WASHINGTON — West Virginia University Health System doesn’t have the name recognition of the Mayo Clinic or Massachusetts General Hospital. It doesn’t have the lobbying firepower in Washington, either.
But this year, unexpectedly, the hospital chain and others in the state are part of the reason that rural hospitals across the country will get a last-minute cash influx of more than $8 billion from Congress in the Covid-19 package that represents President Biden’s first major legislative push.
The hospitals’ longshot lobbying victory came out of their relationships with Sen. Joe Manchin, the West Virginia Democrat who is taking a similarly sudden star turn as a coveted moderate vote in the new, narrowly divided Democratic Senate.
Manchin has already proved his willingness to be a thorn in the side of Democratic leaders on a variety of high-profile issues including raising the minimum wage, unemployment insurance, Biden’s nominees, and, thanks to the hard work of the hospitals and their lobbyists, he chose to expend his political capital pushing for funding for vulnerable health providers.
Executives at WVU Health System, for example, are in “constant contact” with Manchin’s office, according to executive vice president of government affairs Karen Bowling.
“In a small state like ours, we don’t need a presence in Washington. We have very good access to our senators, and congressmen too. We know each other,” Bowling said, adding that she has the cellphone numbers of staffers in Manchin’s office.
Hospitals started from scratch in their push for more funding. Biden’s initial outline for his Covid relief package did not include any money for hospitals at all. Nor did the version that passed the House in February, and none was included in early drafts of the Senate’s package.
West Virginia’s hospitals are an unlikely team to make the case. The state hospital association employs only one lobbyist; he just registered in November. New York’s state hospital association, in contrast, employs or contracts with 23 lobbyists.
But the hospitals have Manchin’s ear in part because they are some of the largest employers in the state — WVU Health System overtook Walmart in 2016 to become the state’s single largest private employer. It owns, operates, or manages 18 hospitals, including six critical-access hospitals, Bowling said.
Manchin’s office is highly engaged on the issue of rural health care. West Virginia Rural Health Association Executive Director Richard Sutphin said Manchin’s staff overseeing health care proved during a February meeting organized by the National Rural Health Association that they were well-versed in the financial pressures facing rural providers.
“It’s a good feeling that the boots on the ground in Washington know the problems we are dealing with,” Sutphin said.
Manchin’s office did not respond to a request for comment on his advocacy for more provider funding.
Rural hospitals have been particularly hard-hit by the pandemic, given their slim margins to begin with. West Virginia alone had three rural hospital closures in 2020.
While some Democratic lawmakers had voiced skepticism that hospitals really needed more financial assistance, rural hospitals in West Virginia argued they operated on thin margins before, with high proportions of their patients insured by public payers that pay lower rates for care.
They found a sympathetic ear with Manchin, who initially pushed for $35 billion for hospitals and health care providers, knowing Democratic leadership couldn’t lose his vote.
Senate leadership said they didn’t have room in the budget for that much money, three health care lobbyists told STAT, but they were able to squeeze in $8.5 billion after unemployment benefits were pared down. There wasn’t much opposition to targeting the money for rural providers.
The funds for rural providers won’t benefit some major health systems and hospitals important to other lawmakers who have previously championed hospitals’ interests, including Senate Majority Leader Chuck Schumer (D-N.Y.) and House Ways and Means Committee Chair Richard Neal (D-Mass.).
“There’s no question about it. That money would not have happened without Manchin,” one of the lobbyists said.
WVU Health System had hoped for some money for safety-net hospitals as well, as its flagship location likely won’t qualify for extra funds, Bowling said, but in the end the funding was limited to rural settings.
The Department of Health and Human Services still has some discretion over how to direct the funds and which providers precisely qualify, but West Virginia providers are cautiously optimistic.
Manchin will continue to play a pivotal role in legislative debates to come, and Bowling said she is grateful for his exaggerated influence.
“It puts us on the map,” Bowling said.