Union County on the brink of facing medical budget cuts

UNION COUNTY, N.C. — The North Carolina Senate is reviewing the 2025 Appropriations Act (Senate Bill 257) that may create major deficits in healthcare services across North Carolina, including Union County.

In 2023, North Carolina passed the State Appropriations Act, which included about $11.2 million in state funding for free and charitable clinics across the state from 2023 until this year.

The bill was presented as a way to make base budget appropriations for current operations of state agencies and was led by N.C. House representative Dean Arp.

Now, a new version of the state appropriations act is going back and forth between the state Senate and House. Possible budget cuts referenced in the bill are tightening the resources that Union County relies on and may leave many people across the state without health insurance.

The budget in the bill allocated $11.2 million in one-time funding over two years to clinics across North Carolina. It specifically allocates targeted grants for specific clinics or regions, but lacks an equitable funding mechanism for the full network of 70 free and charitable clinics.

HealthQuest of Union County Executive Director Christina Olmstead had been watching to see what the outcome of the bill would be since she stepped into the role in October 2024.

The U.S. House Budget for Medicaid cuts include $625 billion, which could cause up to 496,000 North Carolina citizens to lose coverage. In Union County, 34,000 citizens could lose coverage.

"What we're seeing back and forth is that free uncharitable clinics across the entire state of North Carolina have not been included in the state funding for this next fiscal year," Olmstead said.

This includes HealthQuest of Union County, which is having to do most of the work.

HealthQuest is a recipient of state appropriated funding through NCAFCC and Charitable Clinics. However, it is not specifically listed as an individual entity on a line item in the budget, Olmstead said.

"Across the state, we would be looking at decreased funding," Olmstead said. "We have our state that's saying, 'Hey, we're going to reduce the funding for free charitable clinics.' At the same time, we have our federal response saying that we might be seeing Medicaid cuts coming down the pipeline."

Patient impacts

Olmstead said when customers visit HealthQuest of Union County, they are usually not in their best health.

"Their health is failing, they're looking at a very, very serious diagnosis or a chronic condition," she said. "When they find us and come to Health Quest, we not only help them with their health, but we get them connected to all of the other nonprofits in the area too."

One customer's mother was visiting from outside of the country when she suffered a stroke. And unfortunately, on day three of their vacation, she was in the hospital. When they were trying to release her mother, they let her know that to prevent an additional stroke, she needed a medication that was going to cost $600 a month. For that family at that time, that was horribly out of reach of their financial budget.

"They were left with the decision of, 'What do we do?'," Olmstead said. " 'Do I have to potentially watch my mom pass away from another stroke? Or do I have to possibly limit the food rations in my house for my children?' Nobody should have to make that choice. No one should have to choose between basic needs and their health. And those are the types of stories that we're seeing coming through."

Another customer picks up prescriptions for both of his parents at HealthQuest of Union County who are unable to work, but are not quite old enough to qualify for Medicaid. This family make barely enough not to receive assistance, but not nearly what they need to afford insurance or their prescriptions.

"If they had to pay it out of pocket for those prescriptions, they would be looking at more than $1,300 a month," Olmstead said. "That's more than a mortgage payment in most cases."

Other deficits

While HealthQuest of Union County is focused on helping the whole person in every client, they are using every resource to educate customers on the impacts they may face from budgets Senate Bill 257.

There may also be increased strain of services in emergency rooms and a higher number of preventable clients in the emergency departments.

That means patients may have to wait longer times if a individual have a medical emergency. It looks like increased cost for the community. It looks like more uncompensated care that's putting a strain on our healthcare system.

That may also create higher healthcare costs for everyone, including insured residents.

"What happens is you have all of these costs coming from preventable, uninsured members of our community," Olmstead said. "If they could be prevented, they don't have to pass on those costs to those that do have insurance. If we have people who are chronically ill, they're not getting treated and they can't go to work."

Paying close attention

The N.C. House passed the third reading of Senate Bill 257 on May 22 with a vote of 86-20 before a failed vote by the senate to hold a second reading of the bill was recorded on June 3.

While the results of the bill are out of Union County's control, "the only thing that we can do is acknowledge it, adapt to it, and be creative with our solutions as we move forward and continue supporting everyone in our community," Olmstead said.

Olmstead said the state and Union County are in a "awkward limbo period" of figuring out if clinics across the state will receive state appropriations or not.

"The question becomes; will (the) state budget fill the gap to meet current and projected needs in the face of federal budget changes?," Olmstead said. "Unfortunately, this is a question we do not have an answer to as the NC Senate and House work towards an agreement."

"Best case scenario, we'll see a reduced dollar amount over the next few years," Olmstead said. "Worst case scenario, we won't have any funding from the state. And that's just not Health Quest."

Regardless, Olmstead is focused on helping each customer identify their needs to survive.

"I am acknowledging as a new leader in a very tumultuous time that we have a lot of challenges ahead of us, but there's one thing I'm confident about is this community," Olmstead said.

"We're neighbors, whether the state budget passes or not, whether it includes us or not," Olmstead said. "The first step is to remember that we are all neighbors in the same community. By looking at the positives and looking at the future, I think that's one of the best tools we have."