Of the many changes that President Trump and the current GOP majorities in Congress have enacted over the last year, perhaps none will have consequences as far-reaching as the dramatic rollbacks to healthcare access and affordability. Women in North Carolina will bear the brunt of these changes, since they disproportionately depend on Medicaid and the Affordable Care Act (ACA). Attacks on reproductive health care, including prenatal and maternity care under Medicaid, as well as cuts to children’s health care, make it harder for women to stay healthy and protect their families.
The President’s signature legislative achievement so far, the One Big Beautiful Bill Act, makes historic cuts to Medicaid that will ultimately result in more than 10 million people losing coverage nationwide, the closure of dozens of rural hospitals and clinics, and the loss of over half a million health care jobs. Health care is the fastest growing job sector and one in which women make up three-fourths of the labor force.
After decades of expanding coverage and bringing the number of uninsured people to record lows, Republicans in Congress are reversing course: millions of people will lose access to health care coverage and millions more will pay double or triple for the same policy because of new changes to the ACA, the landmark 2010 law that turns sixteen this year.
Just as the ACA reached record enrollment in 2025, the refusal to extend the enhanced premium tax credits is forcing many to drop their coverage. Over 90% of ACA enrollees received premium tax credits in 2025 to make their insurance more affordable. Thanks to increased affordability, ACA enrollment in North Carolina grew to 975,110 last year.
But now that’s history – though it is neither the kind of history we want to celebrate during Women’s History Month nor on the ACA’s March 23rd birthday.
The impact of these changes will be devastating. About 74,000 in North Carolina are projected to lose coverage because of the loss of the premium tax credits. Between the changes to the ACA and the nearly $1 trillion in cuts to Medicaid, 589,000 will lose health coverage by 2034. And, just like during President Trump’s first term, when cuts to Medicaid and the ACA were likewise his top priority, he still has no replacement for the ACA or any new options for comprehensive, affordable care that will provide coverage and protect people from medical debt.
My life was literally saved by access to the Affordable Care Act, which made it possible for me to treat my diabetes without having to ration or skip doses. For two years when I didn’t have insurance, I was rushed to the emergency room four times with dangerously low blood sugar levels. Relying on the emergency room as a primary health care provider is dangerous, expensive for individuals and taxpayers, and far less frequent for those who have health insurance.
To add insult to injury, while thousands forgo coverage, delay treatment and rack up debt, prescription drug, insurance and hospital corporations will see bigger profit margins from these price hikes enabled by the GOP. The President rails against the greed of insurance companies and drug corporations, but he has done nothing to stop them from raising their prices. On the contrary, he has extended big tax breaks for corporate shareholders and created even more tax loopholes that reward big corporations for price-gouging consumers.
Instead of punishing corporate greed, the President and the GOP are doubling down instead on attacking Planned Parenthood–a critical source of healthcare, particularly in underserved areas. The new law bans Medicaid funding for all clinics that provide abortion even if abortion is a tiny fraction of the services they provide. Half of all Planned Parenthood patients are covered under Medicaid and the vast majority are not seeking abortion, but rather cancer screenings, STD treatment and pre-natal care.
Medicaid is the nation’s lead payer of birth control, coverage for pregnant women and births. After birth, Medicaid pays for up to a year of postpartum care in most states, including North Carolina, and for the child’s health care. These attacks on Medicaid and the ACA make reproductive health care harder to access.
The federal cuts to Medicaid may put these services, and also SNAP benefits, out of reach. Millions of families with children depend on SNAP to put food on the table. Under the OBBBA, food stamps are cut back very substantially. An Urban Institute report estimated that the SNAP cuts would affect 3.3 million families with children and reduce their benefits by an average of $840 per year.
This March, instead of celebrating the contributions of ACA coverage and Medicaid expansion to women’s health care improvements, millions of women in North Carolina are experiencing first-hand reversals in progress under new federal laws that put healthcare at risk for the foreseeable future.
Jean Busby is the director of Action NC’s Senior Organizing Network
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