By Jaymie Baxley
Addressing a crowded ballroom at a Raleigh hotel last Wednesday, Gov. Josh Stein said he is “gravely concerned” about congressional Republicans’ plans to slash federal funding for Medicaid.
“These proposals would take away people’s access to health care, destabilize rural hospitals and challenge the bipartisan progress we have made here in North Carolina,” said Stein, who noted that more than 3 million North Carolina residents — about a third of the state’s population — depend on the government-funded health insurance program.
The cuts being contemplated in Washington are meant to offset the cost of President Donald Trump’s promise to extend trillions of dollars worth of expiring tax breaks. A resolution passed by House Republicans in February directs the Committee on Energy and Commerce, which oversees Medicaid, to reduce spending by $880 million — something experts say cannot be achieved without making significant cuts to the program.
Stein said those cuts could have expensive consequences.
“Here’s the thing: If you cut Medicaid, that does nothing to stop people from getting sick,” he said. “Instead of going to a primary care doctor that treats symptoms on the front end, folks will end up in the emergency room, where it costs a heck of a lot more money. The cost of taking care of people will simply go up.”
The governor’s comments came near the end of the 2025 Rural Summit, a two-day conference focused on issues that affect rural communities. Stein said rural areas, which are home to a disproportionately large share of the state’s Medicaid enrollees, are likely to bear the brunt of the proposed cuts.
“I am pushing our federal delegation not to vote for any budget that includes cuts to Medicaid,” he said to applause.
Stein isn’t alone. Advocacy groups, health care professionals and Medicaid beneficiaries from across the state have made similar appeals to members of Congress in recent weeks.
The question now: Will that advocacy make any difference?
Expansion at risk
While cuts to Medicaid would affect beneficiaries in every state, the stakes are particularly high in North Carolina.
In December 2023, North Carolina became the 40th state to expand access to Medicaid by raising the income limit for eligibility. Nearly 640,300 people have gained coverage since the expansion took effect, accounting for about 20 percent of the state’s total enrollment.
The federal government pays 90 percent of the cost for expansion participants under an enhanced funding rate secured by the state during the Biden administration; hospitals pick up the remaining 10 percent of the tab through a special tax assessment.
But the measure is tied to a “trigger law” that immediately discontinues expansion if that federal match falls below 90 percent. Jay Ludlam, head of Medicaid for North Carolina, has told state lawmakers that any reduction in the share paid by the feds will cause residents who joined the rolls under expansion to lose coverage overnight.
Ludlam has also estimated that proposed cuts to the program would cost North Carolina $27 billion over the coming decade. An analysis by the Commonwealth Fund and George Washington University found that the proposed cuts could cause the state to lose 35,500 jobs in 2026.
Earlier this month, more than 500 current and former health care professionals signed a letter to the state’s congressional delegation extolling the “life-changing” benefits of Medicaid expansion. The measure, they wrote, has given low-income North Carolinians access to “medical care, preventative screenings, dental work and affordable prescription drugs, all without fear of medical debt.”
“We are deeply concerned that funding for this lifesaving program is under attack without thought about the profound and lasting impacts this will have on our patients and our hospitals, especially in rural areas,” they added.
Copies of the letter were recently hand-delivered to the district offices of the state’s U.S. senators and representatives.
Megan Dunn, a nurse and lactation consultant who works closely with families on Medicaid, dropped a copy off at U.S. Sen. Thom Tillis’ office in suburban Charlotte on March 21. She also left a booklet filled with personal stories from beneficiaries.
“Cuts would be devastating,” she said. “Health care is a human right and shouldn’t be determined by an individual’s employment status or ability to pay. I support anything we can do to increase access to health care.”
Tillis, a Republican, wasn’t at the office, but a member of his staff told Dunn the materials would be sent to him in Washington.
‘We won’t stand for it’
Earlier that morning, Theresa Draughn drove an hour and a half from her home in Burlington to leave copies of the letter and booklet at U.S. Rep. Richard Hudson’s (R-NC 9) district office in Southern Pines. She made the delivery on behalf of Down Home NC, a nonprofit that advocates for working-class residents in low-income communities.
