Trump’s threats to repeal the Affordable Care Act would devastate North Carolina

The Affordable Care Act expanded access to healthcare for millions of Americans. A second Trump presidency could end that progress, especially in rural North Carolina.

Fourteen years ago, on March 23, 2010, President Barack Obama signed the Affordable Care Act (ACA) into law.

Despite the law’s impact in giving millions of Americans health coverage for the first time, Donald Trump made repealing the ACA a signature focus of his 2016 presidential campaign, and as president, he came within one vote of succeeding, but ultimately failed when the late Sen. John McCain of Arizona voted to save the law in the Senate.

This year, Trump is back on the campaign trail and once again threatening  the ACA. 

“We’re gonna fight for much better health care than Obamacare. Obamacare is a catastrophe. Nobody talks about it. You know, without John McCain, we would have had it done,” Trump said earlier this year.

Repealing the ACA would have particularly devastating effects on North Carolina, Gov. Roy Cooper said at a press conference in Raleigh on Thursday. 

“More than a million North Carolinians now getting federal subsidies to help pay for their premiums would have to pay more for their coverage, if they could even afford it at all. A middle class family could face $13,000 more in annual premiums,” Cooper said. 

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On the campaign trail, Donald Trump has expressed his continued desire to see the Affordable Care Act repealed. That would be a “nightmare” for North Carolina, Gov. Roy Cooper said at a Thursday press conference commemorating the 14th anniversary of the law. Repealing the ACA would lead to significantly higher healthcare costs for over a million North Carolinians who receive federal subsidies, and could cause the 400,000 North Carolinians who benefited from the state’s recent Medicaid expansion to lose coverage. Cooper noted that many who have signed up for Medicaid expansion under the ACA are receiving care for the first time in their lives. #affordablecareact #ncpolitics #obamacare #health #healthcare

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Rural NC would be hit hard

North Carolina has the second highest number of people living in rural areas in the country, behind Texas.

The ACA also made Medicaid expansion possible in North Carolina, and provided many people with coverage for the first time in their lives. As of March 2024, the state has enrolled nearly 400,000 people through its Medicaid expansion program, 25% of whom live in rural areas.

NC Secretary of Health and Human Services Kody Kinsley said that many rural hospitals were in dire straits prior to expansion.

“We don’t have to look back that far to remember what happens when you don’t have health coverage. We’ve had nearly a dozen rural hospitals close over the last decade. And that’s because hospitals, and other providers are businesses. And disproportionately, we’ve had a large number of uninsured folks in rural North Carolina. Medicaid expansion is changing that,” he told reporters on Thursday.

Kinsley said that expansion is providing needed coverage to the state’s rural residents.

“We’re seeing folks enrolled faster in rural communities than anywhere else in the state. The leading county in North Carolina is Robeson County, with signups,” he said.

Democratic House Leader Robert Reives, who represents Chatham and parts of Randolph County, echoed Kinsley’s remarks about rural hospitals, and cited the near-closing of Randolph Hospital just a few years ago.

“The General Assembly had to step in and try to save Randolph’s hospital,” he said. 

Reives emphasized how Medicaid expansion was providing financial relief to rural hospitals like Randolph—support that otherwise wouldn’t exist.

“Rural hospitals are always working at a deficit, because they’re treating people, and doing things for people that are not ‘profitable’ for the entity,” Reives said. “When that hospital is not getting reimbursed, and when they don’t have something like Medicaid to help fill in those gaps, at some point in time they close down.”

The real-world consequences of hospital closures can be significant for the community.

“If you’ve ever seen anybody in an emergency, the difference in 30 minutes makes a difference …  So when you have people, that suddenly, their ambulance ride gets extended further and further out because they don’t have a hospital near them, that is a huge deal,” Reives emphasized. 

ACA repeal would end Medicaid Expansion

Republican State Senate leader Phil Berger cited the federal government’s lasting commitment over several years to the program as one of the reasons he got on board with the expansion last year.

“The federal government said that they would be paying 90% of the cost…Since then, we have seen the federal government be controlled by Democrats, controlled by Republicans. We have seen almost every iteration that you could have of control by one party or the other or joint control. And they haven’t changed that 90-10 split.,” he told PBS in early 2023.

Without the ACA, however, states would lose that support and would not be able to maintain coverage for the newly insured. 

“Many people who just signed up for Medicaid expansion, and many people who are getting healthcare coverage for the first time in their adult life, that dream come true, could turn into a nightmare,” Cooper said of the consequences of an ACA repeal.