Virginia Democrats Warn More Healthcare Strains Loom After November Election

Christina Rivera kept her health insurance this year because she needed major back surgery. But maintaining coverage meant absorbing a monthly premium that rose from $235 in 2025 to $1,336 in 2026 — with a higher deductible.

“That’s just not reasonable for anybody who is relying on the ACA for healthcare,” said Riviera, a Charlottesville-area resident and founder of the nonprofit Called to Justice. “I don’t have that sitting around. It’s not in the cushions of the couch.”

Small nonprofits often depend on the Affordable Care Act marketplace because reasonably priced group coverage is out of reach, Rivera said. After enhanced federal premium tax credits expired last December, her insurance bill became another financial burden alongside groceries, gasoline and utilities.

She and others have already exhausted familiar ways of stretching their budgets, Rivera said, from delaying turning on the heat to cutting food purchases or carpooling. She estimated the higher premium will cost her an additional $14,000 this year, and her surgery left her little choice but to maintain coverage.

“Something has to give, because people just can’t sustain these costs,” she said.

Rivera shared her experience on Tuesday on a call with reporters organized by the Defend America Action PAC that also included Democratic federal and state lawmakers five weeks before the Nov. 3 midterm elections.

They urged Virginians to vote, arguing that pressure on household budgets could deepen as additional provisions of H.R. 1, the tax-and-spending law President Donald Trump signed July 4 of last year, take effect in January.

“Republicans in 2024 campaigned on lowering costs,” said U.S. Rep. Jennifer McClellan, D-Richmond.

McClellan blamed Trump’s tariffs, the war in Iran, federal workforce reductions and cuts to healthcare and food assistance for worsening Virginia’s affordability problems. House Democrats, she said, should reverse the benefit cuts, restore Congress’ tariff authority and protect federal employees.

The congresswoman also argued that higher insurance costs could discourage families from seeking preventive care.

Virginia’s 2018 Medicaid Expansion, which McClellan backed at the time as a member of the state Senate, helped connect more residents to regular care while supporting rural hospitals, she said, and recent policy puts some of those gains at risk.

The Democratic lawmakers made their case as Virginians report growing financial unease.

A Roanoke College poll released earlier this month found consumer sentiment fell sharply in August as inflation and a cooling labor market weighed on household finances.

Healthcare costs have been affected by two separate changes in Washington.

Congress allowed enhanced ACA premium tax credits to expire at the end of 2025. Separately, H.R. 1 made changes to Medicaid eligibility and financing, as well as food assistance.

Virginia’s ACA marketplace had 295,000 enrollees as of late August, down 94,000 from last year, according to state data reported Sept. 2. The decline has been attributed in part to the expired subsidies, although employment and income changes also affect enrollment.

Another round of changes arrives on Jan. 1.

Certain adults enrolled in Medicaid will have to meet new work or community engagement requirements, generally requiring 80 hours a month of qualifying activities. Exemptions include pregnancy, medical frailty and some caregiving responsibilities.

Virginia officials have said more than 500,000  Medicaid enrollees will face new requirements and additional verification, raising concerns that eligible recipients could lose coverage because of paperwork problems.

Gov. Abigail Spanberger directed state agencies in August to improve outreach and coordination.

Republicans have defended the Medicaid changes as a way to strengthen eligibility oversight and preserve resources for vulnerable patients. The Trump administration says the work requirements will encourage employment and independence.

U.S. Rep. Rob Wittman, R-Westmoreland, who is seeking reelection in one of Virginia’s more vulnerable GOP strongholds, has also pointed to a $50 billion rural health transformation program included in the law. Virginia received about $189.5 million from the program, with $122 million allocated so far.

Wittman broke with most House Republicans in January, however, when he voted to restore the enhanced ACA tax credits that Congress had allowed to expire.

State Sen. Barbara Favola, D-Arlington, who chairs Virginia’s Joint Commission on Healthcare, said Tuesday the commonwealth can cushion some federal losses but cannot replace them entirely.

A commission report released in June identified 13 of the state’s 36 rural hospitals as facing distant or immediate closure risk.

Lawmakers also approved a $150 million state premium assistance program for households earning between 138% and 250% of the federal poverty level, with enrollment beginning in November.

Del. Nadarius Clark, D-Suffolk, said on Tuesday’s call that rural constituents face additional pressures from agricultural trade disruptions, energy costs and threatened hospital services.

“Elections have consequences, and we are dealing with the consequences right now,” Clark said.

Early voting in the midterms is underway and continues through Oct. 31.

“If our constituents are hurting, they need to vote accordingly,” Favola said.

By Markus Schmidt, Virginia Mercury

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