Laurie Buckhout: The One Big Beautiful Bill Threatened To Reverse North Carolina’s 2023 Medicaid Expansion, Risking The Health Care Coverage Of Nearly 43,000 People In NC-01 And 680,000 Statewide

The One Big Beautiful Bill Risked Triggering The Reversal Of North Carolina’s Medicaid Expansion

June 2025: North Carolina Health News Headline: “‘Big Beautiful Bill’ Could Unravel NC’s Medicaid Expansion: Officials Say Proposed Changes Would Set Off A Trigger Law, Potentially Ending Coverage For Hundreds Of Thousands Of Residents.” [North Carolina Health News, 6/27/25]

North Carolina’s 2023 Medicaid Expansion Law Contained A Provision That Would Automatically End The Program If The Federal Government Stopped Covering 90% Of Its Cost. “Tillis explained in a floor speech Sunday evening that he’d reached out to North Carolina legislators, the N.C. Healthcare Association, and Gov. Josh Stein's administration to gather estimates on the bill’s Medicaid impact locally. He said all agreed that the bill’s cuts to Medicaid funding would mean more than 600,000 people in his state would lose healthcare. That’s because when the Republican-led state legislature enacted Medicaid expansion in 2023, it included a provision that would automatically end the program if the federal government stops covering 90% of its cost. Tillis warned his fellow Republicans that the move could damage their party’s election prospects. He argued that a broken promise on Medicaid would be similar to former President Barack Obama’s claim that ‘if you like your health care plan, you can keep it’ under the Affordable Care Act. Tillis says Obama’s statement led to GOP victories.” [WUNC, 6/30/25]

June 2025: North Carolina Health News: The One Big Beautiful Bill Would “Effectively Kill” North Carolina’s Medicaid Expansion And Strip Coverage From Hundreds Of Thousands Of People Who Only Recently Became Eligible. “More than 670,000 North Carolinians have enrolled in Medicaid since the state expanded access to the government-funded health insurance program in December 2023. Medicaid expansion, which passed with bipartisan support after years of resistance from most Republicans in the N.C. General Assembly, raised the state’s strict income threshold for Medicaid. That opened up the program to many working adults with lower incomes who previously made too much money to qualify. The measure has been hailed as a landmark policy change that is reshaping North Carolina’s health care landscape and closing long-standing coverage gaps, particularly in rural and underserved communities. Now, state health officials are warning that President Donald Trump’s so-called One Big Beautiful Bill, a version of which is expected to go before the U.S. Senate for a vote as early as this weekend, would effectively kill North Carolina’s expansion — stripping coverage from hundreds of thousands of residents who only recently became eligible for it.” [North Carolina Health News, 6/27/25]

Since North Carolina Expanded Medicaid In 2023, Nearly 42,600 People In NC-01 And 680,000 People Statewide Received Coverage

March 2025: Kaiser Family Foundation: 42,600 Adults In NC-01 Received Medicaid Coverage Under The Affordable Care Act’s Medicaid Expansion. [KFF, 3/11/25]

[KFF, 3/11/25]

August 2025: WFAE: The One Big Beautiful Bill Could Put Coverage At Risk For The Nearly 680,000 North Carolinians Who Gained Coverage Since The State Launched Its Medicaid Expansion In 2023. “North Carolina lawmakers return to Raleigh this week to continue hammering out the state budget, and one of the biggest questions hanging over them is the future of Medicaid expansion. Nearly 680,000 North Carolinians have gained coverage since the program launched in 2023. But President Trump’s ‘One Big Beautiful Bill,’ the sweeping tax and spending package signed into law earlier this summer, could put that coverage and the survival of some rural hospitals at risk.” [WFAE, 8/25/25]

North Carolina Republican U.S. Senator Thom Tillis Said He Voted Against The One Big Beautiful Bill Because It Would Effectively End North Carolina’s Medicaid Expansion

