The Blue Ridge Breakdown
Republicans in Congress gutted health care funding to expand Trump’s “papers please” goon squad, and now states like West Virginia are left to absorb the fallout, forced to decide whether to slash essential services or scramble to replace billions in lost federal dollars. In this conversation, I’m joined by Mindy Renae Holcomb of West Virginia Citizen Action Group to unpack what that tradeoff looks like on the ground: who pays the price, why so-called “optional” services aren’t optional at all, and what’s still at stake as the legislative session barrels forward.This transcript has been generated with machine and human input and errors are likely. Troy Miller So we are halfway done, just about halfway done with the West Virginia legislative session, which is, for people who don’t know, a 60-day session. We are a part-time legislature here in West Virginia. And so it’s a, it’s a little bit of time to cram in a lot of chicanery and robbery and bad ideas and all of this from income tax cuts that we can’t afford [https://governor.wv.gov/article/governor-morrisey-continues-calls-across-board-income-tax-cut] to taking any sort of regulations off of private schools [https://westvirginiawatch.com/2026/02/02/senate-bill-seeks-to-give-west-virginia-private-schools-freedom-from-government-oversight/] while cracking down and making sure the public schools have to do more with less [https://www.wdtv.com/2026/01/14/4-school-bills-introduced-wva-legislature-would-reshape-education-policy-prayer-athletics-religious-displays/]. All of these things. If you know it is. In summary, it is impossible, I think for any single person to be able to follow everything that’s going on in the legislature [https://www.wvnews.com/news/wvnews/west-virginia-legislature-opens-2026-session-with-nearly-1-000-bills-introduced/article_27157304-d21e-434d-878d-ce329e6e04e8.html]. So with that as backdrop, I do find that you can follow some groups including West Virginia Citizen Action Group and which in who employ my next guest, Mindy Renae Holcomb. Mindy Renae Holcomb, who is their organizing manager, healthcare lead over at West Virginia Citizens Action Group [https://wvcag.org/] and she joins us now. So thank you Mindy, first of all for taking the time here. Mindy Renae Holcomb Oh absolutely. Thanks for having me. Troy Miller Always a pleasure. Okay. With all of that is kind of the background about what may or may not be going on down there. What is you’re the organizing. I’m sorry, I have to get it right. Organizing manager at healthcare lead. So let’s really focus in on that angle. What, what do we have going on? What are you paying attention to? What is particularly bad or particularly good? Take it from there, if you will. Mindy Renae Holcomb Well, yeah, we’re, we’re watching for of course any vaccination adjustments that they, that may be made. You know, reduction in requirements simply because West Virginia has one of the, if not the top vaccination program in the country. It’s one of the good things we are known for and we want to keep that. [https://www.cnn.com/2025/09/05/health/west-virginia-vaccination-requirements-rfk] We want to keep our state healthy. And so we are definitely watching that pretty closely. We’re also watching for things that we will reduce because of the HR1 is which how I simply just demand on referring to it instead of the one big beautiful bill, the big ugly bill is how I I big ugly nasty bill. Yeah. That anything that’s going to reduce any services that are associated with Medicaid, particularly because that is, you know, we have a high population in West Virginia who utilizes Medicaid. We’ve already had the disaster of the, well, this is separate from Medicaid, but the enhanced premium tax credits that got, did not get renewed and those helped lower lower middle class folks afford plans on the exchange on the marketplace. And those have pretty, that, that up in Washington, D.C. that’s pretty much been dropped. So we’ve seen a drastic reduction of folks who are utilizing the marketplace. And I think, you know, even though it’s, you know, because of everything else that’s exploded in D.C. we still need to put pressure on our representatives there to, you know, because this is such an important program and it’s vitally important to West Virginians. So I’m not ready to pull the plug on anything being done. Obviously, it’s not going to help anyone this year, but I think we need to continue to bang that drum so that we can get people back on, get people insured and get them the care that they rightfully deserve. Troy Miller Yeah. And I’ll just say on that front, I think it’s starting to become clearer in people’s actual lives what we were, you know, screaming about last year when all of this was being either inaction on the part of the enhanced tax subsidies or the enhanced subsidies or action in the terms of just gutting rural health systems. And then, you know, saying, oh, here’s, here’s what, $200 million, that whatever it is, that’s a, that’s a band aid for under the amputation after you cut billions out. And we’re seeing like, you know, local business owners here in Jefferson County. There are a number of them who I know have said my family could no longer afford the, the coverage we need. And we’re going to piece it. Well, you know, we’ll try to piece it together, but please call your Congress, your Congress critters here in West Virginia. Yeah, that is huge. And to really hammer it home, West Virginia is also one of the states with the highest rates of people living with disabilities [https://www.valuepenguin.com/disability-rates-study]. And so there’s this whole article or feature over at PBS NewsHour [https://www.pbs.org/newshour/show/how-people-with-disabilities-will-bear-the-burden-of-medicaid-funding-cuts] a couple of weeks ago, particularly about how people with disabilities are going to bear the burden of these Medicaid funding cuts more than other people with disabilities in rural areas are going to disproportionately impact it. And it really pissed me off when I saw a couple of it must have been last month that our Congress people didn’t even manage to get us like the per person, per-rural-patient the same amount of revenue or the same amount of incoming funds to make up the Medicaid cap as, like, rural New York or rural Connecticut [https://www.kff.org/state-health-policy-data/first-year-rural-health-fund-awards-range-from-less-than-100-per-rural-resident-in-ten-states-to-more-than-500-in-eight/]. Which just boggles my mind that we have such bad negotiators in Congress who are willing to just. I mean, with Shelley, her son got an appointment [https://westvirginiawatch.com/2025/07/01/moore-capito-and-matt-harvey-nominated-for-wv-u-s-attorney-positions/] to the federal prosecutor’s office or the representing this dish. So, you know, cool, I guess, for them, but for the rest of us in West Virginia. Yeah. And it’s up to the. It’s up to our state legislature now to either exacerbate this problem through inaction or to start to address the problem from the state level. What are you looking at in terms of that? I know that there are some. There have been some movement that might even have some bipartisan support to, like, not totally hose all of us, but correct me if I’m wrong. Mindy Renae Holcomb Well, what we are concerned about is that Morrissey has said, don’t ask for any state funds to supplement or not supplement, but replace federal funds. So that’s going to put us in a pretty hard, hard way. And also, one of the ways that they are going to have. That they’re going to have to look at this is by cutting optional services. And that would be dental care that we fought so hard to get for West Virginia. I’m really worried about how IDD waiver is going to survive this. That is considered an optional service. So for those that don’t, there are services that are absolutely required under federal mandate for Medicaid. Anything else that is provided through the states is considered optional, and they aren’t what we would consider optional. Troy Miller Right, right. And I just want to ask you to elaborate on IDD a little bit. Mindy Renae Holcomb What is it for sure, Intellectual, developmental disabilities. So folks that have, you know, autism, that need additional care, those who have other, you know, disabilities that affect their ability to work, go to school, that need extra services in order to allow them to live a full life and participate fully in school and in work. Those services can be cut, eliminated. I mean, I’m not trying to put the fear out there, but it’s just. Troy Miller It could be right, something, as you were about to say, they’re not optional for the families, you know. Mindy Renae Holcomb Exactly. Troy Miller These services need to be. Especially, I mean, with dental, it really puts the nail on the head. Like, I’m sorry, we all have teeth. You know, it’s not really an optional thing to take care of them or not. And they’re a big indicator for our general health. Mindy Renae Holcomb 100%. Troy Miller And it’s only because the dentistry lobby has been so effective in America of sectioning themselves off from the rest of healthcare that this is even a discussion. Which is why, right. We don’t have any sort of. Well, we don’t have any universal healthcare, but there’s not even a requirement for dental services on private insurance to cover any damn thing. Basically, it’s all very patchwork, which is why we see commercials on the TV for this type of dental insurance and this type of supplemental dental insurance and all of this. Which is just mind boggling in the richest country in the world at the richest time in our history that we’ve turned an industry into. Hey, do you have teeth? Do you not want them to fall out of your head? Great. You can pay for this extra insurance for it. You know, that’s absurd. And our governor has, of course, he’s not going to supplement the funds with what we actually need. And as I pointed out back then and in past years, these are federally matched funds a lot of the time. So it’s not just, you know, we’re not just cutting the spending by $1, we’re cutting it by $2 to $3 a lot of the time. Just right out of our system and right out of the care that, yeah, West Virginians need just as much as anyone. What else do we have going on down in the legislature? Watch on YouTube, Like and Subscribe! Mindy Renae Holcomb Well, you know, I would argue more. So we have a very aging population. We have a very sick population. So, you know, I would put the argument out there that, you know, I have said from the beginning of HR1 that West Virginia will suffer the most out of anyone in the nation. And I still stand by that statement. And we seem to have a lot of folks who, you know, in our legislature who are prioritizing other pet projects or, you know, I’m just going to name it. And this is me speaking as Mindy, not as a representative of CAG, so I’m taking off that hat for a second. The whole Charlie Kirk Day. I went livid over that. That is not a priority for our state. When we have child care issues, when we have a foster care system that is failing, when we have people