Medicaid cuts worry small business owner Some Virginians worry about whether they'll lose health coverage (copy)

RICHMOND - Katina Moss was surprised to receive a letter in the mail indicating she qualified for Medicaid coverage.

Moss, 51, who lives in Richmond, said she applied for coverage in 2020 or 2021, amid the COVID-19 pandemic. She completed the required forms online but was not sure if she had finished all of them.

"I felt a little uncertain about it, so I was a little bit shocked, first of all, that I had actually completed the form in a way that I had submitted it properly - and then also that I was able to qualify for it," Moss said.

Since then, her coverage has renewed automatically every year.

"I'm like, 'Woo hoo,'" Moss said. "Way to go, Virginia."

Moss is one of 253,976 residents of Virginia's 4th Congressional District on Medicaid, amounting for 32.37% of the district's population - the highest percentage of recipients among the state's congressional districts, according to the Virginia Department of Medical Assistance Services.

On July 4, President Donald Trump signed the bill that will overhaul public health care in the United States. In June, the Congressional Budget Office estimated that the number of Americans without health insurance would increase by 16 million by 2034 - between expiration of expanded tax credits to help pay for insurance under the Affordable Care Act and Medicaid changes under Trump's bill.

In June, Democrats on a joint congressional committee, citing the House version of Trump's bill and the likely loss of enhanced federal subsidies for monthly insurance premiums, estimated that roughly 302,608 Virginians could lose their health benefits - 166,025 from losing Medicaid coverage and 136,583 losing Affordable Care Act subsidies.

Many health care changes are not immediate. For example, enhanced tax credits that helped expand the Affordable Care Act's marketplace are set to expire at the end of this year. Cuts to Medicaid funding and new work requirements under the president's bill are to begin following the 2026 midterm elections, though states could choose to start the work requirements sooner.

Moss is uncertain about whether she will lose benefits as a result of Trump's One Big Beautiful Bill Act but is worried about her coverage and that of her parents, who are on Medicare.

Moss grew up in Henrico County and graduated from Hermitage High School. After completing a degree in business administration at the University of Richmond, she taught high school business classes at Hopewell, then launched her own consulting business, K. Moss & Associates, LLC. She spent several years without health insurance when she resigned from her teaching job, until she obtained Medicaid coverage.

"Going through the process of that and having to figure out how to earn an income to take care of myself, there's a lot of stress involved with that," she said. "So, going through that process and being able to eventually find out that I could qualify for Medicaid was pretty monumental for me, because it gave me one less thing to worry about. I knew that I could go to the doctor, I could get my health screenings and things like that."

Eight years ago, Moss' mother, Roberta Jones, underwent spinal cord surgery but suffered complications that caused two additional surgeries. She remained in the hospital for two months and endured a major rehabilitation process. When she left the hospital, she was in a wheelchair, unable to walk. Jones can walk now, but Moss still plays a role in her parents' care.

Moss' parents rely on Medicare, as well as supplemental insurance coverage.

"My parents, I'm grateful they are still healthy, but they require support as elderly people," Moss said.

In March, the federal government said more than 71 million Americans receive Medicaid coverage, while an additional 66 million are on Medicare.

Moss said she is unsure if she will lose coverage.

"I've thought about it a lot. I'm grateful for being able to qualify for Medicaid," Moss said. "It's never been my plan to stay on Medicaid, so I'm always working to grow my business and earn more income so that I can - if I need to - pay for my health insurance.

"... All I can do every day, really, is just rely on my faith that I'll be taken care of and just move forward. If the world around me decides that it doesn't care about taking care of people anymore, then I have to trust that the community and the collective that I'm a part of, in terms of family and friends, that we're there to take care of each other."

Rep. Jennifer McClellan, D-4th, whose district is based in Richmond, eastern Chesterfield County and eastern Henrico County, voted against the legislation.

"When (people) lose insurance, they're still going to get sick," McClellan said. "They're just not going to get preventative care, or they're going to wait until they're sick enough that they show up in a hospital, where if they can get treated, it's much more expensive to treat. They're going to be treated, and the cost will be recovered by everybody else's health insurance premiums going up."

Republicans' views

Republicans say they voted to strengthen Medicaid by making it more efficient and less wasteful.

Rep. Rob Wittman, R-1st, whose district is based in western Henrico, western Chesterfield and eastern Hanover counties, voted in favor of the bill.

"Our Medicaid system is facing a critical crisis, and comprehensive reforms are essential to ensure that those who truly need assistance receive it, while also safeguarding the program's long-term sustainability," Wittman said in a statement at the time. "This legislation is designed to do exactly that."

Gov. Glenn Youngkin, a Republican, has voiced support for the legislation and has downplayed Medicaid cuts. Following an unrelated event on July 8, he said critics of the law are relying on "extreme assumptions."

"The number that the Democrats are throwing around on Virginians who will lose health coverage is made up," Youngkin said.

Youngkin referred to the law's requirement that "able-bodied adults" in Medicaid work at least 80 hours a month, which could include community services or education. He estimated, based on a state analysis when Virginia expanded its Medicaid program in 2018, that about 40,000 people "will conclude that they don't want to comply with work requirements and therefore wouldn't be eligible for Medicaid."

Moss said she is concerned about the prospect of health care cuts to come.

"That's one of the most disheartening parts about people deciding in the wealthiest country in the world, that there's no space for us to look at how our resources support everyone," Moss said. "Because we are human beings, and there are some certain things I think that we should just allow for, to take care of ourselves as human beings."