ACA Cutbacks Threaten Healthcare Gains

North Carolina is facing a healthcare crossroads as federal rollbacks to the Affordable Care Act (ACA) threaten to unravel recent progress.

With more than 640,000 residents newly covered under Medicaid expansion and nearly a million relying on ACA Marketplace plans, the state stands to lose more than most if proposed cuts go through.

Medicaid Expansion at Risk

In 2023, North Carolina expanded Medicaid to cover individuals earning up to 138% of the federal poverty level—roughly $37,000 for a family of three. This move was hailed as a major step toward improving access to care, especially in rural and underserved communities. The expansion was built on the assumption that the federal government would continue covering 90% of the costs.

Now, with federal support potentially shrinking, the state faces a $319 million shortfall. To compensate, North Carolina has already reduced reimbursement rates to healthcare providers by 3% to 10% as of October 1. These cuts are straining hospitals and clinics, many of which serve Medicaid patients at a loss.

Duke Health, one of the state’s largest healthcare systems, projects losses of $401 million through 2030 due to the funding gap. If the trend continues, some providers may stop accepting Medicaid altogether, leaving thousands without access to care.

Real Lives, Real Consequences

For patients like Jennifer Snowhite, a cancer survivor, Medicaid coverage was life saving. She received rapid treatment thanks to ACA provisions, avoiding financial ruin. Stories like hers highlight the human cost of policy decisions and the stakes for families across the state.

Cancer survivor Katrina “Kat” Williams stated, “All these cuts to medical programs have affected me directly. At the end of this month (October), I’ll loose my insurance, meaning my $400/month anti-rejection medication will cease. I’m trying not to panic, but it’s kinda’ hard when I like to stay alive! That’s not counting the rest of the cocktail I take to survive. If there’s a better way, someone PLEASE let me know!”

Political Gridlock Compounds the Crisis

Efforts to fully fund Medicaid have stalled amid political disagreements between the state Senate, House, and Governor Josh Stein. Disputes over hospital construction projects and tax policy have delayed critical decisions, leaving healthcare providers and patients in limbo.

Meanwhile, federal cuts to ACA subsidies and Medicaid funding are drawing concern from both sides of the aisle. Health officials warn that the consequences could be “serious and far-reaching,” especially for states like North Carolina that recently expanded coverage.

North Carolina Marketplace Coverage in Jeopardy

Nearly 975,000 North Carolinians rely on ACA Marketplace plans, with 96% receiving premium tax credits. If those subsidies expire, premiums could skyrocket, making coverage unaffordable for many working families and small business owners.

A Fragile Future

North Carolina’s recent healthcare gains are fragile. Without sustained federal and state support, coverage losses, provider strain, and rising costs could reverse years of progress. As lawmakers debate the future of the ACA, the lives of hundreds of thousands hang in the balance.