Salisbury, North Carolina – Enid Rodriguez, a 51-year-old resident of Salisbury, knows firsthand the life-changing impact Medicaid can have. Having worked her entire life, first with organizations supporting at-risk children and now co-running a small electrical business with her husband, she has never earned enough to afford health insurance premiums.
Born prematurely in Puerto Rico, Rodriguez has battled severe health conditions since birth, including asthma and chronic gastric issues. Despite receiving care from a reputable free clinic, she required specialized treatment that was inaccessible without insurance. A potential heart attack landed her with a $20,000 hospital bill she couldn’t pay. But everything changed in late 2023 when North Carolina expanded its Medicaid program to include individuals with incomes below or just above the poverty line.
Rodriguez now receives the specialty care she needs, including treatment for an upper GI condition and physical therapy for an old injury. “Medicaid has literally been a lifesaver,” she said, though she worries about the proposed cuts in the Republicans’ “One Big Beautiful Bill” that could strip her of this coverage.
The Threat of a $1 Trillion Medicaid Cut
The legislation, heavily backed by Donald Trump and Republican lawmakers, aims to slash Medicaid funding by nearly a trillion dollars over the next decade. The proposed changes include “work requirements” and financing alterations that could reduce federal contributions to the program. The Senate is expected to vote on the bill soon, but it faces opposition even within the Republican ranks.
Despite public opposition, Republicans are pushing forward, motivated by a longstanding goal to reduce government spending and pass tax cuts. According to the Congressional Budget Office, the Senate bill could leave nearly 12 million people uninsured, a projection supported by numerous academic studies.
North Carolina’s Medicaid Expansion: A Success Story at Risk
Initially resistant to Medicaid expansion under Obamacare, North Carolina eventually embraced the program under Democratic Governor Roy Cooper in 2017. The expansion, which began in December 2023, has since enrolled over 600,000 residents, providing a financial boon to healthcare providers serving low-income populations.
Richard Hudspeth, director of Blue Ridge Health, noted a significant decrease in uninsured patients, allowing the network to expand services like pediatric dentistry and behavioral health. Similarly, CommWell Health, a clinic network in eastern North Carolina, has increased its Medicaid patient base from 10% to 25%, enabling outreach efforts and expanded pediatric services.
“Expansion is allowing us to chip away at that mountain,” said Christopher Vann, vice president of development at CommWell Health.
Potential Reversal of Progress
However, the proposed Medicaid cuts threaten to reverse these gains. The North Carolina law authorizing expansion includes a provision to end it if federal contributions decrease or state spending increases significantly. Features of the GOP bill could trigger this provision, potentially leaving hundreds of thousands uninsured.
Work requirements, a contentious aspect of the GOP bill, could further complicate access to Medicaid. Critics argue that documentation requirements are burdensome for low-income individuals, potentially excluding those with unstable housing or seasonal employment.
“In our county, our [local government services agency] people can’t keep up with what they’re doing now,” said Krista Woolly, executive director of the Rowan clinic. “I think it’s just going to be a big cluster.”
Wider Implications and Political Reactions
The potential impact of Medicaid cuts extends beyond individual patients to healthcare providers and the broader community. Reduced coverage would decrease revenue for clinics, potentially scaling back services and affecting employment.
Even some Republicans, like North Carolina Senator Thom Tillis, have expressed concerns about the bill’s impact on their states. Tillis announced his opposition to the Senate bill, citing its detrimental effects on North Carolina. However, the possibility of significant Medicaid cuts remains, with far-reaching consequences for vulnerable populations and healthcare systems nationwide.
As the nation awaits the Senate’s decision, the future of Medicaid—and the health of millions—hangs in the balance.
