It has been just more than a year since Congress passed HR 1, also known as the One Big Beautiful Bill Act. All four members of West Virginia’s congressional delegation supported this legislation, despite the outsized benefits Medicaid and SNAP (formerly known as food stamps) provide for our state’s people, our health and food systems, and our broader economy compared to other states.
HR 1 funded tax cuts for the nation’s wealthiest people, paid for by making the largest cuts to SNAP and Medicaid in our nation’s history.
While the SNAP provisions have already gone into effect, dramatically reducing access to food for many families, the most significant changes in the law regarding Medicaid have yet to be implemented. Despite that, West Virginia is already beginning to see the harms of congressional action regarding their access to health care, which will only worsen in 2027 and beyond as new Medicaid restrictions roll out.
Nationally, Medicaid enrollment has steadily decreased in recent years, and West Virginia has experienced similar declines. Medicaid enrollment in the state decreased by nearly 5% between July 2025 and March 2026, from 512,000 to 487,000. The decrease in child Medicaid and CHIP, however, outpaces the overall and adult enrollment change, at 5.7%, from about 206,000 kids to 193,000 kids. This reduction in coverage has coincided with the state’s unemployment rate increasing over the same period, which indicates the losses are not simply a result of people finding work and not needing Medicaid anymore.
Our members of Congress supported HR 1 with claims that eligible people would not be impacted by the cuts. Child coverage losses were not considered at all. Between April 2023 and April 2024, data showed that 75% of people who lost Medicaid coverage did so not because they were necessarily no longer eligible but because they experienced barriers filling out and returning their paperwork on time. These barriers include difficulty understanding the paperwork, not knowing how or being unable to submit supporting documents, or living at a different address and not receiving relevant paperwork by mail.
It will soon become more difficult to receive Medicaid benefits
Beginning in January, obtaining and maintaining Medicaid coverage will become even more difficult, as the largest cuts in HR 1 are achieved by requiring people to report work, education or volunteer activities or otherwise lose their coverage.
While Congress included some provisions to help chronically ill people keep their Medicaid, recent guidance from the Trump administration means far more vulnerable people will lose their health coverage, which will disproportionately impact West Virginia’s outsized population of people with chronic illnesses and disabilities. For example, a cancer diagnosis alone will not be sufficient for someone to be exempt from work reporting requirements — they will now also have to prove how their illness significantly impairs their ability to work.
A recent study found that more than half of West Virginians are unaware of changes going into effect in January 2027. The state’s Medicaid agency has anticipated that tens of thousands of people across West Virginia will lose access to health care over the next several years. Because of the Trump administration’s new red tape for people with serious illnesses, updated estimates will be even higher. The changes we have already seen in Medicaid enrollment will be a drop in the bucket compared to losses coming in 2027 and beyond. Most of these people will have no other health care options available to them.
These aren’t just numbers — these are lives. Children not being able to go the doctor for preventive services. People being forced to ration their prescription medications or forgo them entirely. Families going to the emergency room for problems that routine care could have addressed. West Virginians’ quality of life decreasing dramatically, making working a job, caring for their families, and being active members of their communities that much harder.
It is important to reiterate that all of these cuts were made to pay for tax cuts for the wealthiest Americans. Celebrating 250 years of the United States’ existence alongside the one-year anniversary of this legislation paints a stark picture. In the wealthiest country to ever exist, the most vulnerable are being sacrificed in order for the rich to grow richer. The disparity between the wealthiest Americans and the average West Virginian only grows deeper as a result of HR 1.
But it does not have to be this way. Congress can reverse course on this law and choose instead to invest in families and provide health insurance to vulnerable populations.
