David Toscano: For Youngkin, a big bill is coming due

Twenty-six billion dollars. That's the staggering price tag Gov. Glenn Youngkin's own Department of Medical Assistance Services just placed on the Virginia impact of President Donald Trump's One Big Beautiful Bill Act. Over the next 14 years, this federal wealth redistribution bill will stretch Virginia's budget, strain our hospitals, raise insurance premiums and harm many of our most vulnerable friends and neighbors.

For weeks, Youngkin has dismissed warnings from Democrats as exaggerated and "made up." But now, with these sobering estimates coming from his own administration, denial is no longer an option. The damage may not be immediate, but it will be deep.

The bill will reduce federal monies that hospitals can access to reimburse the cost of patient care. All will feel the squeeze, especially academic medical centers like the University of Virginia and Virginia Commonwealth University health systems, which face new limits on what they can charge for care. Rural hospitals — already operating on razor-thin margins — are at even greater risk.

If Virginia acts quickly, federal grants could be used to reduce the pressure felt by rural hospitals. But the federal government need not award them, and the amounts available are not sufficient to replace the losses. If rural hospitals are forced to close, entire communities will be left without care while losing one of their most stable employers.

A major goal of the Affordable Care Act was to reduce the number of uninsured Americans — and it worked. Two factors explain the success: the expansion of Medicaid in 40 states (including Virginia in 2018, which immediately made 400,000 eligible for coverage) and the creation of health care exchanges supported by federal tax credits. These subsidies helped individuals who didn't qualify for Medicaid, lacked employer-sponsored coverage or couldn't afford private insurance purchase health plans at reduced rates.

The impact in Virginia has been profound. The Virginia Health Care Foundation reports that the commonwealth's nonelderly uninsured rate fell from 14.3% to 7.6% between 2013 and 2023.

Trump's Big Beautiful Bill failed to extend vital tax credits, and many will expire at the end of the year. According to Virginia's State Corporation Commission, that will cause health insurance premiums to spike — by as much as 50% for some on the exchange. This will place enormous pressure on families and likely force many to drop coverage. The commission estimates over 100,000 Virginians will lose their insurance.

We are already seeing the ripple effects of Trump's assault on the ACA. In early July, Aetna announced it would pull out of the ACA marketplace in Virginia and several other states next year. It's a clear warning: Trump's policies are sowing chaos in the insurance markets. And most experts agree this will mean higher premiums not just for those on the exchanges, but across the board.

Finally, fewer Virginians will qualify for Medicaid, making it less likely they will get the care they need — or pushing them toward more expensive emergency room visits. That leaves hospitals to absorb the cost of uncompensated care, or forces taxpayers to pick up the tab through transfers of state "indigent care" dollars to health systems.

Instead of lobbying the administration to reduce the impacts of Trump's wealth redistribution bill, Youngkin insists that people who need services will receive them and instead accuses Democrats of "extreme assumptions" about the bill's affects. Now, we can see estimates provided by his own staff, and they are not pretty.

Meanwhile, Youngkin has been busy on Fox News, touting his dismantling of diversity, equity and inclusion initiatives and embracing all things Trump while ignoring the budgetary and human challenges about to hit the commonwealth. As unemployment claims rise in Northern Virginia following federal layoffs, the governor's only visible response has been to peddle an online jobs portal. The Republican response — from Youngkin, from candidate Winsome Earle-Sears — has amounted to little more than "Get over it."

It didn't have to be this way. In 2017, Trump was also in the White House and working to destroy the Affordable Care Act. His attacks were disrupting the insurance marketplace; rates were rising, and insurers were pulling out of the exchanges. In August of that year, Anthem Blue Cross Blue Shield announced it would stop offering individual health plans within Virginia's ACA marketplace. Shortly after, Optima Insurance followed suit. Nearly 200,000 Virginians were at risk of losing coverage, and several counties faced the prospect of having no ACA provider at all.

But here the comparison ends. Then-Gov. Terry McAuliffe intervened. He called, cajoled and pressured the companies to return. His efforts worked, and coverage options were returned for thousands of Virginians. At the federal level, leadership in both parties, including Sen. John McCain's famous Senate vote, saved the ACA. Strong leadership matters.

If Virginians think the state is spending too much on health care now, wait until next year's budget — when the real financial impact of this market disruption begins to take hold. As tax credits expire, premiums rise and people lose coverage, demand for state support will grow.

But when that storm hits, Youngkin's term will be over, and he likely will be spending more time in places like Iowa and South Carolina, cheerleading for the president's agenda and quietly auditioning for a run of his own. It will be left to a new governor and General Assembly to pick up the pieces.