As the end of September 2025 approaches, health care policy debates are reaching a fever pitch across the United States, with the fate of millions of Americans’ coverage hanging in the balance. From the halls of Congress in Washington, D.C., to statehouses in North Carolina and Maine, lawmakers, health care advocates, and everyday citizens are locked in a high-stakes struggle over Medicaid funding and the extension of crucial health insurance subsidies. The looming threat of government shutdowns and drastic budget cuts has turned these issues from abstract policy disputes into urgent, real-world crises for families, providers, and communities.
In North Carolina, the situation has grown particularly dire. On September 25, 2025, Governor Josh Stein delivered a scathing critique of state lawmakers, accusing them of “playing political games instead of coming to an agreement” on the state’s Medicaid budget, according to WTVD. With no deal in sight and the General Assembly out of session until October, Stein warned that sweeping Medicaid cuts would take effect on October 1, affecting nearly 3 million enrollees. These cuts, ranging from 3% for home health and ambulance services to 10% for hospitals, nursing homes, and hospice care, could have devastating consequences for patients and providers statewide.
“This will lead to longer wait times, delayed diagnoses, and worse health outcomes for the patients of our state, especially for those who live in rural communities and who are already marginalized and underserved,” said Dr. Jenna Beckham, an OB-GYN who spoke at a Raleigh health care clinic. The uncertainty has left providers questioning whether they can continue serving Medicaid patients, while families worry about losing access to essential care.
Stein’s administration has been sounding the alarm for weeks, pointing to a $319 million shortfall in Medicaid funding despite additional appropriations approved earlier in the summer. Without further action, the Department of Health and Human Services has been directed to identify “reversible” cuts, hoping that funding can be restored before long-term damage is done. “The General Assembly has failed you, but it is not too late for them to step up and do the right thing,” Stein said, urging lawmakers to return and pass a clean bill to keep Medicaid running.
The budget impasse centers on disagreements between House and Senate Republicans. The Senate has pushed to allocate $208.5 million in federal funds toward building a new children’s hospital in Wake County and investing in rural health, while the House has balked, questioning the necessity of a new hospital and advocating for broader budget negotiations. Senate Majority Leader Michael Lee insisted that the projects were previously agreed upon, while House Speaker Destin Hall countered, “Why would we give hundreds of millions of dollars to a new hospital in Wake County that’s doing pretty good economically?” The standoff has left the state government budget three months overdue, with no resolution in sight.
At the federal level, the stakes are just as high. On September 25, U.S. Representative Deborah Ross of North Carolina joined a panel of health care advocates to urge the public to contact Congress and demand action on two fronts: reversing Medicaid cuts and extending enhanced tax credits for health insurance premiums. The U.S. Senate was set to reconvene on September 29 to debate measures to avert a government shutdown, but Democrats warned that failure to act could trigger a cascade of negative effects.
“The Senate had more senators vote to extend the tax credit and protect Medicaid than to let the costs go into effect,” Ross said, as reported by NC Newsline. She emphasized the urgency of making changes before open enrollment begins, noting, “It will be mass confusion and we know who will be to blame for it, and that is the Republicans in Congress.” The Congressional Budget Office has projected that without an extension of the Affordable Care Act’s enhanced subsidies, the number of uninsured Americans will rise by 2.2 million in 2026.
Personal stories brought the stakes into sharp relief. Shannon Dingle, a Medicaid recipient whose teenage daughter has cerebral palsy, described how the Medicaid waiver program allows her daughter to live at home and attend school in Raleigh. “We were praying about it, we were trying to figure out where we could bring things together, and I believe that God answered by providing Medicaid, by providing the waiver program that allows her to live and thrive at home and go to school here in Raleigh,” Dingle shared. However, she noted that the renewal process has become more burdensome, requiring additional documentation and references despite no change in her daughter’s needs. “This is about people who, like my daughter, deserve health care and shouldn’t have to be paying more or going without because they can’t pay the bill.”
Health care leaders echoed concerns that cuts would ultimately drive up costs for everyone. Scot McCray, CEO of Advance Community Health, offered a stark example: “Instead of going to us for a nominal fee of $40 for a comprehensive physical on our slot fee, no difference, $40, that same patient can end up at an [emergency department] on average for $1,200, with no insurance and no cash to pay.” He argued that the system’s failure to find long-term solutions only perpetuates a costly, inefficient cycle.
Meanwhile, in Maine, the debate over health insurance subsidies has become a flashpoint. On September 26, advocacy groups and faith leaders pressured U.S. Senator Susan Collins to support an extension of premium tax credits that help lower costs for people buying coverage through the Affordable Care Act marketplace. According to Maine Morning Star, about 85% of the 61,000 Mainers enrolled through the state’s CoverME.gov marketplace rely on these credits, which are set to expire at the end of the year. Without them, some could see premiums spike by as much as 117% in 2026.
Senator Collins, who chairs the Senate Appropriations Committee, said she supports extending the credits but prefers to address them outside the must-pass government spending bill. “It is clear that we need to act on this issue, but our focus right now needs to be on avoiding a harmful government shutdown that would cause disruptions to vital programs that many Americans rely on every day,” Collins said in a statement. However, Democrats and advocacy groups argue that waiting could leave Mainers exposed to unaffordable premiums and coverage gaps, especially with finalized 2026 rates showing average increases of 23.9% for individual plans and 17.5% for small employers.
Faith leaders, including Rev. Tara Humphries of Allen Avenue Unitarian Universalist Church, framed the issue as a moral imperative. “We are individuals, part of something much larger and more deeply connected than our own selves, and justice calls us to consider that when making decisions that impact the whole. So, I hold my elected officials accountable when they fail to act in the best interest of their most vulnerable constituents.”
As the clock ticks down to critical deadlines, the debate over health care funding has exposed deep divisions—not just between political parties, but also over fundamental questions of responsibility and priorities. For millions of Americans, the outcome will determine whether they can afford to see a doctor, fill a prescription, or care for a loved one with special needs. The decisions made in the coming days will ripple far beyond legislative chambers, shaping the health and well-being of communities for years to come.
