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Hundreds of thousands of Virginians could lose insurance coverage if Medicaid expansion is rolled back
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Hundreds of thousands of Virginians could lose insurance coverage if Medicaid expansion is rolled back
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Cardinal News
Serving Southwest and Southside Virginia
In 1934, President Franklin Roosevelt traveled to the Roanoke Valley to dedicate the new veterans’ hospital, one of 50 built during a nationwide building boom for such facilities in the aftermath of World War I.
To this day, the Salem VA Medical Center remains the only veterans’ hospital personally dedicated by a sitting president of the United States.
Nine decades and one year later, President Donald Trump is essentially aiming to be FDR in reverse by downsizing the federal government. And one of the places he’s looking to make cuts is the agency that oversees those veterans hospitals.
Mathematically, this makes perfect sense. The Department of Veterans Affairs is by far the biggest federal department, employing 21.3% of the federal workforce. For complicated reasons, the three military services are counted separately from the civilian functions of the Defense Department, so if you added all those together, they’d be more. Still, to put Veterans Affairs in context with departments other than the military, Homeland Security is the next biggest with 9.35% of the federal workforce, followed by Justice at 5.52%, Treasury at 4.55% and Agriculture at 3.87%. Veterans Affairs is so big because it’s running a national health care system.
Trump’s goal to eliminate the Department of Education makes headlines, but the department has the smallest employment of any Cabinet secretariat. According to the Department of Government Efficiency, the Education Department accounts for just 0.31% of federal wages.
The Education Department employs about 4,200 people; Veterans Affairs more than 486,000.
There is much symbolism in doing away with the Education Department, but numerically, it doesn’t make much of a dent in the size of the federal government. Reducing Veterans Affairs would.
Trump is planning to cut more than 80,000 positions from the department, according to an internal memo obtained by the Associated Press.
There are several ways to put this in context:
- 80,000 jobs is about 16.4% of the department’s workforce. That sounds like a lot. That’s also more than some entire federal departments. That’s more than the entire Department of the Interior (62,890), the Department of Transportation (55,806) and the Department of Commerce (47,650). That’s 4.42 times the size of NASA, which presumably Trump is counting on to carry out his goal of sending astronauts to Mars. Trump could eliminate the Education Department 19 times over and still not eliminate that many jobs.
- On the other hand, those projected VA cuts would take the department’s workforce back to 2019 levels. That doesn’t sound so bad.
So which is this? A draconian dismantling of veterans’ health service or a modest readjustment to where we were before the Biden presidency? I can tell you who will decide this framing. It won’t be me, and it won’t be Fox News or MSNBC, either. It will be veterans. If they see no detrimental change to their health care, then this is no big deal, except to the people who are losing their jobs and their families. If veterans do see a change, then this could be a politically calamitous move for the Trump administration.
The same applies to any of the other agencies where Trump is making cuts. Broadly speaking, people think the federal government is too big. Outside of the Washington area (which I must point out again is hugely important to the Virginia economy), Trump’s cuts, in and of themselves, aren’t likely to elicit much outrage except among those who don’t like Trump anyway. That’s why Republican members of Congress are unlikely to be moved by the demonstrators who have gathered outside their offices; none of those people are likely Republican voters anyway. Sorry to be so harsh, but that’s just the political reality. Democratic members of Congress would not be moved by protesters on the right if the situation were reversed. I recently spoke with Ward Armstrong of Henry County, the former Democratic leader in the House of Delegates. “I don’t know that the public is too torqued up over the loss of federal jobs,” he said, “but wait until they cut the farm subsidies or start these tariffs and GM sales go down.” In other words, people will need to see something that impacts them directly before they’re upset.
The political challenge for Democrats is that many of the moves Trump has made don’t have an immediate, and obvious, impact on the general public. Trump’s order to reduce the administrative costs that universities can charge for research has sent off alarm bells in academia because it undoes the economic model for much research. That ought to be a concern in the Roanoke Valley, which is building a new economy based in part on biomedical research, but people aren’t going to march in the street over administrative costs on research grants. Maybe years from now somebody will ask, “Why haven’t you cured such-and-such a disease?” and the answer will be “Remember back in 2025?” But that’s an abstract connection for many people now.
My sense is that this gives Trump pretty wide political latitude to remake the federal government — up to a point.
The political challenge for Republicans is that many of the things Trump is doing might have a more immediate impact on people — and, in many cases, a disproportionate impact on his own supporters.
That’s why these Veterans Affairs cuts represent a potential pressure point. There’s not a broad constituency out there for, say, the U.S. Agency for International Development. People don’t drive around with bumper stickers for USAID or wear baseball caps proclaiming that they once worked for the agency. But there are lots of military veterans, and here’s the key statistic: 65% of veterans cast ballots last fall for Donald Trump. If they feel these cuts hurt the health care they’ve been promised, then he’ll have political problems. Veterans are politically untouchable; politicians can run against foreign aid and win points for doing so, but no politician wants to be tagged with depriving Uncle Charlie of a timely doctor’s visit at the VA after he spent all those years serving his country. Already there’s concern bubbling up: Cardinal’s health care reporter, Emily Schabacker, attended a regularly scheduled town hall at the Salem VA last week and wrote about how veterans showed up with questions about what the cuts would mean. Perhaps the key line, in which she referenced a 30-year Army vet who recently moved to Virginia: “Osvaldo Ponzo has attended other town halls but has never seen one become so heated, he said.” For now, that’s based on fear about what the cuts will mean; what happens if Ponzo and others actually see those impacts?
