How an empty North Carolina rural hospital explains a GOP senator's vote
against Trump's tax bill
[July 03, 2025]
By AMANDA SEITZ
WASHINGTON (AP) — Though patients don't rush through the doors of this
emergency room anymore, an empty hospital in Williamston, North
Carolina, offers an evocative illustration of why Republican Sen. Thom
Tillis would buck his party leaders to vote down President Donald
Trump's signature domestic policy package.
Martin General is one of a dozen hospitals that have closed in North
Carolina over the last two decades. This is a problem that hospital
systems and health experts warn may only worsen if the legislation
passes with its $1 trillion cuts to the Medicaid program and new
restrictions on enrollment in the coverage.
Tillis' home state showcases the financial impact that more Medicaid
dollars can have on hospitals in rural and poor regions throughout the
country. Tillis said in a floor speech on Sunday, explaining his vote,
that the GOP bill will siphon billions of dollars from Medicaid
recipients and the health system in his state.
“Republicans are about to make a mistake on health care and betraying a
promise,” said Tillis, who has announced he will not seek re-election
because of his opposition to the bill. Along with Republicans Susan
Collins of Maine and Rand Paul of Kentucky, he joined all Democrats in
voting against the bill.
Tillis later accused the president and his colleagues of not fully
grasping the full impact of the bill: “We owe it to the states to do the
work to understand how these proposals affect them. How hard is that? I
did it.”
For Martin General Hospital in Williamston, North Carolina’s decision to
expand Medicaid came just too late. The emergency room abruptly closed
its doors in the eastern North Carolina county that's home to more than
20,000 people in August 2023. The closest hospital is now about a
30-minute drive away.
Then-Democratic Gov. Roy Cooper faulted the state's failure to expand
the Medicaid program to more low-income adults sooner to prevent Martin
General's closure.
North Carolina began offering Medicaid expansion to its residents in
December. Today, more than 673,000 people are receiving this coverage.
Now, Tillis and other state officials are worried the Republican bill,
which will limit how much Medicaid money is sent back to providers,
threatens funds for hospitals in their state again. And it could trigger
a state Medicaid law that would close down North Carolina's otherwise
successful expansion of coverage unless state legislators make changes
or locate funds.
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The vacant Martin County General Hospital sits abandoned behind a
chain since being closed in August of 2023 in Williamston, N.C.,
shown, April 10, 2024. (AP Photo/Karl B DeBlaker, File)
 The Medicaid dollars that
Republicans seek to scale back in their bill have helped buttress
the remaining rural hospitals across North Carolina, said Jay Ludlam,
a deputy health secretary who leads North Carolina Medicaid.
“This has been a lifeline for our rural hospitals here in North
Carolina and has helped provide and keep them open,” Ludlam said.
“Rural hospitals play an integral role in communities both as a
point of access for health care but also for the local economy
because of the contributions that those hospital and hospital
systems make to those communities.”
Republicans have responded to concerns with a provision that will
provide $10 billion annually to rural hospitals for five years, or
$50 billion in total.
Around the country, 200 hospitals have closed or shuttered emergency
services in the last two decades, many of them in red states across
the southeastern and midwestern U.S.
States that have declined to expand Medicaid coverage, the health
insurance program for the poorest of Americans, have seen the
closures accelerate. Tennessee, for example, has shed 500 beds since
2014, when a federal law first allowed states to expand Medicaid
coverage to a greater share of low-income people. It’s one of 10
states that has not expanded Medicaid.
More than 300 hospitals could be at risk for closure if the
Republicans' bill becomes law, an analysis by the Cecil G. Sheps
Center at the University of North Carolina at Chapel Hill found last
month. The center tracks rural hospital closures.
“Substantial cuts to Medicaid or Medicare payments could increase
the number of unprofitable rural hospitals and elevate their risk of
financial distress,” the analysis concluded. “In response, hospitals
may be forced to reduce service lines, convert to a different type
of health care facility, or close altogether.”
—
Associated Press writer Gary D. Robertson in Raleigh, North
Carolina, contributed to this report.
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