Here in West Virginia people who use the ACA exchanges and rely on tax credits are seeing their premiums go up as much as 387%. This was done with the full approval of our completely useless Congressional delegation. Some rural hospitals closed down after the announcement that WV would lose $1 billion because of the Big Beautiful Bill and our useless carpetbagging governor Pat Morrisey  bragged last week about getting $200 million to replace it.

He went so far as to say this  :

“The $199 million investment for 2026 provides a transformative foundation to improve health outcomes, expand access to care, and strengthen families and communities throughout West Virginia,” Governor Morrisey said. “This award positions our state to deliver better care closer to home and build a healthier future for generations to come. It is also the highest per capita award of any state that West Virginia touches.”

Read it again:  “It is also the highest per capita award of any state that West Virginia touches.” Hmmm.

Let’s look more closely at these “investments”.

State awards for 2026, the first of five years, average $200 million, ranging from $147 million in New Jersey to $281 million in Texas (Figure 1). Differences in total awards across states in the first year (and most likely in future years) are modest relative to large differences in rural populations and rural health needs more generally. For example, Texas has about thirty times as many rural residents as New Jersey (4.3 million versus about 140,000) but is only receiving about twice as much funding in the first year ($281 million versus $147 million). Differences in total awards across states are relatively modest primarily because half of the rural health fund (50%) is being distributed equally across approved states, regardless of need, as required by law. Because all states have been approved for funding, each is slated to receive $100 million from this half of the fund in 2026 and in each year from 2027 through 2030.

So in reality the crack team of WV Senators and House Reps managed to get a highly rural state an extra $100 million. Just incredibly pathetic.

And it’s worse than you think. Here is the breakdown of the most rural states in the US:

Here is what states received:

This was the formula that the WV Congressional delegation—all Republicans—thought was suitable:

First-year awards per rural resident vary widely across states, ranging from less than $100 in ten states to more than $500 in eight states according to KFF analysis (see Figure 2). State awards are partially, but not closely, tied to rural population, meaning that first-year awards per rural resident are generally relatively small among states with the largest rural populations. For example, Texas has the largest rural population in the country—and the largest total award in the first year—but will receive the smallest payment per rural resident ($66 in 2026). In contrast, states like Rhode Island, New Jersey, and Alaska, with far fewer rural residents, will receive substantially higher amounts per rural resident ($6,305, $1,069, and $990 respectively, with Rhode Island being an extreme outlier). Only a quarter of the $50 billion fund is being distributed exclusively based on measures of state need, with just 5% of the fund that is based on rural population. Other measures of need, according to CMS, include the number of rural facilities, land area, the share of hospitals receiving Medicaid disproportionate share hospital (DSH) payments, and other factors.

It was supposed to be a replacement fund for *rural* hospitals. And yet it wasn’t. And the governor bragged about this nothing burger, too.

It’s just another day here in the Mountain State where the rich people are picking at every resource we have, with the full cooperation of the WV GOP.

I’ll leave you with this–this situation is already depressing enough.