'Medicaid saved my life': Advocates say federal cuts could gut rural health

After a 2009 divorce, Barker in 2022 left a different abusive relationship.

"I was attacked and strangled by a boyfriend," she recalled. "I don’t think I was supposed to leave that house alive. I had been hit in the back of the head, side, front and slammed into the floor. Luckily, I escaped."

She was admitted to the emergency room with a concussion and received further testing due to head trauma.

"Testing that would have never been performed if I didn’t have Medicaid," she added.

Barker, 48, later followed up with a neurologist and another specialist who discovered a tumor below her right ear.

"Removal was risky. [I risked] facial paralysis and the word no one wants to hear — cancer," she said.

But surgery was a success, and the mass was removed. It turned out to be benign, and Barker's face healed quickly.

Life seemed to be moving on. Barker and her toddler had a new home, and she had improving health and a job with health insurance. But the trauma lingered, causing issues with post-traumatic stress disorder and other aspects of her mental health, and ultimately cost her that job.

Once again, Barker depended on Medicaid to get the help she needed, including paying more than $200 a month for medicine. And once again, she found another job. Now, she's a part-time student at Marshall University, working on her business degree while also working as a manager at a restaurant at the Capitol Market in ÂÒÂ×ÄÚÉä. She also recently signed a contract to begin a new job, which she says will raise her out of the Medicaid income bracket.

"Medicaid saved my life more than once," Barker said.

Doctors predict cuts could mean 'life or death' 

In a 215-214 vote, the House of Representatives advanced its budget bill last month. The Senate has yet to vote on the bill, though if the Senate passes a modified version of the bill in late June, the legislation would then have to go back to the House for another vote because both chambers must pass the exact same legislation.

Currently, Medicaid is one of the areas the bill targets for cuts, limiting access to the program.

Independent analyses project that West Virginia would be hit hard by deep cuts to Medicaid and food benefits for low-income people in the budget reconciliation bill passed by the House of Representatives to pay for tax cuts favoring the wealthy.

Between 56,000 and 88,000 fewer West Virginians would be enrolled in Medicaid in 2034 — 10-16% below Fiscal Year 2025 levels — if most of the major budget provisions become law, according to an analysis published by State Health and Value Strategies, a program of the health-focused philanthropic group Robert Wood Johnson Foundation.Ìý

°Õ³ó±ðÌýKaiser Family Foundation, a nonpartisan health policy research group, projects a similar range of West Virginia Medicaid enrollment losses: 56,000 to 94,000, with a midpoint of 75,000 that would represent a 14% decline.

Barker described the current health care system as a systemic trap where people on assistance programs like Medicaid are caught in rigid income brackets, unable to fluidly transition out of poverty.

"You get stuck because ... if you make this much, you get Medicaid, but if you make a little more, you can't afford private insurance," she said.Ìý

If those boundaries are even more limited, she theorizes more people will be stuck in poverty.

Barker further asserted that "taking these services away is going to force people to go without treatment" and that people "will have to choose between food or their medicine."

In his previous practice, Dr. Joe Jarrell, a retired internal medicine specialist with 25 years of experience, including stints at Cabin Creek Health Systems and other Kanawha County locations, had already seen cases where patients chose basic necessities over medical care.

The Kaiser Family Foundation estimates a 10-year decrease in federal Medicaid spending for West Virginia, ranging from $4 billion to $7 billion if the House reconciliation bill becomes law.

CBO: 10.9M people could lose health insurance

Total cuts in Medicaid spending nationwide would reach $1.3 trillion or more under the House reconciliation bill, per the State Health & Value Strategies published analysis, with West Virginia losing $6.6 billion in the federal share of Medicaid expenses — a 13% drop — and $1.1 billion in the nonfederal share — a 9% downturn — from fiscal years 2025 to 2034.Ìý

The State Health & Value Strategies-published analysis warns that its estimates understate coverage losses and funding cuts, as it does not account for the proposed curtailment of states setting up new hospital provider taxes. This would cost states like West Virginia, California, Illinois, Michigan, New York and Ohio billions of dollars.

The independent, nonpartisan Congressional Budget Office released an analysis of the House reconciliation bill on June 4, finding that bill provisions would result in 10.9 million people losing their health insurance. One day later, it released a projection that the bill would increase deficits from 2025 to 2034 by $2.4 trillion.Ìý

Dr. Kenneth Wright, a ÂÒÂ×ÄÚÉä-based physician specializing in physical medicine and rehabilitation, said the suggested Medicaid cuts would devastate West Virginia's "broken" health care system. He explained that hospitals, which typically operate on narrow margins, would likely not survive such funding reductions.

"Some things [hospitals] do make a lot of money [but] a lot of things they do lose money," Wright said. "So, if they didn't have that money coming in, it would drive a lot of them to the point where they would, at the least, have to close necessary services, and some probably wouldn't exist at all."

Jarrell and his wife, Dr. Susan Westfall, a retired family care doctor in ÂÒÂ×ÄÚÉä, both agreed.

All three physicians, who attended a rally in late May at the West Virginia Capitol in support of preserving Medicaid, warned that the economic impact would go far beyond health care. Hospital closures and cutbacks, they said, would cause job losses, shake local economies and worsen overall community health.

