Exactly two months after President Donald Trump signed his policy megabill in a July 4 celebration at the White House, a Virginia health care company blamed the law for the closure of three rural clinics serving communities along the Blue Ridge Mountains.
The closures, Augusta Medical Group said in its statement, were part of the company’s “ongoing response to the One Big Beautiful Bill Act and the resulting realities for healthcare delivery.”
Rural health providers that rely on Medicaid funding were already under strain before the bill cut federal health spending by hundreds of billions of dollars over the next decade. Now, Democrats are linking that crisis to Trump and Republicans in elections this year and next.
Democratic gubernatorial nominee Abigail Spanberger recently campaigned in Buena Vista, a 6,600-person town that is losing its clinic, as she tries to improve her party’s standing with rural voters ahead of this fall’s election. Candidates for governor, potentially faced with the job of navigating the cuts, have been among the most vocal about the threats to rural health care, including Keisha Lance Bottoms in Georgia, Rob Sand in Iowa, Gov. Kathy Hochul of New York and former Biden administration Interior Secretary Deb Haaland in New Mexico.
“Rural hospitals are closing, at the end of the day. We’re seeing the tip of the iceberg here in Virginia, and it’s a sign of what’s to come,” said Marshall Cohen, a veteran Democratic strategist at the political firm KMM Strategies.
Ken Nunnenkamp, executive director of the Virginia GOP, pushed back on criticism of the Augusta Health closures in a statement to CNN. Augusta Health, which declined to comment beyond its statement, noted in its announcement that patients at two of the clinics could be reassigned to other facilities less than 10 miles away and that it would use a mobile clinic to serve people affected by the third closure.
“If two health clinics consolidate in order to provide better, more consistent, and more accessible service to the patients from both locations, that is a win for rural communities,” Nunnenkamp said in a statement.
How the ‘One Big Beautiful Bill’ affects rural health care
Under the legislation, Medicaid spending is set to fall by more than $900 billion over the next 10 years, according to projections from the nonpartisan Congressional Budget Office. About 7.5 million more people would be uninsured in 2034 due to the policy changes, with 5.3 million of them being affected by the addition of work requirements for many low-income adult enrollees, according to the CBO’s most recent analysis.
The work requirements are likely to affect rural communities more, said Tim Layton, an associate professor of public policy and economics at the University of Virginia, because it’s harder for residents in those communities to find employment.
“You can expect those places to be impacted by now having people who don’t even have Medicaid,” Layton said. “With fewer people to spread fixed costs across, it becomes harder and harder to stay open.”
People protest Medicaid cuts in Washington, DC, on May 22. – Astrid Riecken For The Washington Post/Getty Images/File
Rural health care providers disproportionately rely on Medicaid enrollees. They were already struggling with limited patient pools and long-term population loss.
Researchers at the University of North Carolina, cited in a letter by Democratic senators opposing the GOP legislation, identified 338 rural health facilities nationwide endangered by the policy changes, including six total in Virginia.
Candice Crow, a mother of four children who have autism, heavily relies on the Bon Secours – Southampton Medical Center in Franklin, Virginia, one of the facilities on the researchers’ list. She’s been raising concerns with local media and spoke to CNN.
“The staff there are so kind and caring. They do go above and beyond. They’re very accommodating for the special needs children and all their little medical complexities that they have,” Crow said. “Every minute counts when it comes to emergencies. This could cost someone their life, so you’re taking away their lifeline.”
Republicans note a rural health fund in the bill
To alleviate the impact of the cuts, Republicans in Washington created a $50 billion fund for rural health providers, inviting “all 50 states to apply for funding to address each state’s specific rural health challenges.”
“If we invest this money wisely, we won’t just have health care systems barely hanging on in rural America,” said Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services. “They’ll start to thrive.”
Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, speaks during a news conference following Senate Republicans’ weekly policy lunch at the US Capitol on September 16. – Elizabeth Frantz/Reuters
Nunnenkamp, the Virginia Republicans’ executive director, called the fund “effectively the largest investment in rural hospitals in decades.” US Rep. Ben Cline, the Republican representing Virginia’s 6th District, which includes the three closed clinics, also pointed to the fund and defended his vote for the bill.
“Provisions like work requirements to root out waste, fraud, and abuse do not take effect until December 2026 or later. By making these reforms in cooperation with our health care providers, we can ensure that all Americans, especially those in rural areas, receive the high-quality health care they deserve,” Cline said in a statement.
Layton said the rural health care fund was a “short-term patch,” noting that “$50 billion will go pretty quick.”
The Kaiser Family Foundation, a national nonprofit focused on health policy, wrote in a July study that “federal Medicaid spending in rural areas is estimated to decline by $137 billion, more than the $50 billion appropriated for the rural health fund.”
Virginia Lt. Gov. Winsome Earle-Sears, the GOP nominee for governor, has also proposed tapping the state’s rainy day fund to help cover additional funding.
“We want to make sure that whatever happens with Medicaid, we have the money here to help. We have the money and the budget to help. You know, we have put money aside for rainy day,” Sears said at an event in Marion, according to a report from Cardinal News. “The bank account has never been that full. And so we are ready for any changes that happen.”
Spanberger says that rainy day fund – which outgoing GOP Gov. Glenn Youngkin said last month held $4.7 billion – won’t be enough.
“This is not a rainy day. This is a bad bill that came out of Washington,” Spanberger said on the first day of early voting in Virginia at an event in Fairfax on Friday. “They are throwing those costs on the state, and in the interim, people will fall off of their health care, so the problem is immense.”
Democrats create their own message
Pete Barlow is a Democrat running to unseat Cline and lives in Augusta County, where two of the affected clinics are. “This administration has really taken a bloody ax to rural health care. It’s incredible, and it’s going to have downstream effects for years to come,” Barlow told CNN.
He says that as he speaks to people in the community, they don’t always immediately “connect the dots” about why they are losing services, but it’s a recipe for eventually breeding deep frustration. “How is it making America great again for us to be cutting our rural health care? It blows me away,” he said.
Lynlee Thorne, political director of Rural GroundGame, a group supporting Democratic candidates in Virginia, said Democrats are “willing to listen” as they engage with rural voters on the policy changes. According to CNN exit polls, Trump won two-thirds of rural voters in the 2024 election.
“We’re not simply coming in to tell people that they’re going to be hurt, and we’re not just pointing to bar graphs and charts to make our case through big numbers, but we’re saying we care enough about you to be here and to hear how this is going to impact you,” Thorne said.
The conversation doesn’t stop there, she added.
“We also need to talk about what it is we’re going to do for people, how we’re going to fight to fill that gap,” Thorne said.
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