What happens when a single vote in Congress means 260,000 North Carolinians might have to stretch their grocery budgets even further? That’s the reality now facing the state, as President Trump’s “One Big Beautiful Bill Act” is set to slash federal support for both SNAP and Medicaid—two programs that have long served as lifelines for low-income families and rural communities.
The numbers are stark. SNAP, which helps over 1.6 million North Carolinians—including nearly 650,000 children—put food on the table, is on the chopping block. According to the Food Research and Action Center, the average participant in North Carolina received just $173 a month last year, or about $5.69 a day. For every meal a food pantry provides, SNAP delivers nine—so when benefits shrink, food banks simply can’t fill the gap. “If there were to be about a 10% cut to SNAP the food bank would have to provide upwards of 13 and a half million meals a year. For our food bank that’s not sustainable, it’s not possible,” the Food Bank of the Albemarle warned in a statement quoted by the Center for American Progress.
The strain is already visible. Food insecurity has climbed to 13.5% of U.S. households, with rural and Southern states like North Carolina hit hardest. As Feeding America’s latest “Map the Meal Gap” shows, food insecurity has risen in all 50 states since 2021, and the end of pandemic-era expansions to SNAP only accelerated the trend. In North Carolina, one in six rural residents has relied on SNAP, compared to one in nine in urban areas. Local food pantries are bracing for longer lines and emptier shelves as federal dollars dry up, echoing the words of Nourish Up’s Tina Postel: “We’re not serving lobster in our pantry.”
But the bill’s impact goes beyond food. Medicaid cuts are poised to hit rural North Carolina especially hard. More than 1.2 million rural residents depend on Medicaid, and 39% of the state’s Medicaid beneficiaries live in rural counties. As the Center for Children and Families at Georgetown University found, some rural counties have more people on Medicaid than voted in the last election—a testament to just how vital the program is for local health and economies. Medicaid covers nearly half of all births in rural North Carolina and pays for over 60% of nursing home stays statewide. When Medicaid funding shrinks, rural hospitals—already struggling—face even greater risk of closure. “If you slash Medicaid funding for North Carolina, some of these hospitals that depend on Medicaid reimbursement are going to close, and that has health impacts for people in rural areas who have nowhere else to go,” said Georgetown’s Leonardo Cuello.
The Congressional Budget Office projects that the Senate bill would reduce federal Medicaid spending by $1.04 trillion over ten years, resulting in 11.8 million more uninsured people nationwide (source). In North Carolina, Medicaid expansion just last year added over 600,000 newly eligible residents—many of them working adults in rural areas. Now, those gains are at risk.
Advocates point out that the trade-offs in the tax bill are sharp. Yes, the legislation expands the child tax credit, increases deductions for tips and overtime, and temporarily raises the cap on state and local tax deductions. But these benefits are paired with deep cuts to SNAP and Medicaid, programs that have proven to reduce poverty, improve health outcomes, and support local economies (source). According to the Tax Policy Center, the wealthiest 20% of households will see the largest tax breaks, while the lowest-income families could actually lose income after factoring in lost benefits (source).
North Carolina has tried to innovate in rural healthcare, piloting Medicaid waivers and telehealth expansions to keep care accessible. The Senate bill does include a $50 billion rural health fund, but experts say it’s dwarfed by the $155 billion in projected Medicaid cuts to rural areas over the next decade (source). As Mark Holmes of UNC Chapel Hill put it, “Medicaid decreases the uncompensated costs that hospitals are covering. We might call this ‘charity care’ in a more layperson kind of language, but the notion is that if you are sick and you go to the emergency room, they’re going to take care of you. And if you have Medicaid, then hospitals are getting money for it.”
The coming months will test the resilience of North Carolina’s safety net. As food banks, rural hospitals, and advocacy groups brace for the fallout, the question remains: how will communities adapt when the federal lifelines they’ve relied on for decades are suddenly pulled tighter than ever before?
