House bill puts hundreds of thousands in NC at risk of losing health coverage
If a bill passed by House Republicans early Thursday morning becomes law, more than 260,000 people in North Carolina are expected to lose Medicaid coverage, according to KFF, a national nonprofit focused on health care policy.
Children, pregnant women, some elderly individuals and people with disabilities can benefit from Medicaid coverage.
That comes as tax credits from the Affordable Care Act are set to expire, bringing the number of North Carolinians who could lose health care coverage to more than 470,000.
And that would nearly offset the number of people added as Medicaid recipients after North Carolina lawmakers expanded the program in 2024. In December, former Gov. Roy Cooper announced that expansion allowed 600,000 people to sign up for health care coverage.
But Republicans spent weeks attempting to cut $880 billion from the House Committee on Energy and Commerce budget and settled on changes to the Medicaid and Affordable Care Act programs that put North Carolina recipients at risk.
That proposal comes as part of the reconciliation process to set the budget guidelines for the federal government over the next 10 years and is being used as a vehicle to implement many of President Donald Trump’s campaign promises.
Three changes Republicans are proposing for health care coverage are to add work requirements to qualify for Medicaid, to prevent federal funding to be used for gender transition care and to prevent immigrants in the country without legal authorization from enrolling in Medicaid.
Work requirements
If the bill becomes law, adults between 18-64 signing up for Medicaid must spend 80 hours per month working, volunteering, going to school or a combination of those options. That new work requirement will begin in December 2026.
This is expected to save $300 billion over a 10-year period.
States would be required to verify that a person meets these qualifications and has been doing so for at least 30 days before enrolling them into Medicaid.
Work requirements proposed in past plans could jeopardize 47% of Medicaid recipients in North Carolina, according to the Center on Budget and Policy Priorities, which opposes such requirements. Since North Carolina recently expanded Medicaid, that number is still in flux, the left-leaning think tank noted.
House Republicans did include exemptions for people who suffer from a serious medical condition or who have a dependent child.
Gender transition care
The bill also prohibits Medicaid funds from being used for gender transition procedures. The bill specifies that this prohibition is for surgeries, implants or medications to transition from the gender a person was assigned at birth.
What isn’t included in the prohibition is treatment to prevent early puberty, genetic disorders and chromosomal abnormalities.
Medicaid funds could be used to reverse gender transition procedures or anything that may prevent death or impairment to major bodily functions.
Timing
While potential threats to Medicaid have made news for months, members of Congress and the public didn’t get to view the final version of the bill until late Wednesday night when many Americans were already sleeping.
The House began voting on the bill early Thursday morning with passage at 6:56 a.m. along party lines, with the exception of Republicans Rep. Warren Davidson and Thomas Massie, who voted with Democrats. Rep. Andy Harris, a Republican from Maryland, voted present.
And two other Republicans, Reps. Andrew Garbarino and David Schweikert, did not vote. House Speaker Mike Johnson told reporters Garbarino missed the vote after falling asleep.
State reaction
North Carolina Democrats and Republicans stayed loyal to their party’s positions throughout the negotiation process.
Rep. Virginia Foxx, a Republican from Banner Elk, led a marathon meeting that lasted more than 19 hours in which members of the House Committee on Rules hashed out the final negotiations of the bill before it reached the House floor.
Following the bill’s passage, North Carolina lawmakers are offering their constituents very different takes on what the bill does, depending on party. North Carolina is represented by 10 Republicans and four Democrats.
Republicans quickly celebrated.
Rep. Mark Harris, from Charlotte, said the bill “emphasizes the importance, and dignity, of work by requiring able-bodied Americans to work in order to be eligible for Medicaid and food assistance. And, it also defunds Planned Parenthood and taxpayer-funded transgender surgeries in Medicaid.”
Rep. Pat Harrigan, from Hickory, said in a news release that the changes to Medicaid would “remove at least 1.4 million illegal immigrants from Medicaid rolls, protecting access for eligible Americans and ending rampant fraud and abuse.”
Democrats had a far different take.
Rep. Deborah Ross, of Raleigh, called the bill “reckless” and “cruel,” saying it would strip 14 million Americans from health care coverage.
Rep. Valerie Foushee, of Hillsborough, said while Republicans promised “to not touch Medicaid, they brought a bill to the floor that would trigger more than $500 billion in Medicaid cuts.”
For months, Republicans have made promises not to cut Medicaid and protect Americans who need it.
Rep. Tim Moore, a Republican from Kings Mountain, said in March that reports of potential cuts to Medicaid was “fear-mongering” and said there “was no way” there would be cuts to the program.
Trump reportedly told House Republicans Tuesday, “Don’t (expletive) around with Medicaid.”
What now?
The bill now heads to the Senate for further negotiations.
More than likely, senators will make extensive changes to portions of the bill and send it back to the House for approval.
Sen. Thom Tillis, a Republican from Huntersville, was asked Thursday in comments that circulated on video if he was concerned about the cuts to Medicaid.
“The main thing we have to do is satisfy the president’s objective that we have to have no harm to qualified people for the safety net programs,” Tillis said. “But with that limit there’s still billions of dollars in savings that I think we can achieve for the betterment of those programs.”
Senate Minority Leader Chuck Schumer took to the floor early Thursday morning to criticize the bill’s passage saying, “this bill was already the largest cut in Medicaid in American history, but now these cuts have been rushed forward and will happen as soon as next year.”
He warned that moving up the timelines leaves rural hospitals with less time to prepare for the fallout and it risks layoffs and potential closures of rural hospitals, community health centers and urgent care clinics.
Majority Leader John Thune also spoke on the Senate floor Thursday morning but didn’t address the bill.
Johnson has warned Senate Republicans that his majority is slim — currently he can only lose three votes — and anything senators change could lead to a marathon of negotiations with Republican hardliners who he battled with around the clock to get the House version passed.
This story was originally published May 22, 2025 at 4:11 PM with the headline "House bill puts hundreds of thousands in NC at risk of losing health coverage."
