Dead Set on Destruction
By 
The Grim Reaper was invited to North Carolina and he’s not going to decline an invitation:
The only hospital in Martin County, N.C., closed in 2023, but the electricity is still on inside. Air conditioning continues to keep its empty patient rooms cool. And the county still pays the bills for the building’s medical gas system.
That is because the people of Martin County, in rural eastern North Carolina, have been determined to keep the beige brick building from deteriorating — and to somehow reopen their hospital, which had been struggling financially for years.
When North Carolina expanded Medicaid later in 2023, after the hospital shuttered, offering government health insurance to the state’s low-income adults, Martin County saw an opportunity. Plans materialized to partly reopen the hospital, largely because federal dollars were pouring into the state to cover patients’ care under Medicaid.
But those plans are now in jeopardy, as is Medicaid coverage for hundreds of thousands of North Carolina residents, after Congress passed President Trump’s sweeping domestic policy bill. To help pay for tax cuts, the bill slashes federal spending on Medicaid, leaving states that expanded the program under Obamacare in a particularly difficult spot.
If Medicaid expansion is eliminated in North Carolina, Martin General Hospital almost surely will not reopen — “a catastrophic and deadly consequence,” said Paul Roberson, a real estate agent and community leader in Williamston, where a sign in front of the hospital reads, “CLOSED. If you need immediate assistance, dial 911.”
“Not having the hospital here is costing lives,” Mr. Roberson said, noting that the nearest hospital was about a 30-minute drive away. “This is the most important thing for us.”
Health experts say that rural America stands to suffer the most if the Medicaid population shrinks; Mr. Trump’s bill will lead to 11.8 million more uninsured Americans by 2034, according to the nonpartisan Congressional Budget Office. In North Carolina, which has one of the largest populations, the effects could be particularly dire.
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More concerning to state officials is that the Trump law could trigger the end of Medicaid expansion in North Carolina by lowering a tax the state depends on to cover its share of the cost. The new law may also force the state to end a related program that boosts federal payments for hospitals that treat Medicaid patients. Lawmakers could pass a legislative fix, but they have remained deadlocked over the state budget, and some health experts said they doubted a solution could be reached.
One interesting thing to note is that Martin County is not the kind of 90-10 Trump district that will typically be most vulnerable to Josh Hawley’s gleeful crushing of Medicaid — it voted for Obama twice and Trump carried it by 10 points. Whether this will cause a significant number of people to change back is a question that will help determine the course of American politics over the next couple decades.