dying and people in rural areas who are going to have little to no access to health care if we lose some of our rural hospitals. And our Senate took the time that we pay them for out of our tax dollars to do this. It just seemed absolutely ridiculous to me and asinine. And again, I’m speaking as Mindy, not as a representative of CAG, but I just, I was furious because it’s these little things that we have to look at that. You’re wasting time. We have real issues here in West Virginia that need addressed, and we need you to take this seriously. This is not a time to be a sycophant. This is a time to actually stand up and work for the people of West Virginia. Because that’s what we vote you in there for, and that’s what we pay you for. Troy Miller Yeah. No, importantly, it is very. It’s what we pay them for to not do. You know, I always hear Republicans accusing liberals or whoever of virtue signaling. And it’s like, I don’t know, man. When 30 state senators can sit down there and discuss this even, and none of them even. I don’t know. When I saw that, I was like, we should put it on the day that he ever visited West Virginia. And nobody has been able to answer when that ever happened. And so good. Moving on. That’s the day we celebrate Charlie Kirk and his relationship to the state. The day that he visited in his life. Moving on. We don’t do it. Okay, now we could get to some actual issues, like what do we do about this amputation of rural health that is not being fixed by the amount of funding that’s coming down, that we’re not getting the amount of per person needed that the other states are getting. And even when they are working on the things that they say are producing jobs and all this, people don’t think about the fact that public health encompasses a lot more than just our physical health. If you don’t have good roads and you live 40 minutes up the mountain out here in, you know, Shannondale, Jefferson County, it takes 45 minutes for an ambulance to get there. And if you have a heart attack, you’re dead. And this is deemed a county issue. And the counties are left with, you know, constantly trying to figure it out with limited funds because of how West Virginia’s whole state is set up. And for folks that don’t know, basically everything has to happen through Charleston, especially with roads. The history lesson there, for anyone who might not know it, is that during the Great Depression, the West Virginia state government bought the roads from the counties, basically. And this is why every road in the state is a state road, so the counties didn’t have to go bankrupt in the Great Depression. Okay. But what that means is we have 60 days basically to do any sort of legislative action on roads that will comprehensively address it, or we have to leave it to the governors and the Department of Transportation, which ultimately have to be funded by the legislature during the 60 days. It is a quaint way to run a state. It is ineffective these days. And I’ll say, I’ll just plug now, like my belief that actually we should have a full time legislature. And I know it’s not the most popular thing for people to say, but like I think they should actually get paid a little more so that more normal people can do it as a job. Mindy Renae Holcomb And you know, let’s talk about the amount of women we have in our legislature or the lack thereof. Exactly. And it’s because, I mean, I have looked into running. I have looked into it and I don’t see how I can possibly afford to do it and still help support my family. It’s just not feasible. And I’m fortunate I have family that live in Charleston so I can stay with them, you know, when I’m there. So that would leave an expense, but it’s still not feasible for me. And you know, to leave a full time job for 60 days, you know, to come. It’s just almost impossible. And let’s just put it bluntly, women take the burden of child care in families. And so we’ve made it almost impossible for the everyday working person. Troy Miller Right. Mindy Renae Holcomb No matter your sex, to participate. We’ve got a lot of lawyers, a lot of doctors, you know, etc., and very few just general working people who are able to participate in our government. And that’s a shame because I think we need more people like us in our legislature. And yeah, I want to see more women there. And so if we can make it more accessible, I think that’s the ideal thing to do. Troy Miller Yeah, I mean, I think that’s hugely important to make clear. It’s not easy to run for office. I was very fortunate to be able to with my job two years ago and with the freelance work I do and all of this. But there’s no way to actually do it with a full time job because of how broken our electoral system is. You’re spending your entire time either knocking on doors and trying to talk to people where they are or asking people for money so that you can reach people with advertising and all of the different types of things. It’s not the most. I don’t know. I’m glad that I’m not running for office at that outside of the partisan level right now, but it is absolutely inaccessible for people. I’m happy that so many people have stepped up. But then there is the question. I’m over here in Jefferson County. Somebody pointed out to me the other day that I could drive to New York City faster than I could drive to Charleston from out here. I have two routes and both require leaving the state at some point to come back into the state unless you take a really through the mountains type route. And that makes it very difficult when everything has to go through