Ellen Allen: The foundation of WV economy is health care (Opinion)

This Op-Ed was originally published on April 17, 2026 in the Charleston Gazette-Mail.

Gazette-Mail political columnist Phil Kabler recently wrote about data centers being the final decimation of West Virginia. Perhaps he is right. However, I suggest that the $1 trillion in health care cuts over the next decade may be the ultimate killer.

For generations, our state’s fortunes rose and fell with extractive industries like coal and natural gas. But today, health care has become the most reliable source of jobs, growth and stability — especially in rural communities where a hospital or clinic may be the largest employer left — leaving West Virginia at a crossroads, and the stakes couldn’t be higher.

The impact of health care cuts will be felt across West Virginia, but not evenly —and nowhere is that clearer than in our most vulnerable hospital systems. In the southern coalfields — McDowell, Wyoming, Logan and Boone counties — hospitals face a perfect storm: heavy reliance on Medicaid reimbursement, negative revenue streams and low patient volumes. These communities have experienced dramatic population loss and aging, compounded by high rates of disability, opioid use disorder and black lung disease, leaving their health care
systems especially exposed.

The risks extend into the Central Appalachian region, where counties like Braxton, Clay, Webster, Nicholas and Roane depend on hospitals that serve as the sole providers for multi-county areas. With extremely low patient volumes and long travel distances for care, these facilities operate on thin margins and are critical lifelines — meaning any disruption threatens not just access to care, but the viability of entire regions.

Health care is one of West Virginia’s most powerful economic engines, generating nearly $17
billion in annual activity, supporting roughly 14% of the workforce and employing more than
54,000 people — making major systems like Vandalia Health and WVU Medicine the state’s
largest private employers, surpassing traditional industries like coal and natural gas.

In W.Va., health care and the economy are intertwined.

The strength of West Virginia’s health care system is inseparable from the strength of its economy — yet that foundation rests on a uniquely fragile set of financial realities. Nearly three out of four hospital patients in our state rely on coverage through Medicare, Medicaid or PEIA — almost double the national average. While that payer mix helps ensure access to care, it also leaves our entire health care system — and the economic stability it supports — deeply exposed to decisions made in Washington.

The “Big, Beautiful Bill” slashes more than $1 trillion from Medicaid — but those dollars aren’t abstract; they are what keep hospital doors open, covering the gap between the cost of care and what providers are reimbursed. Without that support, already-thin margins disappear quickly, putting rural hospitals at immediate risk and sending ripple effects through major hospital systems, the health care workforce, and entire local economies.

West Virginia secured a historic $199 million from the Rural Healthcare Transformation Fund — the highest per-capita award in the region. This investment can modernize facilities, expand telehealth, and improve coordination, but it is a supplement. While we will receive some amount of RHTF funds in each of the next four more years, it can’t offset deep federal cuts or replace sustained, reliable coverage.

At the same time, the system faces a growing workforce crisis, with nearly 4,000 hospital positions unfilled and nursing shortages projected to reach double-digit levels. Hospitals are increasingly forced to rely on costly traveling staff and overtime, driving labor costs up more than 14% in just two years, even as patients grow older and sicker. Together, these pressures are pushing hospital finances to the brink and threatening the long-term stability of care across the state.

West Virginia’s health care system is both our greatest strength and our greatest vulnerability — our most reliable economic engine and one of our largest employers, yet dangerously dependent on government funding and strained by a shrinking workforce. That tension is not sustainable. The choices we make now will determine whether we build a resilient, modern system that meets the needs of our people or continue operating on the brink. Federal investments have opened a window of opportunity, but they cannot carry the weight alone; without sustained support, a stable workforce, and a firm commitment to protecting core programs like Medicaid, that window will close quickly.

In West Virginia, health care isn’t just part of the economy — it IS the economy. And if we fail
to protect it, everything else is at risk.