Op-ed: North Carolina’s Hospitals Are Feeling the Heat In More Ways Than One
North Carolina’s Hospitals Are Feeling the Heat — Literally and Politically
Source: NC Political News
By: Bill Graham
Date: August 2025
Summary:
Hospitals across North Carolina are overwhelmed by record-breaking heatwaves — and now, by new Medicaid funding cuts buried in Congress’s latest budget bill.
WakeMed in Raleigh recently reported a surge in heat-related emergency visits, including cases involving children.
The new budget bill, while lowering taxes for families and businesses, includes Medicaid changes that could cost N.C. $32 billion over the next decade, according to state analysts.
Senator Thom Tillis (R-NC) voted against the bill, warning that it threatens Medicaid expansion and rural hospital funding.
Quotable:
“Senator Tillis stood up and did the right thing. But he stood alone. No other member of North Carolina’s delegation followed his lead. And that’s a problem.”
— Bill Graham
By the numbers:
$32 billion — Projected loss to N.C. hospital and Medicaid funding over 10 years
660,000+ — North Carolinians at risk of losing coverage if Medicaid expansion collapses
1 — N.C. senator (Tillis) who voted no to protect Medicaid
Zoom in: What’s at stake
Without current funding models like the hospital assessment model, North Carolina law requires the state to end Medicaid expansion altogether.
That means loss of coverage for low-income families, seniors in nursing homes, and workers.
Programs like HASP (Healthcare Access and Stabilization Program)—which fund upgrades, doctor recruitment, and urgent repairs—could vanish.
One rural hospital used HASP funds to fly in compressor parts during the heatwave just to keep its HVAC system functioning and patients safe.
What could have happened:
The House version of the bill had a more measured Medicaid approach—including work requirements and targeted reforms. But the Senate's version:
Gutted key Medicaid support structures
Ignored the House’s proposed reforms
Prioritized a quick vote over policy stability
The bottom line:
Bill Graham, a conservative and former gubernatorial candidate, calls the Senate version a "sabotage" of N.C.’s health care progress.
“North Carolina made a choice to expand Medicaid. That decision has improved lives... It deserves protection, not sabotage from Washington.”
North Carolina’s Hospitals Are Feeling the Heat In More Ways Than One
By Bill Graham
Just a few weeks ago, WakeMed in Raleigh reported (https://abc11.com/post/heat-related-sickness-sends-dozens-hospital-including-3-children-central-north-carolina-wakemed-says/16828912/) a surge in heat-related emergency cases, including three children. They weren’t alone. Hospitals across North Carolina have been overwhelmed this summer, not just by record temperatures, but by the growing pressure to do more with less.
And now, Congress is making that job even harder.
The massive budget bill that just passed delivered real wins on taxes. It lowers the tax burden for working families and small businesses, and I applaud that. But buried in the same bill are changes to Medicaid that could devastate hospitals across our state and unravel the progress we’ve made.
Senator Thom Tillis had the courage to call it out. He voted no, warning that the bill would cost North Carolina billions, threaten Medicaid expansion, and put rural hospitals on the chopping block. He’s absolutely right.
In fact, North Carolina’s own budget analysts estimate (https://www.tillis.senate.gov/services/files/41E71724-D0FE-43B7-98C0-0E7821013421) the state could lose $32 billion in hospital and Medicaid funding over the next decade because of this bill. The hospital assessment model that helped finance expansion is being gutted. Without it, North Carolina law requires the state to end expansion altogether, which would strip coverage from more than 660,000 people.
That includes children, low-income workers, and seniors in nursing homes. It also includes the hospital systems that care for them, especially those in rural areas already hanging on by a thread.
Programs like the Healthcare Access and Stabilization Program (HASP), which hospitals use to fund critical upgrades and recruit doctors, will be the first to go. I’ve seen that one rural hospital recently used those dollars to fly in compressor parts to fix a failing HVAC system during the heatwave — just to stay open and keep patients safe. Others have used them to expand cancer care or bring back OB-GYN services in counties that had lost them.
If that funding disappears, so do those services.
What’s frustrating is that this didn’t have to happen. The House proposed a more measured approach to Medicaid — one that included work requirements and targeted waste. There was room for debate and improvement. But the Senate version steamrolled those options in favor of cuts that make North Carolina’s health care system less stable and less secure. To get a bill done before an arbitrary deadline.
Senator Tillis stood up and did the right thing. But he stood alone. No other member of North Carolina’s delegation followed his lead. And that’s a problem. We need lawmakers who will put their state ahead of Washington dealmaking, especially when the stakes are this high.
I’m a conservative. I’ve run for governor. I believe in reform, in accountability, in fiscal responsibility. But none of that means we should make it harder for families to see a doctor, or force rural hospitals to close their doors.
North Carolina made a choice to expand Medicaid. That decision has improved lives, stabilized hospitals, and strengthened our workforce. It deserves protection, not sabotage from Washington.
Congress should fix this mistake. In the meantime, let’s recognize what real leadership looks like. Senator Tillis showed up for North Carolina. It’s time others did too.
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