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¸é±õ°ä±á²Ñ°¿±·¶ÙÌý—  fully embraces the massive federal tax-and-spending bill that signed into law last week, including cuts to that Democrats and state hospitals say would cause hundreds of thousands of Virginians to lose health care coverage and potentially threaten the survival of small rural hospitals.

Youngkin, speaking after an unrelated news event on Tuesday, said the spending package would deliver tax relief of about $2,800 per family. Most of that relief would come from extending the provisions of the tax cuts that the president signed into law in 2017. The law also eliminates taxes on tips and overtime and creates a $6,000 tax credit for seniors.

The Republican governor also praised the law's provisions for $180 billion in new spending on border security and immigration enforcement, citing the benefits of tighter border controls under Trump that he said "makes a huge difference for the safety of Virginians."

Youngkin also accused Democratic critics of inflating potential losses of insurance coverage under the new law, which the Congressional Budget Office estimates would increase the number of uninsured Americans by 11.7 million people through 2034.

Democrats on the U.S. Congress Joint Economic Committee estimate that more than 322,000 Virginians will lose health coverage under the bill's provisions for Medicaid and the expected expiration of enhanced federal premium subsidies for insurance. 

Health coverage

"The number that the Democrats are throwing around on Virginians who will lose health coverage is made up," Youngkin said, asserting that the measure's critics rely on "extreme, extreme assumptions."

Youngkin cited the law's requirement that "able-bodied adults" in Medicaid work at least 80 hours a month, which could include community services or education. He estimated, based on a state analysis when Virginia expanded its Medicaid program in 2018, that about 40,000 people "will conclude that they don't want to comply with work requirements and therefore wouldn't be eligible for Medicaid."

The state initially included a work requirement in expansion of its Medicaid program, but never implemented it.

Sen. Creigh Deeds, D-Charlottesville, dismissed the governor's assertion as "just silly."

"The numbers that Democrats have been using are right on the money," said Deeds, who chairs the Senate finance subcommittee on health and human resources. "The governor is not credible on this issue at all."

He cited a $632 million shortfall in the state's Medicaid program this year that he called highly unusual midway through the state's two-year budget cycle.

The Kaiser Family Foundation said last week that Virginia is one of the states hit hardest by the Medicaid cuts in the new law, losing between $25 billion to $41 billion in federal funding over 10 years. The midpoint in that range, $33 billion, represents a 21% loss in funding.

Virginia hospitals

Youngkin did not address the biggest threat that Virginia hospitals see in the budget bill, which the U.S. Senate reshaped to sharply reduce existing provider taxes that the state relies upon to pay its share of Medicaid expansion costs. Hospitals also pay the tax to generate additional federal reimbursements to cover the cost of care, especially in rural and urban hospitals with large Medicaid patient populations and thin operating margins.

Beginning in 2028, the law will gradually reduce the provider taxes from a maximum 6% to 3.5%. It also will cap reimbursements in expansion states at 100% of the maximum Medicare reimbursement, which hospitals say represents about 88% of their true costs. The cap is higher for states that didn't expand Medicaid.

Manatt Health, a consultant for the Virginia Hospital & Healthcare Association, said U.S. hospitals would lose $665 billion over 10 years, or 18% of their Medicaid funding under the law, as amended by the Senate and then endorsed by the House of Representatives. The Senate version of the bill cuts Medicaid funding by $100 million more than the bill that the House passed initially on May 22. Virginia was one of 16 states hit the hardest, according to Manatt, with a 37% increase in the size of cuts to its funding under the Senate bill.

The final package, after Vice President JD Vance broke a tie vote in the Senate a week ago, made much deeper cuts in funding for the 41 states, including the District of Columbia, that have expanded their Medicaid programs under the Affordable Care Act, than those states that have not. The Senate bill cut Medicaid funding for expansion states by 21% more than the House version and just 6% more for states that have not expanded their programs, Manatt said.

The cuts come primarily from reduced provider taxes and caps on Medicaid reimbursement to hospitals, as well as expected enrollment declines because of the work requirement and requiring states to review eligibility every six months instead of once a year.

Julian Walker, a spokesman for the Virginia Hospital and Healthcare Association, said that based on an initial assessment, "we project that the changes to provider tax and state directed payment program policy will have a significant financial impact on hospitals. Those changes could ultimately cost Virginia hospitals more than $2 billion annually.

"That essential funding helps hospitals sustain their operations, support patient access to care, strengthen the state and local economy, and provide employment across Virginia."

SNAP nutrition aid

Youngkin also played down the effect of cuts to the Supplemental Nutrition Assistance Program, or SNAP, under the new law. Effective in late 2027, the law will increase the state's share of administrative costs from 25% to 50% and require states to pay part of the benefit for the first time. That's expected to cost Virginia a total of $360 million a year.

Youngkin said the state could avoid paying $270 million as its share of the benefit if local departments of social services are able to lower their administrative error rate to less than 6%.

The latest error rate in Virginia is 11.5%, reflecting both overpayment and underpayment of benefits.

The final bill, as approved by the Senate, would not be as costly to Virginia as the original House version, which would have required the state to pay up to $450 million a year in benefits and $87 million in additional administrative expenses, according to James Williams, Youngkin's commissioner of social services.

Youngkin said Tuesday that he intends to work with local social services departments to reduce the error rate below 6% to avoid what he called a "copay."

"I am confident that Virginia, by the time this comes into effect, can do this, but it's going to require us to transform the way that the SNAP benefit is managed," he said.

Middlesex County Social Services Director Rebecca Morgan, who is president of the Virginia League of Social Services Executives, said Virginia calculates the error rate with a tiny number of randomly sampled cases.

"What we're proposing is that Virginia increase the number of cases that are reviewed, so we have a better chance ... of lowering the payment errors," Morgan said Wednesday.

She said the state also would need to increase resources for training and to improve, if not replace, its outdated case management system to lower the rate below 6% in the federal fiscal year that begins Oct. 1.

"That's going to be a challenge," Morgan said.