At the political free-fire zone that is the University of Virginia, academics isn’t the only target over which the right and left are dueling.
There’s also a sprawling hospital with a giant staff. And while DEI — supposedly junked last week by the university’s overseers, most of whom are Republicans — is a big deal in the classroom, a bigger deal in the UVA health-care system is how its M.D.s and other professionals do their jobs.
That fight — shaped by an investigation by a state-selected, white-shoe law firm of alleged misconduct by its CEO, who resigned last month — the second to quit in barely five years; a Trump administration-induced retreat on gender care and a nasty tussle over compensation for physicians — is small stakes compared to a huge threat to UVA Health’s finances: deep cuts in federal spending.
It was anything but an afterthought for three former rectors, or chairmen of the university’s governing body, the board of visitors.
In a nine-page letter to the system’s interim head that largely refutes criticism of its management, Whitt Clement, Rusty Connor and Jim Murray warn that UVA Health — with Virginia Commonwealth University, one of two public hospitals in the state required by law to provide care for all, regardless of ability to pay — could be devastated by reductions in Medicare and Medicaid. The former provides health care for seniors; the latter, for the poor.
“Major cuts to Medicare or Medicaid reimbursements could be financially crippling for UVA, more so than any other Virginia hospital system,” said the three — all Democratic appointees, referring to proposals by congressional Republicans to reduce federal spending by $880 billion to pay for continuing Trump tax cuts. “In the coming months, our health system may well face an existential crisis. We have only stopgap leadership on hand to meet any crisis.”
And while this menacing possibility may be clear to those in Charlottesville, it still seems abstract to budget-writing politicians in Richmond.
The budget sent by the Democrat-controlled legislature to Republican Gov. Glenn Youngkin last month overlooks — somewhat — an expensive what-if: reductions in federal spending for Medicaid.
When Medicaid, in which 1.9 million Virginians are enrolled, was expanded in 2018 to bring some 600,000 uninsured residents under Obamacare, Democrats — then controlling the governorship and nearing a full takeover of the General Assembly — included a requirement that the program be suspended if Washington’s contribution to expansion dips below 90% of its cost.
Such a decline would seem a certainty if Congress and the White House prevail in pruning spending by nearly $1 trillion.
Schapiro: In Virginia, Dems party like it’s 2017
That possibility spurred Sens. Ghazala Hashmi of Chesterfield, a candidate for lieutenant governor, and Creigh Deeds of Charlottesville — both Democrats with large numbers of constituents who rely on VCU and UVA hospitals for health care or jobs — to propose that the state develop a plan for keeping Medicaid intact should the $5.1 billion Virginia receives annually from the federal government evaporate.
Such a provision — it specified a 45-day turnaround for a remedy — was not included in the budget now before Youngkin, who has until March 24 to sign, reject or seek revisions to legislation passed by the General Assembly in January and February. The governor can fly-speck individual items in the budget, vetoing them and accompanying language, or proposing changes lawmakers would vote up or down in their spring session April 2.
Medicaid was a pricey concern for Virginia well before Republicans in D.C. signaled likely reductions in the social safety net.
Schapiro: A rural county gets the blues
Youngkin, in introducing his fiscal wish list in December, recommended using surplus revenue to plug a $687 million hole in the Medicaid budget. He also proposed that an existing House of Delegates-Virginia Senate committee be authorized to consider fixes for Medicaid, which covers just under 1 in 5 Virginians, though the panel would not necessarily work under a deadline.
The urgency with which the state is responding to reductions in federal spending and employment — both pillars of a Virginia economy driven by service industries heavily reliant on the Pentagon, the security agencies and government research — has been amplified by election-year politics. Virginians in November will be choosing Youngkin’s successor and deciding control of the House, now barely held by Democrats.
In the House and Senate, also majority-Democrat, bipartisan committees have been appointed to monitor Trump’s continuing attack on agency budgets and payroll. And the Democratic leadership is holding out the possibility of the General Assembly convening in special session to adopt ways to cushion the state’s economy against Trump hammer blows.
Youngkin finds himself in an uncomfortable position, enthusiastically endorsing Trump’s policies and attempting empathy for fired federal workers by setting up a website to help guide them to private-sector jobs.
Plus, because federal largess is not confined to the Northern Virginia suburbs, anger over Trump’s reductions is widespread. Federal spending — civilian and military — is abundant in two other vote-rich regions, Richmond and its suburbs and along the Atlantic coast. These are blue-trending metropolitan areas where Youngkin’s Republican Party, the foundation of which is the dwarfed rural vote, must be competitive to win statewide.
Beyond thousands of jobs — 145,000 Virginians are civil service employees or contractors, putting this state third to California and the District of Columbia — health care, particularly for seniors and low-income people, is the face of federal beneficence. Hospitals, public and private, know this well.
They also know that Medicare and Medicaid funding are essential to their fiscal health. This is why UVA Health, with the goal of strengthening a once-weak bottom line, has forged partnerships with hospitals beyond Charlottesville, some of them of rural and struggling.
It’s good for those who need health care. And that’s great for business.