Experts worry the tax-and-spending bill will gut healthcare and hospitals, especially in states like North Carolina
“It’s going to have to hit them first,” said Laurie Stradley, CEO of Impact Health in Asheville, a Medicaid-funded non-profit providing social services to some people still digging out from the flood [from Helene].
When Trump’s sprawling tax-and-spending bill passed on Thursday, it heralded more than $1tn in federal cuts to Medicaid, which experts worry will push Republican-led states to abandon parts of the program and leave people without access to timely healthcare.
North Carolina will lose $32bn in the next decade
The Medicaid cuts in the bill could have particularly acute consequences in
North Carolina, a politically competitive state, where experts said the bill could trigger a “kill switch” to end Medicaid expansion.
“If the state spends any state dollars to implement the expansion population or expansion coverage, it triggers an automatic ending to Medicaid expansion,” said Kody Kinsley, North Carolina’s former secretary of health and an architect of the state’s Medicaid expansion.
[Several other states also have such an automatic mechanism. This is not about rooting out fraud; it's eliminating the program entirely in these states.]
‘Hospitals will be forced to restrict services, or close’
Rural states such as
Kentucky are expected to be disproportionately hard-hit as well. Thirty-five of the rural hospitals at risk of closure – about 10% – are in Kentucky, even though Kentucky’s 4.5 million residents comprise about 1.3% of the US’s population. About a third of Kentucky residents are on Medicaid, according to figures from Kentucky’s cabinet for health and family services. The program benefits about 478,900 adults.
Another issue is the potential for Republicans’ cuts to drive up the cost of healthcare for Americans who are privately insured, including through employers. As hospitals fight to survive, they will try to extract as much money as possible from other sources of funding – namely, commercial insurance.
[They can't turn people away from the emergency room, so they either close or make up for their losses somewhere else.]