Why It Matters

The Virginia Hospital & Healthcare Association is lobbying to protect hospital finances amid sweeping federal Medicaid cuts. Congress passed the One Big Beautiful Bill Act in July 2025, cutting Medicaid while imposing work requirements and allowing enhanced premium tax credits to expire. These changes threaten rural hospital viability—particularly acute in Virginia, where six hospitals in Southwest and Southside regions face closure risk. VHHA’s lobbying targets directed payment programs and Disproportionate Share Hospital funding as potential lifelines.

By the Numbers

VHHA filed its fourth quarter 2025 disclosure spending $60,000 on healthcare policy advocacy. The organization has filed 81 disclosures since 2015 totaling $2.17 million. In-house lobbyist Julie Dime leads federal advocacy, having filed 16 disclosures worth $330,000 since April 2022.

VHHA maintains a hybrid lobbying strategy, supplementing in-house efforts with external firms including K&L Gates LLP, Holland & Knight LLP, and Forward Global US Inc.

The Agenda

VHHA is lobbying on Medicaid directed payment programs, proposals to modify Medicaid spending, Medicaid provisions within H.R. 1, and enhanced premium tax credit extensions. The association’s focus aligns with relevant legislation like the Save our Safety-Net Hospitals Act and the Keeping Obstetrics Local Act, both addressing hospital reimbursement and rural healthcare stability.

Broader Context

Congress is actively restructuring federal healthcare policy. House Republicans unveiled plans for significant Medicaid cuts, while Senate Minority Leader Chuck Schumer announced a "Protect Medicaid" bill to reverse these cuts.

Senators Mark Warner and Tim Kaine warned that GOP plans could devastate rural Virginia, potentially closing six hospitals due to inadequate Medicaid reimbursement. Enhanced premium tax credit expiration affects coverage demand while new Medicaid restrictions pressure hospital finances.

Between The Lines

The One Big Beautiful Bill Act includes the largest cuts to safety-net programs in recent history, with per-capita caps potentially reducing federal Medicaid spending by $900 billion over 10 years.

The national crisis is acute: [over 700 rural hospitals are at risk of closure, with 27 rural hospitals closing or planning to close labor and delivery units according to a report by Boston University’s School of Public Health.
Additionally, DSH payment reductions of $24 billion are scheduled, making state-directed payment programs increasingly critical.

Competitive Landscape

VHHA joins coordinated industry-wide advocacy against potential cuts:

  • Doctors Hospital at Renaissance Ltd.: Spent $280,000 in 2025 lobbying on Medicaid directed payment programs and DSH payments.

  • UPMC: Lobbying on Medicaid DSH, provider assessments, and the 340B program.

  • HCA Inc.: Engaging on enhanced premium tax credit extensions.

The Bottom Line

VHHA spent $60,000 in the final quarter of 2025 pushing for favorable reimbursement protections as Congress debates deep Medicaid cuts. The effort reflects broader industry-wide advocacy, indicating coordinated push back against policy changes that could strain Virginia’s healthcare infrastructure.

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