CHARLOTTE — North Carolina Black Alliance representatives were on the ground during the national NAACP convention here earlier this month.

During a session on the state of America’s democracy, U.S. Rep. Lauren Underwood, from Illinois, urged audience members to get a copy of the Constitution and read it.

“We have to know our rights,” said Underwood, the first non-white person and first female to serve Illinois’ 14th congressional district. “We spend so much time talking to immigrant communities about knowing their rights, and we walk around and we don’t know ours. And it’s a problem. If something happens, you’ll be like, ‘That’s not right.” Well, how do you know? Let’s know our rights.”

Underwood told attendees they can help initiate a course correction within American democracy both through face-to-face meetings and at town-hall settings with their congressional representatives.

“If they don’t do town-hall meetings, then pull up on ’em at an event, OK? They’ll be so pressed to take a picture with you because they know they need to take a picture with a Black person,” Underwood said.

The convention’s theme was The Fierce Urgency of Now.

Impact on the Economy

North Carolina taxpayers, low-income individuals and everyone in between will be affected by the newly passed federal tax and spending bill. The 2017 Tax Cuts and Jobs Act (TCJA) is set to expire after 2025. As a result, this new tax and spending bill restores favorable corporate tax treatment, while significantly impacting Black North Carolinians economically over the next four years and beyond. Here’s a breakdown of the key economic impacts.

Taxes

The new law introduces tax exemptions for overtime pay and tips, a deduction for auto loan interest, and an additional standard deduction available for some seniors, all of which violate basic tax principles of treating taxpayers equally.

Corporations and businesses will be able to write off the cost of research and development and the cost of equipment in the first year it was purchased. Manufacturers will be allowed to fully deduct the cost of building new manufacturing facilities.

Wealthy Americans will benefit far more from the tax package than those lower on the income scale. While all households will see their taxes reduced, some 60% of the benefits will go to those making $217,000 or more (the top 20%). These households will receive an average tax cut of $12,500, or 3.4% of their after-tax income. The lowest-income households, who earn about $35,000 or less, will receive an average tax cut of only $150, less than 1% of their after-tax income. Middle-income households will see their taxes reduced by about $1,800, or 2.3% of their after-tax income, on average.

The state and local tax deduction known as SALT will be raised from $10,000 to $40,000 for five years. This provision will primarily benefit upper-middle-income earners since lower earners typically do not itemize deductions for income and property taxes.

Employees who work in jobs that traditionally receive tips could deduct up to $25,000 in tip income from their federal income taxes, while workers who receive overtime could deduct up to $12,500 of that extra pay. Under the new law, the child tax credit will permanently increase to $2,200. The current $2,000 child tax credit was set to return to its pre-2017 level of $ 1,000 in 2026.

National Deficit

Lowering the amount of tax revenue the country collects, while increasing spending on defense and immigration enforcement, will contribute to an increased debt limit. The Congressional Budget Office (CBO) estimates the bill will add over $3 trillion to federal deficits over the next 10 years. Black North Carolinians will feel the consequences of the nation’s ever-growing debt in their wallets. The CBO estimates the bill will potentially increase interest rates. That could make mortgages, car loans and credit card payments more expensive. Congress will need to address the debt limit in the coming weeks. The U.S. could be unable to pay its bills as early as August, which could lead to another government shutdown standoff.

Impact on health care

Ingrained in the Big “Beautiful” Bill are deep cuts that will unravel the progress North Carolina has made to expand healthcare access and fight food insecurity. Programs like Medicaid and Supplemental Nutrition Assistance Program are lifelines for Black, brown, and rural communities. In North Carolina, an estimated 3 million people rely on Medicaid coverage. Under Medicaid Expansion, this number grew, providing approximately 600,000 people with access to affordable care, with copays capped at $4. In the first month of launching Medicaid Expansion in North Carolina in December 2023, Black people made up 38.1 percent of those enrolled, even though we only make up 22.1 percent of the state population. Medicaid cuts will strip away coverage for hundreds of thousands of North Carolinians who only recently gained coverage through expansion. Alongside these cuts, reductions to SNAP benefits will undercut one of the most critical tools we have to reduce hunger, leaving families to navigate higher grocery costs and fewer healthy options in communities where fresh food access is already limited. Affordable health insurance and access to care create healthier outcomes. There’s nothing big or beautiful about a bill that will lead to 579 avoidable deaths in North Carolina per year.

