Editor’s Note: Congress passed the One Big Beautiful Bill Act in a 218-214 vote on July 3. Every Democrat and two Republicans, Kentucky Rep. Thomas Massie and Pennsylvania Rep. Brian Fitzpatrick, voted against the bill.
Immediately following the bill’s passage, both North Carolina Gov. Josh Stein and North Carolina Department of Health and Human Services Secretary Dev Sangvai released statements denouncing the legislation, which now heads to President Donald Trump’s desk for a signature.
“Congress and the White House are charging forward with a bill that will have devastating consequences for the people and economy in North Carolina, while also significantly increasing the national debt to pay for tax breaks for the wealthiest among us,” Stein wrote.
“Today’s passage marks a significant moment with real consequences for North Carolina,” Sangwai wrote. “While the full impact will become clearer in the coming weeks, we already know that it will result in billions of dollars being taken out of our state’s economy and will undermine the health of North Carolinians.”
Almost half of Cumberland County residents are at risk of losing health insurance after the U.S. Senate passed its version of President Donald Trump’s One Big Beautiful Bill Act yesterday.
Currently being debated in the House, the “Big Beautiful Bill,” as it’s colloquially called, combines most of the president’s domestic policy priorities. Those include increasing the U.S. Department of Defense’s budget and making permanent the 2017 Tax Cuts and Jobs Act.
Most concerning to North Carolina Gov. Josh Stein and North Carolina Department of Health and Human Services staff are the bill’s proposed cuts to funding for Medicaid, the federal health insurance for people with limited incomes, and the Supplemental Nutrition Assistance Program (SNAP), which helps low-income earners afford groceries. The bill looks to slash $287 billion in federal funding for SNAP and $793 billion for Medicaid over the next decade, in addition to cuts to the Affordable Care Act, according to an analysis from KFF.
“It will be a crisis,” Stein said in a media briefing with NCDHHS staff on July 1. “What we are seeing at the federal level would be a devastating loss for North Carolina.”
One in four North Carolinians, or almost 3.1 million people, are covered by Medicaid, according to NCDHHS. Over 1.4 million state residents, or one in eight residents, rely on SNAP for food every month.
NCDHHS officials also worry about how the bill’s proposed work requirements and the increased paperwork needed to prove eligibility will impact North Carolinians. The requirements would require Medicaid and SNAP beneficiaries to prove they completed at least 80 hours of work, education, community service, or a combination of the three per month.
“There are going to be a lot of administrative and bureaucratic additional requirements that are going to fall on, largely, working North Carolinians who live in predominantly rural counties,” said Jay Ludlam, NCDHHS deputy secretary of NC Medicaid, during the media briefing.
“Our worry is that the timeline required to implement these changes will be too fast for us to have the appropriate systems and the hiring and training in place, causing otherwise eligible individuals to lose their eligibility because we were rushed to put in these administrative burdens,” he said.
Cumberland County Department of Social Services officials already expressed concern about the version of the bill that passed in the House in May, which would have caused slightly fewer to lose their Medicaid coverage but more to lose SNAP benefits. Brenda Jackson, director of Cumberland County Department of Social Services, described the proposed cuts as “scary.”
As it stands, the Senate’s version of the bill would risk the health care of Cumberland County residents in different ways:
- Over 28,000 residents covered under Medicaid expansion would lose their health insurance, according to data from NCDHHS. The loss would stem from a clause written into the state’s Medicaid expansion legislation that requires the state to immediately halt the program if federal funding falls below 90%. The bill’s provisions would lower the federal funding rate for Medicaid expansion below that threshold.
- The 138,198 residents on some type of Medicaid plan, including Medicaid expansion, would be required to prove they meet proposed work requirements and recertify their eligibility twice a year. Ludlam said approximately 255,000 North Carolinians would lose their coverage because of these work requirements, mostly because of paperwork.
When it comes to SNAP, the impacts of the bill’s proposed provisions in Cumberland County are similar. In May, 33,677 Cumberland County households received SNAP, according to the Cumberland County Department of Social Services. Another 3,364 applied for the benefits. Those households would have to go through the same work verification process required for Medicaid, risking the benefits of over 100,000 North Carolinians, according to Karen Wade, NCDHHS policy director.
The bill would also impact the county and state’s finances. The bill proposes billions of dollars in cuts to federal spending on Medicaid and SNAP, forcing the state and county to supplement the losses. Under the Senate version of the bill:
- North Carolina would need to find $420 million a year to provide its residents with SNAP benefits. The bill would also require the state to find an additional $65 million a year to pay for the administrative costs of providing SNAP benefits. “To fill this hole would either require significant new state dollars or cuts to other critical state services,” Wade said.
- Simultaneously, the state would need to find almost $40 billion over the next decade to supplement the loss in federal funding to Medicaid. These possible added expenditures come as North Carolina faces a revenue shortfall of over $2.46 billion by fiscal year 2030, according to the General Assembly’s nonpartisan fiscal research division.
- Those dollar amounts don’t factor in the costs to train social workers to implement the new requirements and verification process or the extra workload it places on them. Ludlaw said those costs would be placed on county social services departments. “It’s going to put a lot of pressure on our county offices,” he said. “The concern in North Carolina is going to be that the support these county offices are going to need — the testing that they’re going to need — in the time frames that they’re given will just simply be insufficient.”
- Administrative costs to maintain Medicaid and SNAP will, in part, be passed onto local governments, Jackson said in May. In anticipation of increased costs, she said Cumberland County Manager Clarence Grier didn’t include many new spending initiatives for the county’s social services department in his proposed budget, which the board of commissioners ultimately approved on June 19.
Congress is rushing to pass the “Big Beautiful Bill” by July 4, an arbitrary deadline set by Trump. The president is considering extending that deadline, according to Politico.
CityView Reporter Morgan Casey is a corps member with Report for America, a national service program that places journalists into local newsrooms. Morgan’s reporting focuses on health care issues in and around Cumberland County and can be supported through the News Foundation of Greater Fayetteville.