Charleston in a 60 day period. Which I would say another thing that we need to do, but something we need to be careful about, is restore power to counties and empower counties to be able to spend on things they need. I want to say we need to be careful because over in Ohio 10 years ago, when John Kasich was governor, he kicked all of the road responsibilities down to the counties without dealing with the fact that the roads still had to be paid for. You can’t balance the state budget by not paying for roads and just making it a county problem. So I want to throw out there that we need to empower our counties more in West Virginia because the more local you get, and this is a fairly conservative position honestly, the better people understand their needs. There’s a limit to that, I think. I support public schools. I don’t think every parent necessarily has the resources or knowledge to teach their kids. There is a place for homeschooling. There is a place for different educational approaches. What is going on right now in the legislature is an absolute backdoor to defund public schools. That’s part of a long process going back to Brown v. Board of Education and through the textbook wars in Kanawha County. Mindy Renae Holcomb I think that’s a lot of what’s happening overall. We are seeing the playbook that was written even before Reagan finally come to fruition. They played the long game. This authoritarianism and Christian nationalism. Troy Miller Let me jump in and say at some point it has become very clear to me that we have two options. We can have power that comes from the top down in an authoritarian style where elites decide things for us. Or we can have a bottom-up system, where power comes from the people. That is the American alternative. Power derives from the consent of the governed. Which is not to say government is in opposition to us, but that it derives its power from our consent and oversight. Which is something we’ve lost. Money in politics has created an oligarchy. That has made the ground fertile for authoritarians. For 50 years, business elites have tried to undo the New Deal, going back to the Lewis Powell memo. They wanted to destroy the Great Society. Books and books have been written about this. What happened recently is they made a trade. They gave up immigration in exchange for everything else they wanted. And they’re paying for it by gutting rural health care and Medicaid. All of this authoritarianism is being paid for by taking health care away from West Virginians. Mindy Renae Holcomb One hundred percent. If you’ve lost your health care or had it diminished, it’s to pay for what we’re seeing right now. Troy Miller Six hundred fifty people deported or arrested in West Virginia. They’re holding it up and saying, see what happens when everyone cooperates with the feds. As a West Virginian, the irony of that is wild. You can kidnap people much easier in a holler than in a high rise. Mindy Renae Holcomb It’s apples to oranges. Troy Miller Yeah. Mindy Renae Holcomb And trust me, I don’t know, it’s just, it’s so infuriating. And it is happening. I mean, we saw it in what hurricane where the fire department was lending them fire trucks to get on roofs to take people, to kidnap them from their jobs. Yeah, I was horrified. Troy Miller Right. And again, it goes back. Oh, yeah. Cooperation with the federal government, famously a conservative value, right, for all these years. And over here in Jefferson County, we have a Customs and Border Patrol station, have had for a long time. My name is Troy Miller. That’s part of the name of the program. The former acting commissioner or whatever for Customs and Border Patrol is another Troy Miller. So a bunch of them really enjoyed taking a picture with me when I was running for office last year with my Troy Miller sign on there. I’m horrified to know what the inside joke might have been. But in any event, yeah. And where does the border that we are patrolling over here in Jefferson County? We’re a landlocked state. No coast, no other country. But the reality is every international airport is a port of entry. And so that boundary line for where Customs and Border Patrol has authority resets everywhere there is a port of entry. People don’t necessarily realize that. But that’s the logic for why we’re right by BWI, Dulles, and Reagan. That’s a lot of federal funding that has been coming in for years. I guess conservatives can be okay with that because it’s not helping people directly. The federal funding they cut literally goes toward people’s health care and rural hospitals. Talk about a job creation program. Medicaid, Medicare, and Social Security are huge job creators in West Virginia. Mindy Renae Holcomb And it’s been proven over and over again. It creates health care jobs, which are good-paying jobs that offer benefits, so people don’t have to rely on social programs. It’s fascinating to me that we’re so focused on social safety net programs when places like Walmart won’t pay a living wage. The owners are billionaires many times over, and they won’t give people enough hours to qualify for insurance. But they put Medicaid paperwork in their welcome packets. So why are we subsidizing them? Why are we giving corporate welfare to billion-dollar corporations that openly put workers in this position? We should be holding corporations accountable. We need regulations that require living wages and benefits. We’re stuck in this system. Until we actually care about people and want to provide health care for our neighbors, we’re stuck here. That’s why I have to work. I’m a