Pushing working families, seniors, and rural communities back into the coverage gap will do more than hurt individual lives — it will undermine the backbone of our state’s health infrastructure. Reduced coverage will increase the amount of uncompensated care provided by hospitals in our state. The financial strain from high levels of uncompensated care is what drove 12 hospitals within the last 20 years to close in North Carolina, with Martin General Hospital being the state’s most recent closure. This policy will devastate more healthcare systems in rural communities. Five rural hospitals–UNC Rockingham Hospital in Eden, Person Memorial in Roxboro, Chatham Hospital in Siler City, Angel Medical Center in Franklin, and Blue Ridge Region Hospital in Spruce Pine–have already been identified as at risk of closure or severe service reductions due to Medicaid cuts. North Carolina is no stranger to climate disasters like hurricanes and tropical storms. As our communities continue to grapple with environmental harms like drinking water contamination, repeated climate disasters, and flooding, the loss of healthcare facilities compounds risk and erodes resilience when the next storm hits.

Impact on the Environment

The catch? Everyone’s impacted, one way or another. By repealing federal funding for domestic electric vehicle manufacturing, as well as the Greenhouse Gas Reduction Fund and the Inflation Reduction Act (initiatives that encouraged clean energy and environmental justice), the Big “Beautiful” Bill undermines clean energy initiatives, while incentivizing fossil fuel expansion and simultaneously creating more pollution and an energy burden. The bill reduces energy capacity by 330 Gigawatts (GW) over the next 10 years; for context, 1 GW can power a medium-sized city (~100,000-500,000 people) per GW, with approximately 165 million people affected, meaning higher energy costs and energy burdens passed on to the consumer. This in conjunction with removal of Clean Air Act and air monitoring initiatives, further affects communities leading to higher rates of asthma, respiratory illnesses, and diseases, while also removing funding for Medicaid and SNAP thus disproportionately affecting Black, Brown, and low-income neighborhoods even more by limiting their ability to live adequate, healthy lives.

This budget bill also encourages fossil fuel production in the wake of removing environmental regulations and clean energy initiatives, resulting in higher emissions. This is approximately 310 metric tons of carbon dioxide over those same 10 years. Phasing out clean energy opportunities, such as solar and wind, while funding the fossil fuel industry can only lead to further pollution, in turn fueling more extreme weather events, including hurricanes and flooding, heatwaves, and wildfires, as well as diseases. This bill also rescinds methane emissions reduction programs for oil and gas, eliminates funding for EPA climate monitoring, low-emissions electricity programs, methane waste mitigation, climate justice, and resilient programs, and terminates renewable energy tax incentives. Overall, this budget bill represents a drastic step away from protecting people and the environment, and a stark pivot toward investing in industries that will have the opposite effect.

WILLIAMSTON, N.C. — Elected officials in the North Carolina General Assembly are unable to agree on funding priorities for the people who sent them to the legislature. A final working version of the state budget isn’t expected until late July or August, according to an official close to the money talks. It means to date, there is no guaranteed line item to fund the reopening of Martin General Hospital.

Martin County commissioners are considering a pitch from ECU Health to reopen Martin General as North Carolina’s first rural emergency hospital. It’s a hard-and-fast pitch — no money, no hospital, ECU Health CEO Michael Waldrum said.

“It’s very important that the state helps us with this,” Waldrum said. “We’re so fortunate to have legislators that understand these issues and that they are committed to having a rural emergency hospital in North Carolina.”

During a June 4, 2025, public hearing inside the Martin County Government Center, all eyes from an overflow crowd were on state Rep. Shelly Willingham. He heard Waldrum make a case for the $70 million needed to reopen Martin General, and the representative listened to Martin County residents plead for him to persuade his political peers to figure it out and produce the money to make a hospital happen here.

Martin General closed in 2023 when the Williamston Hospital Corporation filed for Chapter 7 bankruptcy. It has meant Pete and Delores Wilson going outside of Martin County to access health care — like earlier this year when the rescue squad delivered him to ECU Health Edgecombe Hospital. His blood sugar and blood pressure were low. The man is 80 years old and has to keep tabs on his heart condition and asthma, too.

“If we’re in critical care, we need help then,” Delores Wilson said. “We don’t need to wait 35, 40 minutes to get some help. We need help then.”