The Veterans Affairs cuts are just one of several places where the interest of Trump’s cutter-in-chief, Elon Musk, runs the risk of diverging from those of Republican officeholders. Congressional Republicans are already discovering the challenge of reducing federal spending when so many of their own constituents depend upon it. The nonpartisan Congressional Budget Office reported last week that House Republicans can’t reach their budget goals without reducing spending on Medicaid.
If that were a program that primarily benefited non-Republican voters, things might be easier. However, a study by Georgetown University found that the highest concentrations of Medicaid recipients tend to be in Republican counties. (Check out this national map courtesy of Georgetown University.) In some counties in eastern Kentucky, more than 40% of the population is on Medicaid, topping out at 45% in Wolfe County. Just over the state line from us in McDowell County, West Virginia, the figure is 39.5%.
Virginia ranks low compared to other states for percentage of population on Medicaid. Virginia’s at 16.7%; only eight other states have a smaller percentage. However, within Virginia, two of the three congressional districts with the highest percentages are represented by Republicans. Democrat Jennifer McClellan in the 4th District has the state’s highest-percentage locality, Petersburg, at 32.7%. But the locality with the second-highest percentage of Medicaid recipients is Danville, in John McGuire’s 5th District, at 29.2%. In Morgan Griffith’s 9th District, at least 10 localities top 20%, with the highest being Dickenson County at 25.1%.
Trump’s plan to shutter the Education Department probably lies in an in-between zone where things could go either way. Democrats may be making a political mistake if they tie themselves too closely to that bureaucracy because few people love bureaucrats. However, Republicans run risks here, too, because federal funding constitutes a much bigger share of rural school budgets than it does those of schools in the suburbs. Whether there’s a formal Education Department may not matter; what matters is whether that funding keeps flowing. If it does, rural voters are not going to care what branch of federal government the check comes from. However, if federal education funding is reduced, then Lee County will have to figure out how to replace up to 25.8% of its school budget.
All this leads to at least five scenarios, which I’ve ranked in ascending order of danger to Republicans.
Scenario 1: Trump gets his way and nothing significantly bad happens.
The fears of big cuts to government services turn out to be overblown. The only people complaining are Democrats who don’t have the votes to do anything. Non-aligned voters don’t really see anything that affects them and life goes on. Trump and Republicans in general get credit for making the government leaner and more efficient.
Scenario 2: Trump triggers a backlash of protests but no real political backlash.
Yes, some Republican constituencies are unhappy with certain cuts, but those voters can’t abide the thought of voting for Democrats, so their protests remain just that, protests. Or, if some previously reliable Republican voters cast ballots for Democrats, it makes no difference because so many districts are either gerrymandered or simply deep red no matter how you draw them. Maybe some deep red districts temporarily turn a lighter shade of red, but that doesn’t really change the nation’s political balance.
Scenario 3: Trump triggers a backlash of protests that helps Democrats in Virginia’s 2025 state elections but doesn’t endanger congressional Republicans.
This is where we start getting into some political nuance. I recently had someone ask me about whether the protests outside the offices of Republican members of Congress were politically significant. My answer was “potentially yes and no.” If those protests energize Democrats and if that higher level of engagement leads to a larger Democratic turnout this fall, that helps the Democratic ticket for governor, lieutenant governor and attorney general, but they’re highly unlikely to persuade Republican members of the U.S. House in strongly Republican districts. Put another way, Reps. Ben Cline and Morgan Griffith won’t feel any political pain, but Lt. Gov. Winsome Earle-Sears (assuming she’s the Republican nominee for governor) could. “Extra” Democratic voters in Roanoke or other places feed into a statewide tally that could boost Democratic fortunes, but there aren’t enough “extra” votes available to dislodge or even endanger the Republican House members. That’s just a matter of math and maps. It’s possible that a big Democratic victory in Virginia in November would send a national message to Republicans. It’s also possible that Republicans would discount any message from a state that voted against Trump three times in a row. And, of course, it’s possible there won’t be a big Democratic victory in Virginia, at all. If there is one, though, its impact could be limited.
Scenario 4: Trump triggers a backlash that forces Republicans to reconsider parts of his agenda.
The cuts to Veterans Affairs and any cuts to Medicaid and education funding cause such consternation among some Republican constituencies that Republican lawmakers prevail upon Trump to stop short of how far he wants to go. We’re already seeing a smidge of that. U.S. Rep. Jen Kiggans, R-Virginia Beach, told WAVY-TV that VA cuts are “not the right direction.” Her views ought to be significant because she represents a swing district; the Republican majority in the House depends upon legislators like her. Whether the White House sees things that way is a different matter. That brings us to:
Scenario 5: Trump triggers a backlash that costs congressional Republicans.
The cuts go forward, with either Republican congressional support or acquiescence. In response, enough voters peel away from Republicans that Democrats make big gains in Congress in 2026.
I don’t think we know enough yet to know which of these scenarios is most likely. However, if Scenario 4 or 5 were to happen, the scenario would likely begin with veterans unhappy about service cuts at the VA.
Looking ahead to this fall’s House of Delegates races
In this week’s West of the Capital, our weekly political newsletter, I’ll take an early look at how General Assembly races are shaping up. Not on the list? You can sign up below!
In this week’s West of the Capital, our weekly political newsletter, I’ll take an early look at how General Assembly races are shaping up. Not on the list? You can sign up below!
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Yancey is founding editor of Cardinal News. His opinions are his own. You can reach him at dwayne@cardinalnews.org… More by Dwayne Yancey 
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