June 2025: WUNC Headline: “Senate Megabill Could Kill NC’s Medicaid Expansion, Prompting Tillis Opposition.” [WUNC, 6/30/25]

June 2025: WUNC: “U.S. Sen. Thom Tillis Says The Senate’s Current Megabill Would Effectively End Medicaid Expansion In North Carolina — And That’s The Main Reason He’s Opposing The Bill.” “U.S. Sen. Thom Tillis says the Senate’s current megabill would effectively end Medicaid expansion in North Carolina — and that’s the main reason he’s opposing the bill. Tillis’ decision to vote against the bill triggered a primary threat from President Donald Trump, which was followed by the senator’s Sunday announcement that he won’t run for re-election next year. Tillis explained in a floor speech Sunday evening that he’d reached out to North Carolina legislators, the N.C. Healthcare Association, and Gov. Josh Stein's administration to gather estimates on the bill’s Medicaid impact locally. He said all agreed that the bill’s cuts to Medicaid funding would mean more than 600,000 people in his state would lose healthcare. That’s because when the Republican-led state legislature enacted Medicaid expansion in 2023, it included a provision that would automatically end the program if the federal government stops covering 90% of its cost.” [WUNC, 6/30/25]

• Tillis Voted Against The Passage Of The One Big Beautiful Bill. “North Carolina Senator Thom Tillis announced Sunday afternoon that he will not be seeking reelection in 2026. This comes after receiving backlash from President Donald Trump for voting against the ‘One Big Beautiful’ bill, which passed 51-49 overnight Saturday. Tillis released a Sunday statement, saying in part: ‘In Washington over the last few years, it's become increasingly evident that leaders who are willing to embrace bipartisanship, compromise, and demonstrate independent thinking are becoming an endangered species.’” [ABC7 Eyewitness News, 6/29/25]

The One Big Beautiful Bill’s Cuts To Medicaid Forced North Carolina To Cut Provider Reimbursement Rates, Causing Some Providers To Stop Taking Medicaid Patients And Risking Clinic Closures

As A Result Of The One Big Beautiful Bill, State Officials Said There Was Not Enough Money In The State’s Medicaid Rebase To Continue Current Service Levels And Reimbursement Rates Through June 2026

The Port City Daily: NC Medicaid Faced A Large Funding Shortfall Due To Reductions In Federal Funding In The One Big Beautiful Bill. “A state budget hasn’t passed yet due to disagreements among the Assembly over tax rates and state employee raises, though a ‘mini’ budget supplement to the Department of Health and Human Services went into effect in August. It included $600 million but was $319 million less than what the DHHS said it needed for Medicaid. The department gave the state legislature an Oct. 1 deadline to release the rest of the money in order to keep operating normally, else they would initiate cuts, notably to provider reimbursements. The General Assembly didn’t agree to the full amount due to funding shortfalls on multiple fronts, including the loss of COVID-19 relief funds and the reductions coming down through President Donald Trump’s One Big Beautiful Bill.” [Port City Daily, 10/19/25]

• July 2025: State Officials Said There Was Not Enough Money In The Medicaid Rebase To Continue Current Service Levels And Reimbursement Rates Through June 2026. “In late July, lawmakers approved $600 million for Medicaid, with $500 million for use by the state Department of Health and Human Services for what is known as the Medicaid rebase. DHHS said the rebase amount fell short of covering needs through June 2026. The agency set cuts to start Oct. 1 if lawmakers didn’t provide more funding. What is the rebase? It’s the funding required to maintain current services and provider payment rates.” [News & Observer, 10/2/25]

North Carolina Was Expected To Lose Nearly $50 Billion In Medicaid Funding Over Ten Years. “Key changes include new federal work requirements for Medicaid expansion recipients, restrictions on provider taxes that fund expansion, elimination of an over $6 billion hospital payment program, and new state obligations to contribute to food assistance programs. These pieces do not all take effect at once, with varying enactment dates. DHHS estimates all these changes could translate to a $50 billion loss in Medicaid funding for North Carolina over 10 years, with hospitals absorbing over 70% of the cuts, according to a forecast dated July 9 provided by DHHS.’” [News & Observer, 7/22/25]

