Hundreds of thousands in North Carolina at risk of losing health care coverage
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Despite U.S. Sen. Thom Tillis' best efforts, hundreds of thousands of North Carolina's poorest will lose health care coverage under a proposed federal budget package, the state's health department said.
- More still would no longer receive help covering grocery bills.
Why it matters: The latest version of the "big, beautiful bill," as President Trump has called it, slashes food and health benefits for the poorest Americans, while giving tax cuts to higher earners, Axios' Emily Peck writes.
Threat level: Among the states whose rural areas could be hit hardest by the proposed legislation is North Carolina, which expanded Medicaid just two years ago and has one of the largest rural populations in the country.
- The legislation would also trigger a state law that rolls back Medicaid expansion, under which nearly 700,000 North Carolinians have coverage.
What they're saying: "I respect President Trump, I support the majority of his agenda, but I don't bow to anybody when the people of North Carolina are at risk, and this puts them at risk," Tillis told reporters, Politico reported.
The big picture: Experts say the cuts could blow a hole in the nation's safety net and unleash a tidal wave of pain — overcrowded emergency rooms, an increase in chronic health care issues, more medical debt, and more people going hungry.
State of play: The legislation could still change, but it's on track to cut 20% of spending on food stamps, or SNAP, with more than 2 million losing benefits nationwide, per an estimate from the Congressional Budget Office provided to Senate Democrats.
- Cuts to Medicaid could lead to nearly 12 million people losing health insurance, per the CBO.
There's a massive overlap here — nearly 30 million of the 38.3 million people receiving SNAP in 2022 were also enrolled in Medicaid, notes KFF.
- It's a double-whammy: these folks would need more for healthcare, while being further stretched on groceries.
The other side: North Carolina U.S. Sen. Ted Budd voted in favor of the legislation because "the people of North Carolina deserve more of their hard-earned wages, a more secure border, a reinvigorated military, responsible spending reforms for government programs, and a thriving economy," he posted on X Tuesday.
- The White House and Congressional Republicans also say work requirements are a common-sense way to reduce waste, fraud and abuse, and that the Congressional Budget Office's assumptions about Obamacare changes are overblown.
Zoom in: Under the earlier U.S. House's version of the legislation, North Carolina would have seen a $6.4 billion decline in federal spending in rural areas over the next 10 years should the proposal become law, according to a KFF analysis. Statewide, North Carolina would lose an estimated $37.5 billion in federal funding over 10 years, per the state's Department of Health and Human Services.
- The Senate's proposal, which passed Tuesday over Tillis' objections, could result in an even greater loss of funding to the state, with DHHS projecting a loss of nearly $40 billion in federal funding over the next decade.
- Work requirements for certain Medicaid recipients would also be implemented with the legislation, which, along with limitations to provider taxes, would trigger a state law that would end Medicaid expansion, DHHS said.
What's next: House Republican leaders are tentatively planning on a Wednesday vote to send the bill to Trump, Axios' Stephen Neukam and Stef W. Kight report.