After two decades leading the Blue Ridge Regional Hospital system and now serving on boards focused on economic development locally and across North Carolina, I see health care as critical for our communities for two reasons: it cares for the well-being of our people, and it serves as a critical piece of infrastructure that sustains our local economies.
This is why I’m concerned about some provisions in the U.S. House reconciliation bill (H.R. 1) that would destabilize our health care system. These provisions would weaken the individual health insurance marketplace and, in doing so, threaten our state’s economic resilience.
Over the past 50 years, here in Western North Carolina, a lot of our economy has changed. We’ve seen our larger manufacturing facilities replaced with small businesses. Many of these smaller businesses, as well as our farmers and other working families, often don’t have access to employer-sponsored health care coverage, so the individual marketplace is a critical lifeline for many of these folks who purchase their own health insurance.
These hardworking North Carolinians who use the marketplace for care often rely on the enhanced premium tax credits, which keep affordable health care within reach for many people by keeping premiums low. H.R.1 does not extend these tax credits.
In fact, more than 900,000 North Carolinians rely on these tax credits. For a working family of four earning around $64,000 annually, the loss of these credits could mean premiums that more than double – an increase of over $2,500 a year. That’s not theoretical. That’s rent, groceries, or a college credit. And it could drive many to drop coverage altogether.
Western North Carolina is already struggling with significant fiscal challenges due to ongoing Hurricane Helene recovery efforts. Now is not the time to hit workers and families with higher health insurance premiums that could, for many rural and low-income households, put health care coverage out of reach.
I’ve seen what happens when people lose their coverage. Inevitably, they delay care until it becomes an emergency, driving up costs and straining emergency departments that are already overextended. For rural hospitals like the one I led, this dynamic creates financial instability and threatens the viability of the very institutions that communities count on in times of crisis.
This is a health crisis in the making. It’s also setting the stage for an economic crisis. As a board member of two economic development organizations, I work to attract new investment to our region and support the small businesses that are the backbone of our state economy. Health care access is a top concern for small businesses, farmers and entrepreneurs. Without stable and affordable coverage options, it becomes harder for small business owners to stay afloat.
H.R. 1 also proposes unnecessary administrative hurdles, like funding cost-sharing reduction (CSR) payments, eliminating auto-enrollment, and imposing strict income-verification rules that make it harder for people to sign up and stay covered. These are not “cost-saving measures,” as they are called. They are arbitrary barriers that inject chaos into a system that needs stability, especially in rural America.
We don’t need new obstacles to affordable health care – we need common sense policy. Extending the enhanced tax credits keeps people insured, reduces uncompensated care, and supports the financial health of rural hospitals and small businesses alike. It’s best for health. And it’s the fiscally responsible thing to do.
I urge Senator Tillis and Senator Budd – and all members of Congress – to reject this harmful provision in H.R.1 and stand up for the working families, small business owners, and rural hospitals that depend on a stable, affordable health care system. Health care is critical for North Carolina’s economic infrastructure. We must protect it.
Keith Holtsclaw is the former CEO of the Blue Ridge Regional Hospital and now serves as a board member for local and state economic development organizations.
