North Carolina's Medicaid expansion has added more than 685,000 people to the program, and the state's hospitals pay its share through assessment taxes. The One Big Beautiful Bill Act, which Michael Whatley, the Republican nominee for U.S. Senate in North Carolina, called "a huge win for all Americans" in July 2025, phases down those provider taxes and the hospital payments they support, which will cost North Carolina and its hospitals an estimated $32 billion in federal support over 10 years, the North Carolina Medical Journal reported.
North Carolina law says expansion coverage "shall be discontinued as expeditiously as possible" if those assessments cannot fully fund the state's share. Whatley also said the law's work requirements are "widely supported in North Carolina," and he backed its rural health fund, which returns a fraction of what the law cuts from rural Medicaid in the state.
What It Cost: North Carolina's Medicaid Expansion and Its Hospitals Under the Law Michael Whatley Praised
- Federal Medicaid funding. KFF's allocation of the Congressional Budget Office estimate is that the law cuts federal Medicaid funding for North Carolina by about $22.5 billion over ten years, 11% of what the state would otherwise receive, and leaves 300,000 more North Carolinians uninsured in 2034.
- Hospital payments. The law lowers the cap on provider taxes from 6% beginning October 1, 2027, settling at a new cap of 3.5% on October 1, 2031, while North Carolina's provider taxes already account for around 4% of the net patient revenue threshold, the North Carolina Medical Journal reported. The rates of the state's Healthcare Access and Stabilization Program (HASP) hospital payments will begin to phase down by 10% per year beginning on July 1, 2028.
- Other services funded by hospitals. With expansion the likely first priority for the remaining provider taxes, the assessments that now fund graduate medical education, postpartum coverage, home and community-based services and mental health services may be in jeopardy of facing reductions or being eliminated entirely over time, the North Carolina Medical Journal reported.
- Coverage and jobs. Changes in the law could take as many as a quarter-million North Carolinians off Medicaid starting in 2027, and in a worst-case scenario the cuts could cause as many as 30,000 layoffs in North Carolina, according to a Commonwealth Fund analysis, WRAL reported in May 2026.
- Hospitals at risk. Public Citizen, a progressive watchdog group, lists Central Carolina Hospital in Sanford among North Carolina hospitals at high risk of closing or cutting services under the law, and FirstHealth of the Carolinas, which runs four hospitals, told legislators in April 2026 that it is projected to be operating at a loss in 2032.
Michael Whatley's Statements on the Law's Medicaid Changes and North Carolina's Expansion
- Whatley Called "a Huge Win" the Law That Limits the Hospital Taxes Paying for North Carolina's Expansion. As chair of the Republican National Committee, Michael Whatley called the final House passage of the One Big Beautiful Bill Act "a huge win for all Americans" in a July 3, 2025 statement. Days earlier, on June 28, 2025, as the Senate took up the bill, he posted "GREAT NEWS We're one step closer to getting the One, Big, Beautiful Bill to President Trump's desk." That endorsement covers the law's limits on the provider taxes and state-directed payments that fund North Carolina's expansion: hospitals agreed to essentially cover the full cost of the state's share through assessment taxes. Under the law, North Carolina and its hospitals will lose the benefit of the state's HASP payments, resulting in a loss of an estimated $32 billion in federal support over 10 years, the North Carolina Medical Journal reported, and KFF estimates that about $3.4 billion a year in North Carolina hospital payments sit above the new limits. North Carolina's 2023 expansion law provides that if the nonfederal share "cannot be fully funded through the sources described in subsection (b)" of the law, expansion coverage "shall be discontinued as expeditiously as possible", as Carolina Journal reported.
- Whatley Said the Law's Medicaid Work Requirements Are "Widely Supported in North Carolina". In a November 2025 interview with Punchbowl News, Michael Whatley defended the law's Medicaid changes, including new work requirements: "Those are widely supported in North Carolina. Those are widely supported across the country." The requirements apply to the adults covered by North Carolina's expansion, who must show 80 hours a month of work, school or service, and states must start them no later than January 1, 2027. The Congressional Budget Office estimates the requirement will reduce federal Medicaid spending by $326 billion over 10 years, and the administration's own rule projects that enrollment would be reduced by 2.3 million individuals in FY 2027. In Nebraska, the first state to start the requirement, over 1,000 people lost or were denied Medicaid coverage between May and August 2026, Human Rights Watch reported.
- Whatley Backed the Law's Rural Health Fund, Which Sends North Carolina $213 Million Against a $6.4 Billion Rural Medicaid Cut. In written answers published by AARP on September 1, 2026, Michael Whatley said the law "included $50 billion to improve rural health care. I fully support these critical provisions." In North Carolina, federal Medicaid spending in rural areas falls by about $6.4 billion over ten years, while the state's first-year award from the fund was $213 million, or $72 per rural resident, by KFF's figures, and the administration limited states to using 15% of federal funding awarded for payments to hospitals and other providers.
Frequently Asked Questions About Michael Whatley on North Carolina Medicaid expansion
What is Michael Whatley's record on North Carolina's Medicaid expansion under Trump?
Michael Whatley called the One Big Beautiful Bill Act "a huge win for all Americans," a law that phases down the hospital taxes and payments that fund North Carolina's Medicaid expansion, and he defended its work requirements for expansion adults. He backed its rural health fund, which returns $213 million in its first year to a state whose rural Medicaid funding falls by billions.
Did Michael Whatley oppose Medicaid expansion in North Carolina?
Yes. In August 2019, as chair of the North Carolina Republican Party, Michael Whatley wrote that Governor Roy Cooper had vetoed the state budget "to try to expand socialized healthcare." North Carolina expanded Medicaid in 2023, and expansion has led to more than 685,000 additional people being added to the program's rolls.
How does the Big Beautiful Bill Michael Whatley praised threaten North Carolina's Medicaid expansion?
The law Michael Whatley praised reaches North Carolina's expansion through its funding: the state's share is paid by hospital assessments, and the law lowers the provider-tax cap to 3.5% by 2031 while North Carolina's provider taxes already account for around 4% of the threshold. The state's expansion law provides that coverage "shall be discontinued as expeditiously as possible" if those sources cannot fully fund the state's share, so the General Assembly will likely have to decide which services the remaining taxes support.
Last updated: 2026-10-25