) have warned that the decrease in funding could lead millions of Americans into medical debt and increase the total medical debt owed by Americans to $50 billion — a 15% jump from current levels.
“Health coverage is prevention. It’s not just treating illness; it’s protecting families from financial ruin,” Kaine and Warner said in a joint press release before the Senate’s vote. “We should be focused on expanding access to healthcare and lowering costs, not ripping coverage away and sticking people with thousands of dollars in new debt.”
Impact on rural hospitals
The proposed cuts could hit rural residents and hospitals hardest. More than one-third of Virginia’s hospitals are already operating in the red, according to VHHA — and a half-dozen Virginia hospitals could experience financial distress that would force them to reduce services or consider closure, according to the University of North Carolina’s Cecil G. Sheps Center for Health Services Research.
Southern Virginia Regional Medical Center in Emporia is one of the six hospitals listed at risk of closure. US Rep. Jennifer McClellan (D–4th) represents the area in Washington. She pointed to the thousands of jobs lost over the past year after the closures of the Boar’s Head meat processing plant and the Georgia-Pacific plywood mill.
“They’ve already had a huge hit,” McClellan said. “Now if their hospital closes, that’s going to have a devastating impact on both the local Emporia community and their government there.”
She also pointed out it would force Emporia residents in need of medical care to drive nearly an hour to Petersburg or across the state border into North Carolina.
McClellan expressed concerns about rural residents in her district, but said the legislation could have ripple effects across all communities.
“It’s the overall impact on public health in general,” McClellan said. “You’re going to lose your health insurance, you’re going to lose access to your hospital, it’s going to be really hard to find a provider that can provide care, and people are just gonna die.”
