By Bill Graham

President Trump has launched into his second term determined to revitalize our economy and restore upward mobility for hard-working, blue-collar Americans. From day one, he has demonstrated that a vital aspect of his mission is to defend working families’ access to high-quality healthcare. That’s why President Trump has repeatedly pledged not to cut core programs for the American people including Social Security, Medicare and Medicaid.

Health insurance should not be a luxury reserved for elites and higher-income households. It is a necessity. Reliable coverage allows North Carolinians to receive care when they need it and protects them from exorbitant costs. Additionally, it contributes to the overall health of our state and alleviates financial burdens that would otherwise strain our local healthcare facilities and impact taxpayers.

Medicaid covers more than 2.6 million North Carolinians who rely on it to be able to see their doctors, fill prescriptions or receive urgent care for an injury or illness. Enrollment spans every corner of our state and all walks of life. About 40 percent of North Carolina children are insured by Medicaid or CHIP. It pays for 38 percent of births in our state. Five out of eight nursing home residents count on Medicaid for care that allows them to live independent, full lives. So do almost a third of adults with disabilities who are not elderly.

Medicaid is essential everywhere, but it fills an especially big need in our rural communities, where people often have even fewer coverage options. North Carolina has the second largest rural population in the U.S. About one out of every three residents live in rural areas. And in some rural counties, an outright majority of the population is insured through Medicaid.

Medicaid doesn’t just support the patients it covers. It helps uphold our entire healthcare system so it works for everyone. Medicare and Medicaid already under-reimburse local hospitals, only paying hospitals an average of 83 cents for every dollar they spend caring for patients, but even still they represent major, essential funding streams that keep many local hospitals open and able to serve patients. One recent report found that 19 percent of hospital services are covered by Medicaid alone. Another study revealed that Medicaid and Medicare collectively make up more than half of rural hospitals’ entire net revenue.

Many of our rural hospitals face serious financial challenges — more than one quarter of North Carolina’s rural hospitals are already at high risk of closing because of financial pressures, and since 2005, 11 rural hospitals have either closed or stop providing inpatient care — the third highest number in the U.S. These hospitals would struggle to absorb Medicaid cuts at any level, and the cuts currently under debate may be too much for them to overcome.

Rural hospitals “rely on Medicaid payments to literally keep the lights on,” one research professor from Georgetown University recently cautioned. “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.”

As Congress approaches finalizing a budget agreement, I encourage North Carolina’s senators and representatives to carefully consider the potentially cascading impacts that Medicaid cuts would have here at home and across the country. A strong economy is built on healthy communities. This begins with upholding President Trump’s promise to protect Medicaid and ensuring that individuals and families from all walks of life, at all income levels, can access the coverage and care they need.

Bill Graham is a former gubernatorial candidate.