Although patients no longer rush through the doors of this emergency room, an empty hospital in Williamston, North Carolina, offers an evocative example of why Republican Senator Thom Tillis defied his party's leaders by voting against President Donald Trump's signature domestic policy package.
El Martin General is one of a dozen hospitals that have closed in North Carolina over the past two decades. It's a problem that hospital systems and health experts say could worsen after legislation passed that cuts $1 billion from the program. Medicaid and adds new restrictions on the enrollment in coverage.
Financial impact already being experienced
Tillis's home state illustrates the financial impact that increased Medicaid funding can have on hospitals in rural and poor regions across the country. The senator said in a floor speech explaining his vote a few weeks ago that the GOP bill would deprive hospitals of billions of dollars. Medicaid beneficiaries and the health system of your state.
“Republicans are about to make a mistake on health care and betray a promise,” said Tillis, who has announced he will not seek reelection due to his opposition to the bill. Along with Republicans Susan Collins of Maine and Rand Paul of Kentucky, he joined all Democrats in voting against the bill.
Later, he accused the president and his colleagues of not fully understanding the bill's impact: "Our responsibility to the states is to do the work to understand how these proposals affect them. How hard is that? I did it."
For Martin General Hospital in Williamston, North Carolina's decision to expand Medicaid came too late. In August 2023, the emergency room abruptly closed its doors in the eastern county, which is home to more than 20,000 people. The nearest hospital is now about a 30-minute drive away.
Then-Democratic Governor Roy Cooper blamed the state for not expanding the Medicaid program to more low-income adults sooner to avoid the closure of Martin General.
📌 How will Trump's federal cuts to Medicaid impact North Carolina?
More than 600 thousand benefits to the expansion
North Carolina began offering the Medicaid expansion to its residents in December. Today, more than 673,000 people receive this coverage.
Currently, Tillis and other state officials are concerned that the new "Big, Beautiful Bill," which limits the amount of Medicaid money returned to providers, will again threaten funding for hospitals in their state. And it could trigger a state Medicaid law that would shut down the state's otherwise successful coverage expansion unless state lawmakers make changes or find funding.
The Medicaid funding that Republicans are seeking to cut in their bill has helped prop up North Carolina's remaining rural hospitals, said Jay Ludlam, the assistant health secretary who leads Medicaid in that state.
“This has been a lifeline for our rural hospitals in North Carolina and has helped supply them and keep them open,” Ludlam said. “Rural hospitals play an integral role in communities as access points for health care and for the local economy because of the contributions those hospitals and hospital systems make to those communities.”
Republicans have responded to concerns with a provision that would provide $10,000 billion annually to rural hospitals for five years, or $50,000 billion in total.
Related: Nearly 62,000 Hispanics have Medicaid in North Carolina.
More than 300 hospitals at risk
Across the country, 200 hospitals have closed entirely or canceled emergency services over the past two decades, many of them in Republican states in the Southeast and Midwest.
In states that have refused to expand Medicaid coverage, the health insurance program for the poorest Americans, closures have accelerated. Tennessee, for example, has lost 500 beds since 2014, when a federal law first allowed states to expand Medicaid coverage to a larger proportion of low-income people. It is one of only XNUMX states that has not expanded such coverage.
More than 300 hospitals could be at risk of closure, according to an analysis conducted last month by the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill. The center tracks rural hospital closures.
“Substantial cuts to Medicaid or Medicare payments could increase the number of unprofitable rural hospitals and increase their risk of financial distress,” the analysis concluded. “In response, hospitals could be forced to reduce service lines, convert to a different type of healthcare facility, or close altogether.”
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