Healthcare is under attack right now. Hospital and health system executives have watched federal and state policies passed to cut reimbursement and limit access to health insurance. They’re also seeing a resurgence in efforts to change the 340B program and require additional spending without more funding flowing into hospitals.
That’s a challenge Karen Bowling takes personally.
Ms. Bowling is president and CEO of WVU Medicine Princeton Community Hospital in Princeton, W.Va., and executive vice president of government affairs for West Virginia University Health System in Morgantown. Before she ran a hospital, she served as West Virginia’s cabinet secretary for the Department of Health and Human Resources, a role that put her inside the legislative and executive machinery that hospital leaders spend their careers trying to influence from the outside.
“Politics is local,” Ms. Bowling said during a “Becker’s Healthcare Podcast” interview. “And you really do need to understand the political environment that you’re in, and you need to really be able to connect with individuals so that they feel comfortable reaching out to you when there are policy decisions that have to be made.”
Rural hospitals like Princeton — where Medicare and Medicaid patients make up a significant share of the patient population — are among those preparing for a potential Medicaid crunch driven by federal and state funding changes. In West Virginia, that exposure is higher than in most states. Any reduction in governmental payer revenue hits harder when those payers represent the majority of a hospital’s revenue base, and rural hospitals have thinner margins to absorb the difference.
“I think even more so today than in any year that I’ve been in the administrative world, we have to really understand their perspective, and we have to have a relationship with them,” Ms. Bowling said.
That relationship cannot be built through association membership alone. Healthcare has no shortage of advocacy organizations — American Hospital Association, America’s Essential Hospitals, 340B coalitions, state hospital associations — and Ms. Bowling values them. But she draws a clear line between association advocacy and direct executive engagement.
“Your representative, when you come in and have a conversation with them, they’re going to know you, and they’re going to find it more meaningful than talking to only a representative from an association,” she said. “We need them. Their advocacy is important, but we have to be an integral part of it.”
Her practical advice to other hospital leaders is to bring legislators to the facility. Invite them in, walk them through operations and make the stakes concrete and local before a budget vote forces the conversation. That kind of access is something no trade group can replicate.
“Spend time with them. Really educate them about what you do at your hospital or your facility,” Ms. Bowling said. “And that way, when they’re faced with decisions, not only will they reach out to you, but they’ll also have the perspective of seeing your hospital or seeing your facility.”
The relationship Ms. Bowling is describing is informational, not ceremonial. When legislators lack a direct line to hospital leadership, they fill the gap with whatever information reaches them, and not all of it is accurate. That information asymmetry tends to work against hospitals, particularly in rural markets where the care delivery reality is furthest from what Washington or a state capital might assume.
Ms. Bowling’s career trajectory — from nurse to state cabinet secretary to hospital CEO — is valuable because she knows what it looks like from the hospital side and from the room where funding decisions are made.
“Have a constant connection or communication with them about issues going on at your hospital or policies that you’ve read about or you see that you think need to be changed,” she said. “But more importantly, don’t rely on your associations to do everything.”
At Becker's 4th Annual CEO + CFO Roundtable, taking place November 2–5 in Chicago, more than 1,500 hospital and health system executives tackle decisions that determine whether organizations thrive or merely survive: protecting margins under cost pressure, choosing where to grow, renegotiating payer relationships, stabilizing the workforce and proving real ROI on technology. This is where leaders work through them together, face-to-face. Apply for complimentary registration now.
