Experts warn that the Republican-led reconciliation bill, dubbed the "big, beautiful bill" by Donald Trump, will slash over $1 trillion from Medicaid, potentially devastating healthcare access in rural areas. The bill, which passed on Thursday, is expected to trigger cuts that could force Republican-led states to abandon parts of the program, leaving millions without coverage.
Medicaid, the largest health insurance program in the US, covers 71 million low-income, disabled, and elderly residents. It pays for half of all births and six in ten nursing home residents. The cuts could have acute consequences in states like North Carolina, where a "kill switch" law could end Medicaid expansion if state funds are used to implement it.
North Carolina's expansion, which began in December 2023, enrolled over 650,000 people in less than 19 months. The state is projected to lose $32 billion in federal funding over the next decade, according to an analysis by Senator Thom Tillis's office. Tillis was one of three Senate Republicans who voted against the bill.
Nationally, the non-partisan Congressional Budget Office estimates that 17 million people could lose health insurance by 2034, with nearly 12 million losing coverage due to Medicaid cuts. "Ultimately, Medicaid being cut is going to kill people," said Molly Zenkler, a nurse at Mission Hospital in Asheville, citing cases of amputations due to lack of diabetic care.
The bill targets complex financial maneuvers states use to draw federal funds and imposes costly work requirements. Republicans argue it addresses "waste, fraud and abuse," but the American Hospital Association notes that most beneficiaries who can work do, and Medicaid is highly cost-efficient.