type 1 diabetic. I have to have insurance to stay alive. I don’t qualify for safety nets, so I have to have a job that provides insurance. That’s the reality. That’s why we see elderly people still working. It breaks my heart. They should be enjoying retirement, but they’re working to survive. And we hear people like Dr. Oz saying if people work a year earlier or a year later, it’ll solve things. They want to work us to death. Because it’s profitable. Troy Miller Yeah. And he said that about eliminating the debt. There’s this whole myth about Social Security solvency. I want to highlight something. It’s fifty-three thousand jobs in West Virginia supported through Social Security expenditures, with a two point seven billion dollar labor income impact. These are earned benefits. We could expand the program. All we have to do is end the billionaire tax break where they stop paying in. Make them pay the same percentage as everyone else. Then we can expand and improve the program. On Walmart, I remember when the No Kings protest started last year. Some conservatives freaked out because a Walton family member donated. They said we should boycott them. No. You should oppose them because they’ve hijacked the country. We subsidize their profits so workers can get health care and food. That’s infuriating. They should be taxed one hundred percent of whatever their workers receive in Medicaid and SNAP. At the end of the year, that’s your tax bill. Until you pay a living wage. Otherwise we’re just subsidizing your bottom line. I think people across the spectrum could agree with that. And yet someone will say it’ll destroy jobs. I don’t care. The jobs aren’t good. If destroying some jobs means everyone gets health care, that’s fine. We said the same thing with the Affordable Care Act. It was a huge improvement. But when Medicare for All came up, Obama said it would destroy insurance jobs. I don’t care. Those jobs exist to deny care. If we had Medicare for All, those workers would still have health care. Not all jobs are good jobs. If a job exists to poison puppies, I don’t care how well it pays. Creating jobs is not the point. Creating good jobs is. So people can have leisure, families, dignity. I don’t need every person in a household working just to survive. That’s not a good economy. Mindy Renae Holcomb I couldn’t agree more. The health insurance industry is smoke and mirrors. It doesn’t improve quality, access, or affordability. It does nothing. It needs to be destroyed. Burn it all down. Troy Miller I’ll just say it does exactly what it’s supposed to do. It creates profits. Once we realize our system is sickness-for-profit, it all makes sense. Those profits fund lobbyists. Two for every member of Congress. That’s how Medicare for All gets shut down. Meanwhile, people would be insured, mobile, free. Mindy Renae Holcomb Let’s look at United. They make billions per quarter. They’re one of the top deniers of care. They use pre-authorizations to make it nearly impossible. They’re snakes. They own pharmacies and pharmacy benefit managers. The money just circulates back to executives. Nothing benefits patients. As someone with serious chronic illness, it’s infuriating. Only a tiny percentage of people fight denials. But when they do, nearly all get overturned. So why deny care? Because people give up. If you’ve been denied care, fight it. It’s a ruse. Troy Miller They hope you give up or die before they pay. Before AI cures cancer, it’ll deny millions of claims. Those jobs will be destroyed anyway. And people will lose insurance to a robot. Powered by data centers built without zoning or taxes. They say data centers bring revenue. Then they eliminate the taxes. Run it like a business. End revenue streams. Give away inventory. And what are they powering? Denials of care. Mindy Renae Holcomb They already are. Insurance companies are already using AI to deny care. It’s disgusting. Your doctor knows what you need. Not a robot. Troy Miller Yeah. Eventually a human just comes on to ask how you’d rate the call. We have to laugh to survive this cruelty-for-profit. So are you hopeful about anything? Mindy Renae Holcomb I’m cautiously optimistic. Stripping care is not the answer. We need new revenue streams. We need to preserve and expand care. The legislature got dumped with this mess by HR1. The feds walked away. Now states are scrambling. I work closely with the West Virginia Center for Budget and Policy. They do excellent, factual work. I encourage people to look at their analysis. Troy Miller I’ll jump in. WVPolicy.org has a piece from February ninth about how the big beautiful bill is a big problem for West Virginia’s budget. Who could have expected that? We’re halfway through the session. West Virginians still have time to contact lawmakers. Public comments are available on the legislature’s website. They don’t have to be long. Just make your point. Mindy, any closing thoughts? Mindy Renae Holcomb Definitely go to wvcag.org. My email is mindy@wvcag.org. Reach out. We’re canvassing, phone banking, talking to people. We want to know what your red line is. We’re building ways to get involved beyond calling lawmakers. We want people across the state involved. Troy Miller Amen. It feels like banging your head against a wall. But they need to hear from you. Some are disingenuous. Others truly don’t know what’s happening in their districts. Thank you for all you do, Mindy. Mindy Renae Holcomb I appreciate you having me. Always love being here. Troy Miller We love having you. We’ll talk soon. 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