While passage Thursday afternoon and signing Friday of the budget reconciliation bill may have been in Washington, its road from and back to the desk of President Donald Trump ran through North Carolina.
That’s where special masters for the judicial branch created a 2022 congressional map intent on splitting the state’s 14 seats of the U.S. House of Representatives evenly. And where the 2024 maps drawn by the Legislature –as the General Statutes instruct – produced a 10-4 edge for Republicans in the nation’s ninth largest state (11 million) with 38% of voter registrations independent of both parties.
Thursday’s vote was 218-214. North Carolina congressmen were loyal to party, and a 7-7 division would not have delivered.
For the record, Republican senators from the state infamously split – Thom Tillis one of three nationwide in the party to object, Ted Budd saying yes. Republican representatives saying aye were Virginia Foxx, David Rouzer, Richard Hudson, Dr. Greg Murphy, Chuck Edwards, Rev. Mark Harris, Addison McDowell and Pat Harrigan.
Democratic Reps. Alma Adams, Deborah Ross, Valerie Foushee and Don Davis all said no.
Dramatic fallout involving all is expected, from Tillis having already said he won’t pursue reelection in 2026 to the opportunities his retirement will create. Next fall’s campaigns were given ammunition for what was done or not done this week.
This was a big one.
Aftermath, however, will be most prevalent to those impacted – the constituents. One final judgment will be their lives; another will be their vote at the ballot box.
The provider tax and state-directed payment provisions, said Tillis, will be the leading harm to North Carolinians. It’ll come through impact on the state budget that absorbs more share of Medicaid responsibility.
Tillis said he got analysis from seven angles, inclusive of those aligned with Democrats, Republicans and independents, in deciding how to vote. It included state lawmakers responsible for their budget, and independent of them from the health care industry. The estimate of negative impact over 10 years was $26 billion.
KFF, formerly the Kaiser Family Foundation, is a nonprofit focusing on health policy. Its research indicated a best-case scenario of $20 billion in impact and a worst-case of $33 billion, putting its projection at $27 billion.
Rural hospitals considered in peril include Blue Ridge Region Hospital in Spruce Pine; MH Angel Medical Center in Franklin; Chatham Hospital in Siler City; Person Memorial Hospital in Roxboro; and UNC Rockingham Hospital in Eden. A plan to reopen Martin General in Williamston on the strength of the Healthcare Access and Stabilization Program within North Carolina’s Medicaid expansion two years ago likely got tougher to accomplish.
Murphy, a 62-year-old practicing urologist, has multiple lens to see Medicaid and his constituents.
After the vote he said of Medicaid, “It desperately needs reform so that it can be a strong program for those who are eligible to receive the benefits. As the only individual in Congress who continues to see patients covered by Medicaid, I have firsthand knowledge of how this program impacts our communities. This bill protects Medicaid benefits for those who are most vulnerable in our society, not able-bodied individuals capable of participating in the workforce, illegal immigrants, and those ineligible for benefits. The $50 billion Rural Health Transformation Program, included in the package, ensures the sustainability of rural health providers with an immediate impact beginning next year.”
Dr. Dev Sangvai, secretary of the state Department of Health and Human Services, said full impact and consequences would clear in the future.
“We already know,” he said, “that it will result in billions of dollars being taken out of our state’s economy and will undermine the health of North Carolinians. This bill includes major changes to Medicaid and SNAP – programs that provide vital support to millions of North Carolinians. There will be a significant reduction in federal funding for services that are core to the well-being of individuals and families across North Carolina.”
Proponents, however, say the changes strengthen the programs because it protects those who are most vulnerable and in need. For example, there is a new work or volunteer requirement for the able-bodied.
“This is a once-in-a-generation win for North Carolian families, seniors and small businesses,” Hudson said. “The One Big Beautiful Bill Act is the most pro-worker, pro-family and pro-American legislation we’ve seen in decades. It means bigger paychecks for middle class families, secure borders, a stronger military, and more freedom for every North Carolinian.”
