I have looked into the eyes of patients who skipped their insulin because they could not afford it. I have watched otherwise preventable cancers progress because someone had no insurance and no way to get a screening. I do this work as a volunteer physician at GoochlandCares, Goochland County’s free clinic — and I need you to understand something: what happens at the ballot box on April 21 will show up in my exam room.
Vote yes on the redistricting referendum. Here is why.
The Science Is Unambiguous: Lack of Coverage Kills
This is not a political talking point. It is peer-reviewed medicine.
Researchers at Yale University’s School of Public Health estimate that a Medicare-for-All system could prevent 68,000 unnecessary deaths per year simply by guaranteeing coverage to everyone. That figure, published in The Lancet, does not even count lives lost among the underinsured — people who technically have coverage but skip care because they cannot afford the copays and deductibles.
Now those same Yale researchers have turned their models on the One Big Beautiful Bill — the legislation Congress recently enacted. Their conclusion is staggering, more than 51,000 preventable deaths could occur annually because of its Medicaid cuts and ACA coverage rollbacks. The Yale team projects that Medicaid cuts alone would cause over 20,000 additional deaths per year, climbing above 51,000 when ACA coverage losses and the repeal of nursing home staffing requirements are factored in. That is more Americans than die each year in car accidents.
And it is about to get worse. Roughly one in ten people who had ACA marketplace coverage last year are now uninsured — because the enhanced premium subsidies that made coverage affordable for millions expired on December 31, 2025, and Congress let them die. Virginia insurers have requested premium increases of 20% or higher for 2026, citing the elimination of enhanced subsidies as the primary driver. In Virginia alone, an estimated 47,000 residents are projected to remain uninsured because they simply cannot afford coverage without those subsidies.
As a physician, I know what that means clinically. Uninsured patients don’t vanish. They delay. They deteriorate. They arrive in emergency rooms with conditions that were entirely manageable six months earlier — and they arrive sicker, more expensive to treat, and sometimes too late.
So, What Does This Have to Do with Redistricting?
Everything.
Right now, Republican-controlled legislatures in Texas, Florida, North Carolina, and Missouri are redrawing congressional maps mid-decade — not because a census demanded it, but to lock in a congressional majority before you vote this November. The Congress that results from those maps will control Medicaid funding, ACA subsidy restoration, rural hospital reimbursement rates, and prescription drug policy for years to come.
Virginia’s referendum is different in every important way. It puts the decision directly to voters — not legislators in a backroom. And it is explicitly temporary: after the 2030 Census, our bipartisan redistricting commission resumes full authority. This is not abandoning the principle of fair maps. It is defending it under fire.
As Legislative Chair of the Virginia Chapter of Physicians for a National Health Program, I track federal health policy the way I track a patient’s vital signs — because it is one. The 51,000 deaths Yale projects annually from the OBBB are not an abstraction. They are patients. They are your neighbors. Many of them are mine.
What Free Clinics Know That Congress Doesn’t
GoochlandCares drove over 35,000 miles in a single year just to get our patients to their appointments — because they have no other way to get there. We provide medical, dental, and mental health care, all free of charge, because the system failed these patients and someone must catch them.
But free clinics were never designed to replace a functioning system. We are the net beneath the trapeze. And right now, the trapeze artists are being told to let go with no net in sight.
When Medicaid contracts and ACA subsidies lapse, the uninsured surge into clinics like ours — already strained, already underfunded. When uncompensated care overwhelms hospitals, those costs get shifted to private insurers, driving up premiums for people who do have coverage. There is no version of this crisis that is good for anyone.
The Bottom Line
I took an oath to do no harm. Staying silent while democracy is manipulated and my patients lose their health coverage — and their lives — would be a harm I am not willing to accept.
Yale’s researchers have given us the number: 51,000 deaths per year. Every year. That is the human cost of the policy path we are currently on. Virginia has a chance on April 21 to send a congressional delegation shaped by Virginia voters — not by maps drawn in Tallahassee and Raleigh — to fight against that trajectory.
Vote yes. Your neighbor’s life may depend on it.
Dr. Bruce Silverman is a retired physician and the Volunteer Medical Director of GoochlandCares, a free clinic serving uninsured residents of Goochland County, Virginia. He is also the Legislative Chair of the Virginia Chapter of Physicians for a National Health Program. The views expressed are his own.
