Cutting What North Carolina Can't Afford to Lose 

The OBBBA’s sweeping federal and state budget cuts – combined with new debt forgiveness mandates and federal work requirements – will devastate hospitals, health systems, and patients across the state.  

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• Hospitals are economic anchors and lifelines for the health of their communities.  Funding cuts threaten to force hospitals to reduce services, delay needed upgrades, or close units, putting care and jobs at risk for thousands of North Carolinians.  

• New funding reductions and federal work requirements could push thousands off Medicaid – not because they are ineligible, but because of paperwork, red tape, and reporting hurdles. Families who finally gained access through Medicaid expansion could find themselves uninsured once again. 

• Many rural hospitals already operate on razor-thin margins. These cuts could be the final blow – closing emergency rooms, halting maternity care, slashing mental and behavioral health services, and even shutting doors entirely. When a rural hospital closes, entire communities can lose their only local source of medical care. 

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To offset these impacts, the OBBBA proposes the Rural Health Transformation Program – a national, competitive $50 billion pool. But with the second-largest rural population in the country, North Carolina would have no guarantee of receiving enough funding to protect the nearly 3 million residents who depend on already fragile rural health systems.