October 2025: State Officials Were Forced To Cut Medicaid Provider Reimbursement Rates After The State Legislature Failed To Appropriate Sufficient Funding For Medicaid

October 2025: North Carolina’s Department Of Health And Human Services Instituted Provider Reimbursement Rate Cuts Of 3%-10%. “What exactly is being cut? Payments to medical providers. According to a list shared by DHHS, the cuts range from 3% to 10%. Acute care hospitals, nursing homes, psychiatric residential treatment facilities and intermediate care facilities will have rate reductions of 10%, according to a letter DHHS Secretary Devdutta Sangvai sent to lawmakers in August. DHHS has also posted a list of cuts effective Wednesday on its website, which will be updated if anything changes.” [News & Observer, 10/2/25]

October 2025: NC Health News: North Carolina Instituted Reimbursement Rate Cuts After The State Legislature Failed To Appropriate Enough To Make Up For The Shortfall In Medicaid Funding. “Lawmakers in Raleigh are deadlocked over Medicaid’s annual ‘rebase,’ the amount of funding needed each year to reflect changes in enrollment, care costs and the rates paid to providers. In June, the legislature, which has not been able to agree on a full state budget, passed a ‘mini’ budget that targeted specific programs, including Medicaid. But because the mini-budget fell $319 million short of what the state Department of Health and Human Services said it needed for full rebase funding, NC DHHS implemented a series of sweeping cuts to adjust for the shortfall. ‘If providers are not paid enough to provide care, if hospitals are not provided enough to pay their employees, they will close the doors or dramatically decrease their services,’ said Wallace, one of several people who spoke out against the cuts in front of the state legislative building on Sept. 22 while the Senate met inside.” [NC Health News, 10/9/25]

October 2025: Reimbursement Rate Cuts Caused Some Clinics To Stop Taking Medicaid Patients And Put Others On The Brink Of Closure

October 2025: Less Than A Month After Provider Rate Cuts Went Into Effect, Some Providers Were Already Opting Out Of Medicaid And Refusing To Take Medicaid Patients. “As the federal government goes into day 17 of a shutdown due to Washington politicians disputing the expiration of Obamacare provisions, Medicaid providers in North Carolina are grappling with less funding already from the state and planning ahead for what could come down the pike. ‘We’re having more patients calling us and requesting to become patients of ours because their old provider is no longer accepting Medicaid,’ Athena Johnson, CEO of MedNorth, said. ‘They already are opting out or not taking any Medicaid patients because of the rate reduction.’ The Department of Health and Human Services reduced Medicaid reimbursement to providers at the beginning of the month due to a North Carolina budget stalemate between Gov. Josh Stein and the General Assembly.” [Port City Daily, 10/19/25]

NC Health News: Because Many Smaller Hospitals And Community-Based Providers Already Operate On “Razor-Thin Margins,” Reimbursement Rate Cuts Could Force Some Clinics To Close Entirely. “Under the announced plan, nearly all Medicaid providers will face rate reductions of 3 percent to 8 percent, while some categories — including nursing homes, hospitals, psychiatric residential treatment facilities and certain ambulatory services — will see steeper cuts of up to 10 percent. The reductions will affect services across the board, from personal care and home health to outpatient therapy and hospital care. Provider groups warn these cuts could destabilize health care access in North Carolina — especially in rural and underserved areas. Many smaller hospitals and community-based providers already operate on razor-thin margins, and a 10 percent cut may force them to stop accepting Medicaid patients — or even shutter services entirely. At the same time, health experts fear the cuts will trigger what Wesley Wallace, a professor of emergency medicine at UNC Chapel Hill, described as a ‘downward spiral’ — less revenue leading to providers who can’t pay staff or maintain services, which leads to further cutbacks or closures.” [NC Health News, 10/9/25]