NC Governor: Imminent federal Medicaid cuts will cost everyone | Opinion
When Garner resident Joanna was diagnosed with degenerative disc disease, she did not have health insurance. Without access to the medication and treatment she needed, her pain got worse. She cut back on her hours at work and eventually had to stop working altogether. That all changed when North Carolina expanded Medicaid in 2023 and Joanna got coverage. She was finally able to get treatment, manage her condition, and return to work.
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Joanna is one of more than 740,000 North Carolina adults who gained access to affordable health coverage through Medicaid expansion in recent years. Now, despite widespread support for NC Medicaid, their coverage is at risk. That is because in H.R.1, Congress cut the Medicaid program by $1 trillion and loaded it with bureaucracy and paperwork.
More than 250,000 North Carolinians like Joanna could lose their health coverage because of these cuts. We know this because a work requirement to push people off Medicaid has already been tried. In Arkansas, under a similar work requirement in 2018, thousands of people lost Medicaid in a matter of months without employment numbers going up. Congress has doubled down on this experiment and taken it nationwide.
For those who lose coverage, the consequences can be catastrophic. But they will not be the only ones bearing the costs. When more people are uninsured, hospitals and clinics face more unpaid care, workers may get sicker and miss more work, families take on more medical debt, and taxpayers and private insurance customers must help cover the cost of care. Rural health care providers are especially vulnerable to going out of business. With families already struggling with the cost of living, North Carolina families and communities cannot afford the added costs that come when tens of thousands of people lose health coverage.
And that is before you count the economic impact of North Carolina losing out on tens of billions of health care dollars over the next decade. Congress points to new Rural Health Transformation Program funding as a cushion for the cuts. But at about $1 billion over 5 years, that program does not come close to making up the difference, and everyone will pay the price.
That missing money will have real consequences. In North Carolina, rural hospitals alone are projected to lose $3.7 billion over 10 years. For hospitals already operating on thin margins, that can mean cutting services, consolidating, or closing altogether. And when the only hospital or maternity ward within driving distance closes, it does not matter what kind of insurance card is in your wallet. Everyone in that community has lost access to care.
Sadly, it is already happening. Congress did not just cut Medicaid last year; it also failed to extend Affordable Care Act (ACA) tax credits that had helped people afford insurance. As a result, 214,000 fewer North Carolinians enrolled in 2026 – the biggest drop of any state.
When people lose their insurance, they do not stop getting sick. Instead, they do not pick up their medications because they cannot afford them. They skip the primary care visit because it would mean just another bill. They wait until a manageable problem becomes a crisis and then head to the emergency department, where care is far more expensive.
Their expensive bill does not disappear. Instead, we all pay. Hospitals cut services or staffing to cover the costs, or they pass on the costs to private insurance companies, and all of our premiums go up. Or hospital doors close, and all patients are left knocking.
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So it is easy to think that you will not be affected by Medicaid cuts if you are not one of the 250,000 people on the chopping block, but that could not be further from the truth.
Around the state, I meet people every week who tell me their bills are stacking up faster than they can pay them. Housing. Electricity. Groceries. Medical bills. At the end of the month, families are deciding which bill has to wait.
Affordability is not a hoax or a political slogan. It is a real issue impacting people’s lives, and H.R. 1 is making it harder for families. And not just in health care. The bill also slashed SNAP food assistance. Initial projections estimate as many as 90,000 North Carolinians could lose their access to food support. Taking away health coverage and food assistance from families already struggling to make ends meet will not make life more affordable.
Congress should reverse these cuts. We should be lowering costs for North Carolina families, not making their lives harder.
Unless Congress acts, Medicaid changes are coming, and we need to make sure people know what to do so they do not lose their coverage. If you or someone you know is covered by Medicaid, use our Know What’s Next toolkit to find out what is changing and whether the new rules apply to you. Make sure that you open and read notices from NC Medicaid and your local Department of Social Services. Keep any records you may need to prove your eligibility. And help us spread the word by sharing these resources with your family, neighbors, and community. By working together, we can get people the information they need to keep their Medicaid coverage.
North Carolina cannot undo federal cuts; only Congress can. But we can help people hold on to the health coverage they are eligible for. And we can keep pushing for a North Carolina where getting sick does not have to mean choosing between seeing a doctor, buying groceries, and paying the rent. Your ability to get the health care you need should not depend on the size of your bank account. Let us work together and provide people access to health care they can count on – because a healthy North Carolina is a strong North Carolina.
Josh Stein is Governor of North Carolina. The Know What’s Next toolkit can be found at https://medicaid.ncdhhs.gov/flyer-changes-adults-19-64-without-disability-english/download?attachment.
This story was originally published October 11, 2026 at 5:00 AM with the headline “NC Governor: Imminent federal Medicaid cuts will cost everyone | Opinion.”
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