North Carolina is justifiably proud of passing Medicaid expansion, which recently extended health coverage to 628,000 additional NC residents after a decade-long legislative battle. Today, Medicaid covers nearly 1 in 4 North Carolinians (3.1 million people) and supports 3 in 10 North Carolinians with disabilities (287,000 people). Additionally, it improves coverage for seniors by covering gaps in basic Medicare and paying for 50% of long-term care. Research demonstrates Medicaid saves lives, improves personal and public health, and lowers the cost of insurance for everyone
Expansion also keeps rural hospitals open, making sure North Carolinians with all types of insurance - or none at all - continue to have access to medical care regardless of their zip code. NC is ranked number 3 in the United States in rural hospital closures with 181 since 2005.
This spring, Congress is widely expected to vote to approve massive Medicaid cuts as part of the budget reconciliation bill. Medicaid cuts are the leading target to partially offset the Trump Administration’s extension of its 2017 tax cuts. The budget reconciliation process avoids a possible filibuster because it requires only 50 votes to pass the Senate, meaning the bill could pass without any Democratic votes.
However, due to the slim Republican majorities in both chambers, only four Republican votes are needed to block potential Medicaid cuts.
If cuts are enacted, North Carolina state law will automatically repeal our Medicaid expansion. This would require the state legislature to reinstate the expansion by passing new legislation and coming up with a projected $15.6 billion over the next 10 years.
To avoid kicking millions of North Carolinians off of their health coverage, the best hope is to prevent Medicaid cuts at the federal level in the first place. U.S. Senators Tillis and Budd should oppose these cuts, as well as all 14 members of North Carolina’s delegation in the House of Representatives, because these cuts will have dire consequences for every single corner of the Tar Heel State.
Medicaid Expansion Benefits All of North Carolina, But Especially Rural Areas
Medicaid expansion benefits everyone, but its repeal would be particularly devastating for rural North Carolina. Medicaid covers 1.2 million rural North Carolinians , more than those covered in either suburban or urban areas. Medicaid and CHIP together cover over 50% of children in rural and small towns, keeping them healthy so they can better learn and thrive.
Medicaid funding dollars also keep rural hospitals and clinics open. Because rural health facilities are smaller and have more non-paying patients, they have much thinner operating margins than urban hospitals. Medicaid expansion has served as a financial bulwark in preventing further rural closures and reductions in critical care, such as maternity care.
Closing healthcare facilities harms all residents, including those with private insurance and Medicare. It results in rural residents having to travel longer distances to receive the care they need. Closures also harm rural North Carolina economies. Businesses are reluctant, for good reason, to move their workforce to areas without accessible and reliable health care.
Many people wrongly think Medicaid is for the unemployed. Two-thirds of Medicaid recipients work, and most of the rest are disabled, attend school, or take care of family members. Nor do many people know Medicaid benefits lower-income seniors by funding long-term care and Medicare cost-sharing.
In today’s economy, when consumers have already seen a dramatic increase in prices for goods, services, and groceries, weakening Medicaid would pass more health care costs onto retail employers, multiplying the cost of tariffs and inflation.
In short, Medicaid benefits us all.
Congress Is Proposing Deep Medicaid Cuts To Fund Billionaire Tax Breaks
The Trump Administration is seeking around $1.5 trillion in federal spending cuts over the next decade. These cuts will not balance the budget, but are intended to partially offset the inflationary effects of $4 trillion in Trump tax cuts (benefiting the top income brackets) and spending increases (mostly for border enforcement and defense).
While there is a lot of political smoke and mirrors due to Medicaid and Medicare’s popularity, proposed cuts have been outlined in Project 2025 and in leaked private Congressional memos.
In late February, the House passed a budget resolution that concealed $880 billion in proposed Medicaid cuts. The budget resolution did not specify any spending cut details, providing only instructions to committees on how much they should cut in total. It instructed the House Energy and Commerce Committee, which has jurisdiction over Medicaid and Medicare spending, to find $880 billion in unspecified spending cuts.
Medicare and Medicaid make up the vast majority of spending under the committee’s control. There is a bull’s eye on Medicaid because it is the largest entitlement not considered a “third rail” like Medicare or Social Security. As the legendary bank robber Willie Sutton said, he robbed banks “because that is where the money is.”
Proposed Federal Budget Cuts Will Be Voted on in a Few Months
Federal budget battles are expected to come to a head in late April or early May 2025. Congress is anticipated to vote then on a budget reconciliation bill that will set future federal spending amounts.
Several Republican Senators have already expressed serious concerns with cutting Medicaid, since millions of working class Trump voters would lose their health coverage. Sen. Josh Hawley, an influential Republican Senator from Missouri, has already stated his opposition: “I don’t like the idea of massive Medicaid cuts. We should have no Medicare cuts of any kind.”
Public pressure can defeat Medicaid cuts.
Federal Medicaid Cuts Will Automatically Terminate North Carolina’s Recent Expansion
North Carolina law has a “trigger” that automatically - without further legislative action - eliminates the state’s Medicaid expansion if the current federal 90% funding match is reduced. The North Carolina Legislature then would have to vote to make up billions in federal cuts with state revenue, which seems problematic.
North Carolina’s best defense of its Medicaid expansion is to convince U.S. Senators Tillis and Budd to oppose the federal Medicaid cuts. We should laser focus on our Senator and save Medicaid expansion for all of North Carolina.
