With a final vote in the U.S. House of Representatives on Thursday, a sweeping tax bill that will touch almost every sector of the economy and overhaul industries like energy and health is headed to President Donald Trump's desk for a signature.
In North Carolina, Gov. Josh Stein, a Democrat, has publicly rallied against what Republicans have dubbed the "One Big Beautiful Bill."
Stein warned that it could threaten the healthcare of as many as 1.2 million North Carolinians; cause 1.4 million people in the state to lose food assistance unless the state can find $420 million to support the program; and cost 45,000 jobs by stymying the state's burgeoning clean tech manufacturing sector.
"The bill is a disgrace, and I am disappointed in those who did not stand up for the people they serve, choosing instead to ignore warnings from local leaders and groups across the state who have sounded the alarm about the dangers in this bill. We cannot simply accept these harmful impacts," Stein wrote in a statement after its passage.
Stein also called upon the Republican-controlled N.C. General Assembly to protect the state's Medicaid expansion,which ensures about 670,000 people. The program's future is imperiled by a state provision that effectively removes North Carolina it if the federal government stops covering 90% of the matching cost for the expansion population.
Additionally, Stein wants the General Assembly to provide about $420 million in funding that he says would now be necessary to keep North Carolina enrolled in the federal Supplement Nutrition Assistance Program.
"This will require taking a hard look at our laws, our state budget, and our long-term revenue requirements," Stein wrote.
Sen. Thom Tillis, R-N.C., pointed to the Medicaid provision as a key reason for his opposition to the bill shortly before voting against it and announcing he would not seek reelection. Sen. Ted Budd, R-N.C., voted for the bill.
In a letter to the state's Congressional Delegation this week, Stein wrote that in addition to the Medicaid expansion population, as many as 520,000 additional North Carolinians could lose health insurance. Those people's coverage is threatened by changes to Medicaid, Marketplace health plans and subsidies, Stein wrote.
N.C. Department of Health and Human Services officials said Thursday they are reviewing the bill's final language to determine its full impact but warned the changes to Medicaid and food assistance will likely cost the state billions of dollars.
"These cuts not only impact the people that rely on them directly but also strain the systems and communities that hold us all together," DHHS Secretary Dev Sangvai said in a statement.
Congressional response
All 10 Republican members of the state's delegation in the U.S. House of Representatives voted for the bill, while all four Democrats voted against it.
Republicans touted passage of the bill, including U.S. Rep. Greg Murphy (R-N.C. 3), a practicing urologist who was known to be concerned about the Medicaid provisions in the package and how they would impact rural healthcare.
In a statement, the eastern North Carolina Republican touted tax cuts and additional spending on border security. He also referenced "innumerable dynamic and spirited conversations" with Trump Administration officials about rural health.
"This bill protects Medicaid benefits for those who are most vulnerable in our society, not able-bodied individuals capable of participating in the workforce, illegal immigrants, and those ineligible for benefits," Murphy wrote in a statement.
He also pointed to $50 billion to stabilize rural hospital systems as a key part of the package.
U.S, Rep. Mark Harris (R-N.C. 8) represents a district stretching from eastern Mecklenburg County to Robeson County. In a statement, Harris wrote that he is proud to uphold President Donald Trump's agenda, including completing the border wall and taking federal funding away from Planned Parenthood.
Harris also expressed concern, though, about the amount of new spending in the bill, which the nonpartisan Congressional Budget Office projects will add more than $4 trillion to the United States' deficit.
"I recognize to undo the damage done to our country by radical progressive Democrats, Congress must authorize the funds to accomplish that goal. However, I fear that if Washington’s overspending addiction continues, the opportunity to put our country back on a path to a sound financial future is in jeopardy. In the coming months, Republicans must use every tool at our disposal to rein in government spending," Harris wrote.
U.S. Rep. Don Davis (D-N.C. 1), who represents an Eastern North Carolina district that is seen as the only competitive Congressional race in the state, expressed disappointment in the bill's passage Thursday afternoon.
"While I wholeheartedly support safeguarding the American people by strengthening our national defense and securing our border, it is also deeply concerning that the average hardworking family in eastern North Carolina will bear the brunt of H.R. 1’s out-of-touch spending, as the wealthiest individuals and Washington, D.C. insiders stand to benefit the most," Davis wrote in a statement.
Reaction from potential Senate candidates
U.S. Rep. Pat Harrigan (R-N.C. 10) celebrated defense spending and provisions making permanent the first Trump Administration's tax cuts. The bill keeps more than 500,000 taxpayers in the district from seeing a 27% tax hike, according to statistics Harrigan provided.
"It cuts taxes for working families, slashes wasteful spending, unleashes American energy and gives President Trump the resources to finish the job at the border. The One Big Beautiful Bill puts hardworking Americans first and allows North Carolina families to keep more of their hard-earned money," Harrigan wrote in a statement.
Since Tillis announced last weekend that he would not seek re-election, Harrigan has been touted as a potential candidate for the seat.
Another politician who has been considering running for the Senate seat is former Gov. Roy Cooper, a Democrat with decades of political experience in the state. In a statement posted to X, Cooper called the bill "shameful."
"Every day people are struggling to make ends meet with higher prices for food, rent and other bills. The bill just passed in DC not only doesn’t help them, it actually hurts working families, seniors, children and veterans so those at the top can have big tax breaks," Cooper wrote.
Wiley Nickel, a Democrat who served one term in Congress and is the only Democrat to have announced a Senate campaign, also slammed the bill and politicians who voted for it.
"Republicans in Congress have yet again caved to pressure from Trump, and in doing so, betrayed their promises to the American people. This bill is a Big Ugly Scam, and is nothing but a tax handout for billionaires that will balloon the deficit and rip health care away from millions," Nickel wrote.
Advocacy group reactions
The Food Bank of Central and Eastern North Carolina said it is "outraged" by the bill's passage.
Amy Berrios, the Food Bank's president and CEO, pointed to SNAP cuts but also to people who could lose Medicaid under the package. Those people, Berrios wrote, will now need to decide whether to pay for food, housing or medicine.
"We condemn this vote in the strongest possible terms. Our leaders should be finding ways to reduce hunger and put people on the path to self-sufficiency — not enacting cruel policies that push more local farms, businesses, and neighbors into desperation," Berrios said in a statement.
The N.C. Healthcare Association, which represents hospital systems across the state, released a statement before Thursday's vote saying that the $50 billion nationwide rural healthcare plan was an inadequate replacement for money that would be lost by capping taxes on healthcare providers and cutting Medicare's payment rates.
North Carolina caps its taxes on hospitals and healthcare providers at 6%, while the federal package drops that to 3.5%. The state uses money from those taxes to help meet federally mandated matches to receive Medicaid funding from the federal government that is sent on to hospitals. The hospitals use that money to help make up for the costs of providing service to the Medicaid population at lower rates.
Capping the tax would effectively wipe out that funding stream for hospitals, the Healthcare Association has warned. That could have significant consequences for safety net hospitals in rural communities.
After Thursday's vote, the Healthcare Association put out another statement saying, "Now that H.R. 1 has passed, the North Carolina Healthcare Association will work closely with state lawmakers to find solutions that preserve access to care for North Carolinians and continue to engage with our members of Congress to ensure they understand the impact these cuts will have on our state’s Medicaid program."
