The U.S. House and Senate have passed legislation that cuts more than $1 trillion from essential health programs like Medicaid health care coverage and SNAP food assistance. As a result, more than 670,000 North Carolinians could lose their health care, and food assistance for approximately 1.4 million NC residents is in jeopardy.
Hard-working residents, rural communities, children, immigrants, and seniors who rely on these services to go to the doctor, buy groceries, and take care of their families will feel the deep impacts of a system that does not value their well-being.
Make no mistake—we will all suffer when these cuts become law.
Children will go hungry. Behavioral health challenges will go untreated. People will not be able to visit a doctor. Rural hospitals will close. And, yes, people will unnecessarily die.
That’s why North Carolina must take action NOW.
We must step up and find resources to keep residents on Medicaid, continue the SNAP food assistance program, and invest in our residents and communities. If we don’t, the long-term societal costs and consequences will be devastating.
The Kate B. Reynolds Charitable Trust has worked for more than 75 years to improve the health and quality of life of North Carolinians with low incomes, and these funding cuts will devastate the safety net that so many residents rely on to make ends meet and live healthy lives. Helping families with low incomes meet their basic needs isn’t a handout. It’s sound public health policy. It’s investing in the next generation. It’s economic stability. It’s seeing everyone’s humanity.
What We Will Lose
Because of this legislation, the losses for our state will be immense. It is a permanent attack on the social safety net, and the consequences will be vast and long-term.
Medicaid cuts will slash health care for hard-working North Carolinians.
More than 3.1 million NC residents use Medicaid to access affordable health coverage, the majority of whom are already working, caregiving, or in school. This includes more than 670,000 people who recently obtained health insurance through Medicaid expansion, which was passed with bipartisan support in NC in 2023. Medicaid supports regular doctor’s visits, mental health, long-term care, maternal care, telehealth, and more.
Specific impacts of the cuts include:
- In some rural counties, more than half of the population is on Medicaid. Rural hospitals alone will see a $3 billion Medicaid cut.
- More than 670,000 people are at risk of losing their health care coverage, as changes to federal payment rates take effect triggering an NC law ending Medicaid expansion.
- New work requirements for people already working and stricter eligibility checks will threaten hundreds of thousands of Medicaid enrollees who could lose coverage due to technicalities and paperwork. Increased paperwork will overwhelm the NC Department of Social Services Offices, especially in rural counties with staffing shortages.
- Medicaid spending will be cut by as much as $48.6 billion—this is lost payments to health care providers and a significant negative impact on the state’s economy.
- The legislation will take away Medicaid from refugees, people granted asylum, and certain victims of domestic violence. These residents who are living lawfully in our state will also lose food assistance.
- A study by Kaiser Family Foundation estimates nearly 500,000 additional North Carolinians could lose health care coverage if health care Marketplace subsidies, provided by the Affordable Care Act, expire after 2025.
Food assistance cuts will harm NC families and local economies.
More than 1.4 million NC residents rely on food assistance, known as SNAP, to afford groceries. Up to $700 million in costs will now shift to the state, potentially forcing NC to end SNAP.
- Approximately 1.4 million seniors, children, and working residents could lose access to affordable food.
- More than 66 percent of NC families participating in SNAP have children and these children are now more likely to go to bed hungry.
- In rural communities, local grocery stores will be severely impacted without people’s access to SNAP, and farm stands may disappear, hurting not only families but entire small-town economies.
- SNAP provides nine meals for every one meal a food bank can offer. With grocery prices still high and the need for food so great, food banks cannot fill the gap.
- When people are hungry, they are more likely to get sick. When children are hungry, they can’t concentrate in school. When families don’t have money to buy groceries, they are forced to make difficult decisions about which bills to pay so people can eat.
North Carolina Must Take Action
Like many in our state, you may be feeling stunned, but this is not the time to cower, it is a time for courage.
We are calling on North Carolina leaders to take action to minimize the devastating effects on residents and families.
The Trust will continue to do everything we can to support equitable access to health care and to help people meet their basic needs. But philanthropy alone will never be able to fill this chasm—in fact, grantmaking across the state is a fraction of the resources needed to ensure North Carolinians have what they need to thrive.
The state of North Carolina has a history of tackling difficult issues in a bi-partisan way to invest in our state, and our response to this crisis should be no different.
North Carolina must step up and find resources to keep residents on Medicaid, continue SNAP, and invest in our residents and communities. If we don’t, children will go hungry, seniors will be harmed, hospitals will close, and residents will die.
While the threats to our state are immense, we must work together and never give up.
We believe a more equitable state and country is possible if we all stand up and fight for a future that honors everyone’s right to health care and everyone’s fundamental humanity.