With ‘Big Beautiful Bill’ now law, critics worry about health and food access in WNC

President Donald Trump’s July 4 signing of a sweeping bill that cuts taxes and increases spending on immigration enforcement and the military is worrying critics and healthcare experts who say the bill, with its deep cuts to federal safety net programs like Medicaid and the Supplemental Nutritional Assistance Program, leaves North Carolina’s most vulnerable residents behind.

Touted by the White House as “a win for workers, farmers and America’s future,” the bill extends tax cuts enacted during Trump’s first term in office, and creates new ones, like eliminating taxes on tips and overtime pay for some workers.

But Trump’s signature legislation, dubbed the “One Big Beautiful Bill,” is also expected to add trillions of dollars to the federal deficit over the next 10 years, according to the non-partisan Congressional Budget Office, and could lead to millions of Americans losing health insurance and federal food assistance. Medicaid cuts are estimated to reach nearly $1 trillion by 2034, according to the CBO, with the Supplemental Nutritional Assistance Program, also known as SNAP, expected to lose more than $250 billion in federal funding.

In North Carolina, which expanded Medicaid eligibility in 2023 and has since enrolled more than 600,000 people into the program, the bill’s critics fear it will have “devastating consequences” for the state’s economy and its residents.

In a July 3 statement released after the bill’s passage in the House, North Carolina Gov. Josh Stein said the bill could result in more than a half-million North Carolinians losing health care coverage while leaving 1.4 million people unable to afford food.

“The bill is a disgrace, and I am disappointed in those who did not stand up for the people they serve, choosing instead to ignore warnings from local leaders and groups across the state who have sounded the alarm about the dangers in this bill,” Stein, a Democrat in his first term as governor, said in the statement.

But Rep. Chuck Edwards, a second term Republican from Henderson County who voted in favor of the legislation, described Stein’s criticism of the bill as “political fear mongering.”

Citing an increase in the standard deduction and the child tax credit, along with the bill’s other tax cuts, Edwards, who represents North Carolina’s 11th Congressional District, said the legislation “clearly takes bold steps in the direction to help working families.”

“All of those things will be strong benefits to the people in Western North Carolina,” he said.

WNC’s safety nets

Edwards downplayed the impact the bill’s provisions — specifically work requirements for Medicaid and SNAP eligibility that will go into effect in 2027 — will have on Western North Carolina residents.

Describing Medicaid as “unsustainable,” Edwards said this latest measure will put the program back on “good fiscal footing” so it can serve pregnant women, lower income families, children, older Americans and people with disabilities, while removing those he said don’t belong in the program, like people living in the U.S. illegally and “folks that are able-bodied and childless and refuse to work.”

According to the CBO, 4.8 million Americans — or 6% of Medicaid-enrolled adults — don’t meet the work requirements outlined in the bill. People living in the U.S. illegally aren’t eligible to enroll in Medicaid, though 1.4 million people who don’t meet the program’s citizenship or immigration status requirements are expected to lose health coverage under state programs.

Dr. Richard Hudspeth, CEO of Blue Ridge Health, a federally qualified heath center based in Henderson County, believes the bill will hit residents in rural Western North Carolina, still reeling in the aftermath of Tropical Storm Helene, particularly hard.

Many of Hudspeth’s patients who gained access to Medicaid under North Carolina’s bipartisan expansion are young people holding multiple jobs, he said, and he fears the bill’s work requirements could create an unnecessary barrier to health insurance coverage.

“Is it truly a work requirement,” Hudspeth asked, “or is it truly a deliberate administrative burden to reduce the number of folks that have eligibility for Medicaid?”

Lower provider tax reimbursement rate provisions laid out in the bill could also hit hard rural hospitals in the region, critics of the bill fear.

In June, Stein had warned that an earlier version of the bill could lead to the closure of five rural hospitals in North Carolina, including Blue Ridge Regional Hospital in Spruce Pine and Angel Medical Center in Franklin.

Before passing the bill, Senate lawmakers created a $50 billion rural healthcare provider fund to offset some of the financial losses rural hospitals are expected to face because of the bill. But according to the state’s Department of Health and Human Services, that fund will only cover a third of the $3 billion in Medicaid payments the state’s rural hospitals are estimated to lose.

Food insecurity could increase under bill

Cuts to SNAP would also threaten access to food in a region already experiencing increased food insecurity. The state health department said the bill could put North Carolina on the hook for $420 million in extra cost share and could even force the state to withdraw from the program entirely, which would place immense pressure on food banks and other nonprofits.

MANNA FoodBank, which operates across 16 Western North Carolina counties, expects to see the “cascading effects” of the legislation play out over the next few years. Micah Chrisman, the nonprofit’s director of marketing and communications, said about 90,000 people in North Carolina’s 11th Congressional District, which covers much of WNC, are at risk of losing their SNAP benefits as program changes are implemented.

To meet that level of potential need, MANNA would have to double its current monthly distribution of 1.5 million meals.

“That would strain even the largest food bank, let alone ours,” Chrisman said.

Cuts to programs like SNAP and Medicaid would also have negative consequences when it comes to children’s health, said Elizabeth Hudgins, executive director of the North Carolina Pediatric Society, a statewide organization representing about 2,300 pediatricians and other child health professionals.

“It’s hard to imagine how a trillion dollars could come out of Medicaid spending and not have an impact across the board on all child health services,” she said.

Nearly half of all children in North Carolina’s small towns and rural areas are covered by Medicaid or the Children’s Health Insurance Program, also known as CHIP, according to a report from Georgetown University’s McCourt School of Public Policy. About 40% of all children in the state’s metro areas are covered by Medicaid or CHIP.

Meanwhile, one in five children in North Carolina experience hunger, according to Feeding America, a nationwide network of nonprofit food banks.

Though it’s still unclear exactly how all the provisions in the bill will be implemented, Hudgins expects access to care and nutritious food for children to be threatened.

“Not only is it going to be real and significant impacts for families,” Hudgins said, “it’s also going to be an immense strain on the systems and communities that hold all of us together.”

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Jacob Biba is the Helene recovery reporter for the Asheville Citizen Times, part of the USA TODAY Network. Email him at jbiba@citizentimes.com.

This article originally appeared on Asheville Citizen Times: ‘Big Beautiful Bill’: Critics worry about WNC health, food access