A new report released by Defend America Action shows that healthcare costs are soaring in North Carolina, and fewer North Carolinians have coverage than they did at the beginning of the year. Those with insurance, especially through the Affordable Care Act (ACA), are paying more than they did last year.
Between the passage of President Donald Trump’s ‘One Big Beautiful Bill Act’ (OBBBA) in July 2025, and the expiration of the ACA tax credits at the end of last year, the actions of the Trump administration and many Republican members of Congress have taken away healthcare coverage and increased the cost of insurance.
The situation may get even more dire.
Sixty-seven percent of Americans say that Congress, which is controlled by Republicans in both the US House and US Senate, was wrong to allow the ACA credits to expire, according to KFF’s January poll findings.
Consumer Affairs reported in January that North Carolina was the sixth most expensive state in the US for healthcare, and some of the cuts from OBBBA have yet to take effect.
ACA costs have skyrocketed
Since the beginning of the year, nearly 165,000 North Carolinians have dropped their ACA coverage, a 21% fall in enrollment. North Carolina has the largest percentage drop in enrollment of any state in the US.
For those still enrolled in the ACA, the Center for American Progress, a liberal think tank, estimated in 2025 that monthly ACA premiums for North Carolinians marketplace enrollees with financial assistance would increase by an average of $626 a month, or 149%.
A 2025 poll from KFF estimated that 1 in 4 ACA enrollees would go without coverage rather than pay double the cost of their premiums.
Deep cuts to Medicaid will leave more people uninsured
Roughly 1 in 4 North Carolinians rely on Medicaid for healthcare coverage and more than 1 million children are enrolled in Medicaid and Children’s Health Insurance Program (CHIP) in the state.
Medicaid also covers half of all births in the state.
OBBBA alone will cut $1 trillion from Medicaid over the next decade. The North Carolina Department of Health and Human Services estimated after its passage that the Tar Heel State will lose around $49.9 billion over this period, resulting in 225,000 North Carolinians losing their coverage. The Commonwealth Fund estimated that in the worst-case scenario, the triggered Medicaid cuts could cause 30,000 layoffs in the healthcare sector next year.
Currently, North Carolina checks Medicaid eligibility once per year. Beginning in January 2027, North Carolina, along with all other states, will be required to check eligibility every six months.
Cuts to Medicaid will also put increased pressure on the state’s hospitals, resulting in an annual $727 million loss.
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