Source: WRAL
President Trump is expected to make significant cuts to federal health care programs — a move that could spike costs for North Carolinians who receive their health insurance coverage through the Affordable Care Act (ACA) and Medicaid.
While a majority of Americans support the ACA, Trump has long criticized it. During his first term, he made several attempts to repeal the program but was blocked by Congress. On the campaign trail in 2024, Trump said “Obamacare stinks” and said he had “concepts of a plan” to replace it.
Making cuts to the program could be as simple as not renewing subsidy enhancements that are scheduled to sunset at the end of 2025. Allowing those subsidies to lapse would, on average, double out-of-pocket costs for ACA enrollees in North Carolina.
Cuts could also take the form of lowering federal reimbursement rates for Medicaid expansion. In North Carolina, that would essentially repeal Medicaid expansion, since the law that enacted expansion includes a trigger that ends it if the federal government reduces the share it pays.
More than 3 million North Carolinians are covered by Medicaid, including more than 600,000 people who were added to the Medicaid rolls in 2024 after the state voted to expand the program.
What’s more, about 975,000 people in North Carolina get their health care coverage through the ACA marketplace, and at least 1 million more have benefited from ACA provisions governing preexisting conditions, preventive care, and parental health coverage through the age of 26.
Trump has already begun reversing health care affordability initiatives that affect North Carolinians. On day one, he signed an executive order rescinding a 2022 directive by President Biden that instructed Medicaid and Medicare to try new strategies to lower prescription drug costs. This policy would have resulted in the development of a list of generic drugs that could be available for a $2 copay.