Draughn, who is married with two young children, moved to North Carolina from New York about eight years ago. She began volunteering with Down Home NC after seeing its members speak during a meeting of the Alamance County Board of Commissioners.
“I saw these people in blue shirts with big red birds on them and I was like, ‘Who are these people?’” she said, referring to the flying cardinal in the group’s logo. “They look like they’re powerful. It looks like people trust them and they know what they’re doing.”
Protecting Medicaid is a cause that hits close to home for Draughn. Her husband lost his job last year, straining the family’s finances. But she said his sudden dismissal came with a “silver lining.”
“After the shock wore off, I realized that now my kids were eligible for Medicaid,” Draughn said.
The program has allowed her 11-year-old son, who has attention deficit hyperactivity disorder and disruptive mood dysregulation disorder, to receive intensive, in-home therapy — something the couple could not previously afford. Children and adults with significant behavioral health needs often receive more comprehensive care through Medicaid than private insurance.
“I do worry about when he’s not on Medicaid anymore, and I’m hoping that there are no cuts made,” Draughn said. “Even a small cut is something that North Carolinians can’t handle.”
Hudson, a Republican representing the state’s 9th congressional district, was not at the office when Draughn visited. She hopes the congressman, who is the only North Carolina legislator serving on the Energy and Commerce committee that oversees Medicaid, will resist cuts to the program.
At the same time, she fears Hudson will ultimately “fall in line with his other Republican mates.”
“I hope that they hear us, and I hope they understand that they are playing with actual people’s lives,” Draughn said. “If they don’t hear us and cuts start to happen, we won’t stand for it.”
Her visit to Hudson’s office wasn’t a total disappointment. Draughn said a staffer told her the congressman is “open to the possibility” of meeting with members of Down Home NC over Zoom.
“That’s something,” she said. “Historically, we’ve not been able to pin him down.”
Where do they stand?
In public appearances and statements to the media, Democrats representing the state have vowed to oppose cuts to Medicaid.
U.S. Rep. Deborah Ross (D-NC 2) has been especially vocal. During an online meeting with constituents in February, she pledged to do “everything I can to fight back” and “protect these essential benefits and services that North Carolinians rely on.”
“Medicaid is about more than health care coverage,” she said at the time. “It’s about giving people peace of mind and dignity. It’s about ensuring that hard working families can go to the doctor when they’re sick, that children can see specialists that can take care of issues early in their lives, and that people with chronic conditions can get the ongoing care they need to live full and healthy lives and contribute to their communities.”
Republican members of the state’s delegation have been more opaque. Press secretaries for Hudson and several other Republican representatives contacted by NC Health News did not respond to messages asking whether they would support or oppose cuts to federal funding.
The deliveries to the lawmakers’ district offices, which took place from March 20 to March 24, were coordinated by the North Carolina Justice Center. Rebecca Cerese, a health policy advocate for the center, said none of the lawmakers had followed up with the nonprofit as of of Wednesday.
But advocates haven’t been met with complete silence from Republicans. The center, Cerese said, has had “good conversations” with Tillis’ legislative aides.
“His office said to us that basically any touch to the 90 percent match was a hard ‘no’ for the senator,” she said. “They seem to really understand what’s at stake.”
Meko McCarthy, a Medicaid recipient in Mecklenburg County, was among the more than 100 North Carolinians who shared their personal experiences with Medicaid for the booklet that was delivered to legislators. If McCarthy loses coverage, she could be forced to pay as much as $300 a month for her prescription medications.
“With the way the economy is and the low wages many people are paid, those costs are simply unaffordable,” she said in the booklet. “When you have to choose between paying for rent, utilities or medical care, most people will choose to keep a roof over their head. This is why we have so many health crises — people are forced to choose between their health and paying their bills.”
Cuts to Medicaid, she added, would be “devastating to those of us who need it.”
“It’s critical that we have access to health care, and that’s something policymakers really need to consider,” McCarthy said. “We need health care for everyone.”
Michelle Crouch of NC Health News/The Charlotte Ledger contributed to this report.
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