ASHEVILLE, N.C. (828newsNOW) — A sweeping Republican-backed overhaul of the national social safety net, signed into law by President Donald Trump on July 4, is sending shockwaves through rural Western North Carolina, where health leaders warn that steep Medicaid cuts could force hospitals to close and strip vital services from underserved communities.

The 900-page legislation, dubbed the “Big Beautiful Bill,” will slash Medicaid spending by $1 trillion over the next decade, reduce access to food assistance and roll back parts of the Affordable Care Act, while also delivering broad tax cuts and enacting the largest investment in immigration enforcement in decades.

However, critics of the BBB, including top North Carolina officials, are sounding the alarm over its projected consequences for rural health systems, especially in WNC.

“This law is a disgrace,””said North Carolina Gov. Josh Stein, a Democrat. “More than half a million people stand to lose their health care. We cannot simply accept these harmful impacts.”

An analysis by the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill found that more than 300 rural hospitals nationwide are at risk of closure under the law. Among them are two in Western North Carolina: Angel Medical Center in Franklin and Blue Ridge Regional Hospital in Spruce Pine, both of which operate on slim financial margins and depend heavily on Medicaid reimbursements.

Health care providers, including not-for-profit systems like AdventHealth, say they are reviewing the impact of the legislation and working to preserve access to services.

“Our focus remains on maintaining access to care,” AdventHealth said in a statement. “We have historically absorbed significant coverage shortfalls to ensure essential health care services for our communities.”

The nonpartisan Congressional Budget Office estimates that the law will leave 11.8 million more Americans uninsured by 2034 and eliminate SNAP benefits for 3 million people. Democrats have dubbed the law the “Big Ugly Bill,” arguing that it favors the wealthy with disproportionate tax relief while leaving working families with higher health costs and fewer options.

North Carolina Health and Human Services Secretary Dev Sangvai warned that the Medicaid changes could siphon billions from the N.C. economy and lead to a health crisis in underserved regions.

“[These cuts] will result in billions being taken out of our economy and undermine the health of North Carolinians,” Sangvai said.

The legislation includes a $50 billion rural hospital support fund and phases in Medicaid changes over eight years, but advocates say those provisions are unlikely to stave off the damage.

Chip Kahn, president of the Federation of American Hospitals, called the cuts “drastic” and warned that they could “slash health coverage for millions” and “threaten entire communities’ access to care.”

Still, the Republican congressional delegation of WNC has defended the law. Rep. Chuck Edwards (R-N.C.), whose district includes much of the region, praised it as fiscally responsible reform.

“H.R. 1 does not cut Medicaid. It reinforces it,” Edwards said. “The bill addresses much of the waste, fraud, and abuse that has caused costs to balloon out of control by 60% over the past five years.”

Democratic congressional candidate Moe Davis disputed that claim, saying more than 650,000 North Carolinians could lose Medicaid coverage by 2027.

I hope they’re told who is responsible before the next election, Davis said.

“So they know who is responsible for the cruelty and stupidity when they cast their votes.”

In Henderson County, UNC Health Pardee said it is still evaluating the impact of the law but acknowledged the challenges ahead.

“While we certainly recognize the significance of the recently passed H.R. 1 … until we have been able to review the bill’s specific measures and timelines … we do not feel it is appropriate to speculate,” the hospital said in a statement. “What we know with certainty is that the legislation does not change what we do or who we serve.”

The hospital also warned that new Medicaid work requirements, eligibility checks, and restrictions on managed care payments could lead more patients to forgo preventive care and rely on emergency services — increasing financial strain on already-stretched rural systems.

While UNC Health is assisting Pardee in navigating the changes, hospital leaders said the law’s long-term consequences could force difficult decisions about services and staffing.

As the nation prepares for major changes to health care delivery, the battle over H.R. 1 is expected to shape political debates ahead of the 2026 midterm elections. For now, rural health providers in Western North Carolina are bracing for an uncertain future.

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