Greensboro's African American Community Newspaper since 1967
More than 600,000 North Carolinians’ health insurance benefits could be negatively impacted if President Donald Trump’s sweeping cuts in his “Big Beautiful Bill” become law.
The proposed legislation, described by Trump and his allies in Congress as a “reform and cost-saving measure,” aims to overhaul the Affordable Care Act, roll back Medicaid expansion, and give states more control over how funds are distributed.
However, critics warn that the plan would likely result in deep federal funding cuts and limit access to care for vulnerable populations. The North Carolina Department of Health and Human Services estimates that as many as 255,000 North Carolinians could lose their Medicaid coverage depending on the final version of the bill.
“Protecting North Carolinians’ health care access is critically important,” said Gov. Josh Stein in a statement. “I am proud of our state’s bipartisan work to expand Medicaid, and I call on that same bipartisan spirit in Congress to stand up and protect Medicaid so we can continue to provide critical care across our state.”
Rural counties and hospitals stand to be particularly affected. Many rely on Medicaid reimbursements to keep hospitals afloat and attract medical professionals to underserved areas.
When GOP state lawmakers passed Medicaid expansion into law in 2023, they wrote in language that it will end the state’s expansion if the federal government ever stops paying for less than 90 percent of the cost. That’s exactly what the U.S. Senate budget would do, putting health insurance at risk for hundreds of thousands of North Carolinians who have been able to buy coverage since that law passed.
Under the bill, federal funding for Medicaid would be capped and converted into block grants, which could lead to a reduction in services if state budgets fall short. North Carolina would be forced to either raise state taxes or cut coverage, both of which are politically and economically challenging options.
U.S. Sen. Thom Tillis, (R-NC), citing the potential impact, voted against the measure this week.
“I cannot support this bill in its current form,” Tillis wrote in a statement. “It would result in tens of billions of dollars in lost funding for North Carolina, including our hospitals and rural communities. This will force the state to make painful decisions like eliminating Medicaid coverage for hundreds of thousands in the expansion population and even reducing critical services for those in the traditional Medicaid population.”
Tillis also announced this week that he will not run for re-election to the U.S. Senate in 2026.
Supporters of the budget bill argue that it promotes fiscal responsibility and reduces federal overreach.
Democratic lawmakers and advocacy groups have also voiced opposition, pointing to the disproportionate impact the bill would have on communities of color and historically marginalized groups.
The Committee for a Responsible Federal Budget (CRFB), using data from the nonpartisan Congressional Budget Office (CBO), found that the GOP package of tax cuts and spending would increase the total budget deficit to $4 trillion over the next decade. The bill’s cuts to social services and programs, which help middle-class and working-class families, aim to provide people making over $212,000 a year with tax breaks and make permanent cuts to corporate taxes that Trump implemented in 2017.
“This bill is not about making healthcare beautiful —it’s about making it unattainable for those who need it most,” said Deena Hayes-Greene, a Guilford County Schools Board of Education member and equity advocate. She added, “And, Black and Brown communities will be hit the hardest.”
As of press time, the “Big Beautiful Bill” was under scrutiny in the U.S. House of Representatives, where it’s been reported that several Republican lawmakers are pushing back against the Senate’s amendments to the bill. Any changes to the House version of the bill would send it back to the Senate for approval, which would push it past Trump’s July 4 deadline.
