There’s a Good Reason North Carolina Fought for Medicaid Expansion

Last week, Republicans in the U.S. House passed their budget blueprint. It’s the budget we were worried about in Project 2025– a mammoth bill that slashes $2 trillion from several essential programs, including $880 billion in cuts to Medicaid, all to fund tax breaks for the ultra-wealthy. 

The Trump Administration’s manipulation of federal funding and threats to dismantle federal agencies have been excruciating, but the Medicaid cuts particularly hit home. 

After a decade-long fight, North Carolina expanded Medicaid access in 2023. Expanding the federal health insurance program for low-income and disabled Americans took extensive research, advocacy, and rallying. We were the 40th state to achieve expansion, but among the first to do it in the South. We did it with bipartisan support, and now 630,000 North Carolinians have health insurance coverage that they wouldn’t have had before. 

Sen. Phil Berger, a prominent North Carolina Republican, reflected on his journey from being a skeptic to a believer in an op-ed published in 2023: “Since it was enacted, every attempt in Congress and by the courts to reverse the ACA and Medicaid expansion has failed…. It’s not going away, and refusing to accept that reality hurts North Carolinians and the state’s finances.”

Not even two years later, North Carolina Republicans have reversed course. Every North Carolina Republican in the U.S. House voted to cut Medicaid. If these budget cuts are approved by the Senate and signed into law by President Trump, North Carolina stands to lose $27 billion in federal health care funding. The 630,000 North Carolinians who recently gained coverage through Medicaid expansion – and all 2.6 million North Carolinians on Medicaid – are at risk of losing coverage.

82% of Americans oppose large cuts to Medicaid, including 71% of Trump voters. They understand that cuts will lead to hospital closures and job losses. They understand that cuts would endanger access to life-saving health care for families, children, rural folks, and the working class. 

Over 1.4 million North Carolina children receive their health care coverage through Medicaid. More than a third (37%) of births and over 60% of nursing home stays in North Carolina are covered by the program. Around 200,000 North Carolinians live with an intellectual or developmental disability, and many of them utilize Medicaid to help treat conditions like autism and cerebral palsy. 

If stats aren’t always your thing (same here), I’ll close with an anecdote. 

My partner is a social worker for pregnant women who receive Medicaid. Most of these women are labeled as having “high risk” pregnancies, meaning they’re more likely to have severe, possibly fatal complications during childbirth.   

The heartbreaking truth is that many of these pregnant women are kids themselves. They’re often 13 or 14 years old. They have to step out of Geometry to take a call from a physician. They’re texting with a social worker under their desk in class, asking about food stamps and whether they can get a car seat for a vehicle that they’re not even old enough to drive. 

These kids aren’t old enough to vote. They won’t be old enough to vote until their own children are 3 or 4 years old. But they will be bearing the burden of these cuts. 

There’s a good reason North Carolina fought for Medicaid expansion, and we need to continue fighting to maintain this crucial lifeline moving forward.