Charity Care West Virginia non-profit hospitals enjoy billions in tax exemptions. In return, the social contract demands they provide meaningful charity care to struggling families. The data shows they are not holding up their end of the bargain. This brief examines the evidence — from IRS filings, Medicare cost reports, and federal subsidy data —…

Regulatory Reform in West Virginia The Problem: A State Buried in Red Tape West Virginia has accumulated one of the heaviest regulatory burdens in the nation. According to the State RegData project, the state now has 131,007 regulatory restrictions on the books — mandatory rules containing language like "shall," "must," and "may not" that impose…

Special Circumstance Reviews Between 2023 and 2025, the West Virginia Board of Education launched nine Special Circumstance Reviews — structured state investigations into county school systems exhibiting signs of serious failure. These reviews, grounded in WV Code §18-2E-5 and WVBE Policy 2322, culminated in state takeovers of multiple districts. Taken together, they reveal not a…

One Door to Opportunity West Virginia’s public assistance programs are scattered across a labyrinth of agencies, offices, and caseworkers — leaving struggling families to navigate a fragmented system at the worst possible time. This brief makes the case for a “One Door” approach: integrating workforce and social services into a single, streamlined department, modeled on…

From Prison to Profession Shawn Tackett, a resident of West Virginia who had spent ten years in federal prison, faced difficulties adjusting to life on the outside. Although he had earned various trade certificates during his time in prison, his criminal record deterred employers from hiring him for jobs in those fields. Moreover, since he…

Civil Society as the Middle Ground During the recent government shutdown, tensions rose for everyday Americans across the socioeconomic spectrum. Furloughed government workers wondered how they’d pay the bills while receiving no pay. Individuals and families leaning on Supplemental Nutrition Assistance Program (SNAP) benefits worried about how they’d keep food on the table when payments…

The Real Cost of Occupational Licensing In today’s economy, over 20 percent of workers navigate the complex landscape of occupational licensing—a scenario with its contours varying drastically across state lines. In West Virginia, the average license for low- and moderate-income jobs takes 214 days of education and experience. What does this mean for our economy…

Restoring Due Process: A Conversation with Delegate Charles Horst Civil asset forfeiture allows the government to seize a person’s property without charging—let alone convicting—the owner of a crime. Across the country, this practice has raised serious concerns about due process, property rights, and the proper limits of government power. In West Virginia, Delegate Charles Horst…

What Are Certificate of Need Laws? If you’ve been following the Cardinal Institute’s work for more than a few minutes, then you’ve probably heard the term Certificate of Need laws, a.k.a. CON laws, come up at some point. If you’re like most people, you might not know what that means. It’s not exactly a term…

West Virginia’s hospital debate is missing a key piece of the financial picture Debates over hospital policy in West Virginia usually follow a familiar pattern. Hospital systems warn that their finances are weak. Industry groups say they have too many patients with government insurance. Certificate of Need (CON) rules are defended as needed to keep…