The North Carolinians that the “big, beautiful bill” will terrify, bankrupt, and kill

These are fraught times in the United States. Elected leaders are racing headfirst down some treacherous and uncharted paths, and at such a moment, it’s easy to lose perspective and get carried away with “sky is falling” hyperbole.

And yet, it’s also undeniably true that some of the changes coming to the American social contract as a result of President Trump’s so-called “big, beautiful bill” are the most extreme in U.S. history. The new law will, for instance, slash hundreds of billions of dollars in federal appropriations for Medicaid health insurance and SNAP food assistance.

Nearly 12 million people across the nation and hundreds of thousands in North Carolina are projected to lose their health insurance over the coming years. Meanwhile, as North Carolina’s food banks explained in a recent urgent plea, the SNAP food assistance that will be cut by almost $200 billion over the next decade provides more than two billion meals each year to the 1.2 million North Carolinians classified as “food insecure.”

The proponents of the legislation allege that it will merely root our “waste, fraud and abuse” in these programs, but as even North Carolina’s Republican senior senator, Thom Tillis, has made plain, that’s just not so.

A report from his office estimates North Carolina will lose $32 billion in Medicaid funds over the next decade and the notion that the state’s health care system could somehow absorb such a hit without dramatically reducing coverage and care is beyond absurd. As the senator said prior to voting against the bill, “So what do I tell 663,000 people [people who’ve gained Medicaid coverage in recent years as the result of the bipartisan expansion law passed in 2023] in two years or three years, when President Trump breaks his promise by pushing them off of Medicaid because the funding is not there anymore?”

And so it is that a huge number of people are quite understandably terrified about what the future holds – both for their own personal financial wellbeing and, indeed, for their life expectancy as the new law takes effect.

This fact was powerfully exemplified last week at a press event in Raleigh at which Wake County Democratic state Senator Jay Chaudhuri spoke alongside a pair of local women who explained how their lives have been dramatically transformed for the better by Medicaid.

Maddie Wertenberg is a Wake County mom who told the story of her son Oliver’s premature birth at which he weighed less than a pound. Wertenberg and her husband had private health insurance when Oliver was born, but even with that, they would still have been left with a crippling and life altering share of the $1.2 million bill his five-month hospital stay ran up.

Fortunately for them, Oliver’s tiny size – she described him as a “nano-preemie” – qualified as a disability for Medicaid purposes and their family’s financial future was rescued as a result. “Medicaid changed my family’s life,” Wertenberg said.

Wertenberg’s gratitude for Medicaid was echoed by a lifetime Raleigh resident named Crystal Upchurch. She explained how she was diagnosed with Lupus in 2009 and how that disease ultimately led to a serious renal condition that requires her to receive regular dialysis treatments — treatments that are, thankfully, covered by Medicaid. As she explained, her ability to continue receiving dialysis treatment is quite literally a life and death matter. “I can’t say it more clearly than this: these cuts could cost me my life,” Upchurch observed.

Similar stories will no doubt abound when it comes to hunger and nutrition. Unless state and local governments somehow find hundreds of billions of dollars to fill the gap caused by the SNAP cuts, food assistance will quickly dry up for millions. This is especially worrisome given the fact that huge numbers of children gain eligibility for free school meals by virtue of their family’s enrollment in SNAP.

Of course, many proponents of Trump’s big bill will tell you they have no intention of cutting off people like Maddie, Crystal and hungry school children. Unfortunately, when experts run the numbers, such arguments are quickly exposed as simply not credible.

Like it or not, the massive Medicaid cuts contained in the legislation will, in fact, make it inevitable that vast numbers of people with stories very similar to Maddie’s and Crystal’s will be sentenced to crippling debt, and/or premature death. After all, that’s what happened in North Carolina during the years GOP lawmakers delayed Medicaid expansion, and the new cuts make a return to those days all but inevitable.

Similarly, the SNAP cuts will cause hundreds of thousands of food insecure people to fall deeper into the abyss of hunger and poverty.

Given this reality, it’s no wonder that so many people already living on the edge are experiencing one of the worst immediate impacts of the mega-bill’s passage: simple terror over what their future holds.

And the utter cruelty involved in intentionally giving rise to such a situation is almost impossible to overstate.