ADRIENNE HOAR McGIBBON: Health care providers in rural parts of Virginia say federal cuts to Medicaid would hurt the health of their communities.

Sovah Health operates hospitals in Danville and Martinsville.

Together, they serve about 160,000 patients in Virginias Southside.

STEVE HEATHERLY: We tend to serve a population that is on the wrong side of the social determinants of health, things like poverty level, income level, education level.

ADRIENNE HOAR McGIBBON: Sovah Health CEO, Steve Heatherly, says about 80% of their patients rely on some form of government funded health insurance.

While Medicaid and Medicare reimburse care providers at lower rates, Heatherly says it's better than having patients without any insurance at all.

STEVE HEATHERLY: Having that funding allows us to invest in new technology, invest in new equipment, upgrade our facilities, recruit new physicians.

And I think more fundamentally, when people, you know, are covered with some form of insurance, they are more likely to get the care they need.

ADRIENNE HOAR McGIBBON: Virginia expanded access to Medicaid in 2018.

Now, nearly 2 million adults and children are covered, which is more than 1 in 5 Virginians.

More of these recipients live in rural parts of the state, according to U.S. Census Bureau data.

Lower reimbursement rates for care put financial strain on the hospitals in those areas.

VICTORIA RICHARDSON: You know, rural hospitals are, a lot of them are kind of hanging on by a thread.

ADRIENNE HOAR McGIBBON: About a third of Virginia's rural hospitals are operating in the red, according to a report by the Virginia Hospital and Healthcare Association as some patients are unable to cover out-of-pocket costs without insurance.

VICTORIA RICHARDSON: They can't turn people away in emergencies so they have to treat them.

And then you end up treating patients that can't pay.

So, you know, they either have to write off that debt or, you know, we have a lot of people that end up, you know, facing pretty tremendous medical debt because they can only go to the hospital in emergency situations.

ADRIENNE HOAR McGIBBON: In Southside Virginia, Heatherly says Sovah Health is financially stable and has been able to invest in new technologies and attracting skilled care providers.

But he worries cuts in federally funded insurance like Medicaid and Medicare could lead to poorer health outcomes.

STEVE HEATHERLY: You can debate what the government should be funding.

You can debate whether you like Medicaid expansion or not.

But what you can't debate is the people who are the beneficiaries of Medicaid expansion, by and large, live healthier lives as a result.

And those people are, disproportionately located in rural communities.

ADRIENNE HOAR McGIBBON: Congressional leaders are set to decide on possible Medicaid cuts over the next several months.

Adrienne Hoar McGibbon, VPM News.