By Dan Doyle, M.D.
Charleston Gazette-Mail, Commentary, Dec. 12, 2025
There are two rural health transformations afoot in West Virginia. One is an innovation transformation being led by Gov. Patrick Morrisey. The other is a devastation transformation brought about by $911 billion in Medicaid cuts in the so-called One Big Beautiful Bill passed by Congress this summer.
As a family physician who has served Fayette County for more than 45 years, I am concerned about the impact that both transformations will have on health care in our state.
As it pertains to what I call the “innovation transformation,” Morrisey announced the concept at a news conference on Nov. 5 and has been touting it ever since. When Republican members of Congress realized the devastation that Medicaid cuts would bring to rural hospitals and rural people in their states, they demanded and got a $50 billion fund intended to prevent rural hospital closures in their state.
The idea is that every state, including West Virginia, gets $100 million per year for five years. The first check should arrive around Dec. 31. The West Virginia application calls for a variety of tech innovations hailing them as great break-throughs. Strangely, almost none of the money goes directly to struggling rural hospitals that the fund was supposed to help in the first place.
For me, this “innovation transformation” is window-dressing designed to distract attention from a greater and much more dangerous “devastation transformation.”
Nationally, the One Big Beautiful Bill cuts $911 billion from Medicaid funding over the next 10 years. About $137 billion of that will be cut from Medicaid for rural states and communities. West Virginia will lose $1 billion per year in Medicaid funding permanently going forward.
According to a study by the University of North Carolina, this puts 700 of 1,800 rural hospitals in the U.S. at risk of closure. Seven of those hospitals are in West Virginia towns and cities:
- Grafton
- Grantsville
- Logan
- Montgomery
- Philippi
- Ripley
- Welch
The effect will be to create more hospital deserts throughout West Virginia.
The OBBA also cut support for Marketplace health care coverage. This affects 15,000 West Virginians starting now. Over the next decade, 55,000 more West Virginians will lose Medicaid coverage due to the OBBA. Many are ironically referring to this shift as “Capito Care,” since all four West Virginia members of Congress voted for this in July and have been praising it as progress ever since.
So, the devastation transformation takes away $l billion per year from rural health care in our state and the innovation transformation gives back $100 million per year. You do the math. It’s a bad deal for the family that loses their health care coverage. It’s a bad deal for the community that loses their rural hospital. It’s a bad deal for local economies all over the state.
In October, I dusted off my stethoscope and went to work as a volunteer at Beckley Health Right, a free clinic for people without health insurance. I’m afraid a lot of people don’t yet know what’s about to hit them.
Dr. Dan Doyle practiced family medicine in Fayette County for 45 years. He is currently senior organizer for the West Virginia chapter of Physicians for a National Health Program.