How Federal Cuts to Medicaid will Harm All of Us
Less than two years, ago Governor Cooper convinced the N.C. General Assembly to expand Medicaid. Now, thanks to “The Big Beautiful Bill” signed into law on July 4, we will lose all we gained through expansion.
Republicans in Congress deny that they are cutting Medicaid. But that’s misleading at best. For sure, they are reducing access to Medicaid by putting in place new bureaucratic requirements that will result in as many as 10 million enrollees losing coverage.
A new 80-hour per month minimum work requirement for every North Carolinian aged 19-64 who qualifies for Medicaid through the Affordable Care Act’s Medicaid Expansion will result in as many as 46% of these adults losing or failing to qualify for coverage. This requirement must be verified by county officials every six months. As a result, anywhere from 260,000 to 496,000 individuals in our state may lose access to Medicaid by 2034. The Center on Budget and Policy Priorities attributes the wide variation in numbers cut to the instability in the low-paid labor market and the flexibility the Bill gives states to determine how they would define compliance.
Since we know that our own Republican-controlled legislature strongly favors work requirements, we can be sure they will define compliance very narrowly – leading to more recipients losing coverage or “churning” on and off Medicaid, caught in red tape as county staff try to keep up with verification paperwork.
Adults who qualify for Medicaid as a result of Expansion will also be faced with increased health care costs. The 2025 Reconciliation Law, signed by the President on July 4, adds cost-sharing requirements of $35 per service, up to 5% of family income for these recipients.
Additional changes in rules governing enrollment and eligibility will result in Medicare recipients who are the most vulnerable — seniors, adults with disabilities, and CHIP recipients – also being stripped of their Medicaid coverage. These cuts result from provisions that delay until 2035 implementation of rules put in place by the Biden Administration that reduced barriers to maintaining and renewing coverage for low income families.
In an interview with WUNC, Don Taylor, Professor in Duke’s Sanford School of Public Policy, made clear the impact of these cuts on our health care system.
I think the Medicaid cuts could be on the order of $250 million to $300 million a year. …a hit of that magnitude to the health system?
I think…there are a lot of faculty who say, “Well, why does that affect us?”… when folk are uninsured, who are our neighbors and friends, and they need care – that responsibility doesn’t go away for Duke. When North Carolina expanded Medicaid a little over two years ago, it meant that some folk who Duke was treating without being reimbursed now got paid Medicaid.
…And if now that money goes away, those neighbors and friends aren’t going to go away, they’re still going to need health care. And Duke still has a commitment to provide that care. So when the state is saying, ‘well, if the federal government cuts back, we’re also going to cut back,’ Duke actually doesn’t have the ability to cut back our responsibility.
In order to absorb the cost of uninsured care, hospitals and other medical facilities in North Carolina – including Duke — will be forced to make cuts that will profoundly affect patient care, including more waiting time and probably more expensive care for the rest of us. For smaller and rural hospitals, it means, once again, that hospitals will shut down, and folks will need to travel farther for health care.
All these impacts are magnified by the Laws additional changes in the Affordable Care Act (ACA) – changes that have no rationale other than reducing enrollment. They include shortening the annual enrollment period and reducing the enhanced tax credits that enabled twice as many people to afford health insurance starting in 2021. On a recent KFF webinar, leaders of state marketplaces projected a one-third decrease in enrollment in ACA from these changes, which would greatly destabilize the health care ecosystem. Across the country, estimates are that more than 15 million people will lose health care once the provisions in the Law go into effect.
Medicare will be under the gun too if Congress takes no further action, because the tax cuts in the bill will increase the deficit, triggering statutory Pay-Go cuts to Medicare of nearly 500 billion dollars over 10 years.
As Ben Rhodes wrote in the NY Times:
Mr. Trump has cut government programs that people depend on but that do not bolster his power or offer opportunities for profit. Indeed, the “big, beautiful bill” that makes up his legislative agenda would be a boon to his family and wealthiest supporters while slashing Medicaid and nutrition assistance. It would add over $2 trillion to the national debt while exploding inequality and making life worse for many Americans.
While the Budget Law’s provisions extending the 2017 tax cuts will go into effect immediately, the Congress has carefully engineered the timeline for the major cuts in health care to not go into effect until after the 2026 elections. They don’t want us to feel the pain that will result from the way this Reconciliation Law devised by Trump rips apart our safety net. We can’t be fooled. We need to do everything we can to elect more Democrats to Congress and our own General Assembly in 2026 so that we can begin to restore our safety net and assure that the needs of the American people – for health care, affordable housing and a livable planet – come first.
Sources include:
https://www.kff.org/tracking-the-medicaid-provisions-in-the-2025-budget-bill/
https://www.kff.org/medicaid/poll-finding/kff-health-tracking-poll-the-publics-views-of-funding-reductions-to-medicaid/
https://www.kff.org/medicaid/issue-brief/allocating-cbos-estimates-of-federal-medicaid-spending-reductions-and-enrollment-loss-across-the-states/
https://www.northcarolinahealthnews.org/2025/03/05/medicaid-expansion-at-risk/
https://www.newsobserver.com/news/politics-government/article306978221.html
https://www.wunc.org/education/2025-06-03/duke-university-federal-funding-loss?utm_source=WUNC+Newsletters&utm_campaign=22248af03c-EMAIL_CAMPAIGN_2025_03_24_03_14_COPY_01&utm_medium=email&utm_term=0_-5bbf193c03-47237667