"In the United States, there are huge numbers of people — particularly here in West Virginia — [who] can't afford to go to the doctor, or go to the hospital, or pay for the medicines that they need," Wright said. "People in rural areas have to drive far enough the way it is, but it could literally mean the difference in life or death."

Susan Westfall added, "After a while, if people are not getting care, then you're taking care of sicker people, or you're less likely to really be able to help them to regain their normal function and their health status."

Work mandates 'make people sicker'

Kelley Moore, a spokesperson for Sen. Shelley Moore Capito, R-W.Va., said Capito was noncommittal when asked for her stance on the Medicaid portions of the House reconciliation bill.

Moore said in a June 4 email that Capito was reviewing the provisions passed by the House and was talking to “those stakeholders who could be touched by changes to the program to better understand their potential impact� in West Virginia.

Spokespeople for Sen. Jim Justice, and Reps. Carol Miller and Riley Moore, all R-W.Va., did not respond to requests for comment.

In the past, Capito and Justice have indicated support for Medicaid work requirements, a significant component of the House reconciliation bill. Work requirements condition Medicaid eligibility for people aged 19-64 applying for coverage or enrolled through the Affordable Care Act expansion group — up to 138% of the federal poverty level — on working or participating in qualifying activities for at least 80 hours every month.

“I think there are a lot of reasons to work besides [working] for a benefit and you're getting money. But also, it's a self-esteem thing,� Capito told reporters last month. “You're contributing to your community. You're getting up and going out.�

However, critics argue that Medicaid work requirements would significantly increase paperwork and complicate treatment compliance.

Rhonda Rogombé, a health and safety net policy analyst at the West Virginia Center on Budget and Policy, said, "There is no evidence that shows that increasing barriers to health care access increases work."

Instead, she said, we have evidence of the opposite.

"We've seen this in SNAP already, and we've seen this in Medicaid in other states, there is no connection between taking health care away, taking food away and increasing jobs numbers. Instead, it just makes people sicker. It limits their ability to access said jobs. When you take away somebody's ability to take care of themselves, how are they going to work?"

Additionally, people in rural communities may face greater challenges in finding sustainable employment opportunities.

Jeannie Nottingham, a former Medicaid recipient who works as a care navigator at Cabin Creek Health Systems, helps people access services like Medicaid. In her work and personal experience, work requirements oust people who need help.

With the similar SNAP requirements already in place, Nottingham says her clients depend on food banks for food. But it isn't because they are resisting work. Instead, she said, they face complex circumstances that aren't always black and white.

"Just because they don't receive disability benefits and are labeled as able to work, doesn't mean that they can go out and get a job right then," Nottingham said. Plus, she and Barker agree that rural areas have fewer job opportunities.

´¡Ìý°ù±ð³¦±ð²Ô³ÙÌýBrookings Institution analysis also suggests proposed monthly work-hour requirements don’t align with the reality of service-sector jobs, which often have unpredictable schedules and pay. The analysis also found the definition of acceptable work effort imposed by policymakers penalizes working families from benefits for which they would otherwise be eligible.

Nearly two-thirds of 26.1 million Medicaid-covered adults already were working full-time or part-time in 2023, according to a Kaiser Family Foundation analysis of U.S. Census Bureau data.

"A lot of people have misconceptions ... that people don't work for Medicaid," Barker said. "I've worked the whole entire time I've had Medicaid."

However, due to the commission-based nature of her past work in retail sales, her income would fluctuate.

The analysis said another 29% of Medicaid-covered adults were not working due to caregiving, illness or disability, or school attendance.

This is the case in Nottingham's family. She said her daughter, who has a child with autism, would be unlikely to find dependable care for her child during work hours, which would jeopardize her access to insurance.

Work requirements would devastate people like those she helps in her care navigation role as well, particularly those who are unhoused or have complex health situations. She emphasized that just because someone isn't officially labeled as disabled doesn't mean they can easily work, as their situation can make it difficult to apply for disability, which she says is a complex process in itself.

And many rely on Medicaid for critical health care and prescription support. Without it, she said they will likely head to emergency rooms to get medication.

Medicaid is, Nottingham said, "what is keeping them alive."

Bill expected to redistribute wealth to higher incomes

Republican leaders have set a July 4 deadline to pass the bill in both chambers of Congress and send it to the president for his signature, but the process could drag past that date.

Reps. Miller and Moore said President Donald Trump's proposed budget bill would help families, but an analysis by the University of Pennsylvania's Penn Wharton Budget Model found that working-age households in the middle of income distribution would see an average lifetime reduction of $3,000 from the package, as they face a chance of needing spending programs that would be reduced.

Households most affected by the cuts to Medicaid and SNAP — those in the bottom fifth of income brackets, would experience the largest losses under the House reconciliation package, averaging $28,000 for the working-age population, according to a Penn Wharton Budget Model analysis published last month.

In contrast, working-age households in the top fifth of income brackets would benefit from lower taxes, gaining $30,000 on average, per the analysis.

Those income brackets are certainly a long way from West Virginians like Barker or Nottingham.

"I've had seven friends over the last 10 years that I've lost," Barker said, saying they have died from various mental health conditions and physical ailments that went under- or untreated. "If they had better access to care, they might have been OK."