Rescuing rural communities

Martin County residents forgoing the lights and sirens of ambulances are looking at 25- to 45-minute drives to emergency rooms in neighboring counties, said Latonya Jenkins, human services deputy director for the Martin-Tyrrell-Washington District Health Department.

“This distance can create significant barriers to timely and accessible health care, particularly for urgent or chronic conditions,” Jenkins said.

ECU Health Edgecombe is roughly 30 minutes from the Wilsons’ home. Martin General would have been 10 potentially life-saving minutes closer if it were open. Which is the thing — if it were open.

The University of Wisconsin Population Health Institute (UWPHI) tracks preventable hospital stays, which are trips to hospitals, emergency rooms and urgent care centers that could have been avoided. Preventable hospital stays are costly, disproportionately impact historically marginalized communities and, long term, can negatively impact health and personal finances.

Nationwide, 2,666 hospital stays per 100,000 people enrolled in Medicare might have been prevented by outpatient treatment, according to the most recent data from UWPHI. Applying a racial filter to that data illuminates inequitable outcomes in Martin County. In 2022, white people in Martin County accounted for 3,495 preventable hospital stays per 100,000 people enrolled in Medicare. That number ballooned to 5,110 for Black people, who tend to earn less money and would have a harder time covering costs associated with ailments such as congestive heart failure and urinary tract infections that could’ve been treated with less financial expense in outpatient settings, where stays are designed for 24 hours or less.

Long time coming

And that’s the other thing — those times when longer-term, inpatient care is needed: Martin General reopening as a rural emergency hospital means it would not be a full-service hospital. For inpatient care, Martin County residents would go to ECU Health Beaufort Hospital, a good 45 minutes away in Washington, North Carolina. Incorporating the Beaufort piece into this would require a $150 million state investment to expand the facility, according to ECU Health’s proposal.

“We remain committed to advocating for state investment to build a sustainable regional system of care to support Martin, Beaufort and surrounding counties in the full budget,” ECU Health spokesperson Ashlin Elliott said.

“I’ll be advocating for it,” Willingham said. “If you don’t have the folks at the table advocating for something, it’s not gonna happen no matter what. No matter how bad it is, nobody is gonna sit up here who’s not advocating for it and say, ‘You know what? We need to go down there and help out Martin County because their hospital closed.’ That’s not gonna happen.”

Willingham’s been at it for a minute.

“We’ve been working on this for the last two and a half years, so this just didn’t happen,” he said.

In 2020, Congress established rural emergency hospitals in response to hospital closures in rural America. With Medicare covering costs, it was viewed as a solution for communities too small to support a full-service hospital. States individually had to pass legislation in order to offer rural emergency hospitals as health care delivery models, Willingham said.

“We pushed for that, and we got it,” said Willingham, acknowledging the limitations of Martin General not reopening as a full-service hospital. “It wouldn’t help them a whole lot if we just opened Martin General [as a rural emergency hospital] because there’ll be no beds there. So that’s why down in Beaufort we need to do the hospital down there, too, because they have the beds. It’s a little complicated.”

It’s a little expensive at $150 million to expand the Beaufort site, plus that $70 million for Martin General.

“With all this stuff that’s going on in Washington, [D.C.], we don’t know what they’re going to pull back and what they’re not going to fund,” Willingham said.  “Like I said, it’s a little complicated.”

On July 4, the One Big Beautiful Bill Act was signed into law. Among the outcomes will be millions upon millions of individuals losing health care coverage through Medicaid, according to the Congressional Budget Office. The new legislation requires folks up to age 64 with no children or disabilities to prove they worked 80 hours each month in order to earn Medicaid coverage. Health care providers at hospitals can’t deny care to uninsured people. If those needing care are among the ones kicked off Medicaid, then hospitals would generate less revenue by providing uncompensated services. Some hospitals would close, especially facilities in rural communities.

Change gonna come?

Jeremy Collins is looking sideways at this.

“What I’m not hearing is a full-service hospital actually opening in Martin County,” said Collins, founder, president and CEO of Blackacre, an antiracism, innovation and connectivity development firm. Collins is converting the old Williamston High School campus into a community hub that would include a shared commerical kitchen and an aquatics center. The site was the former Williamston Middle School.  

Collins isn’t altogether poo-pooing the ECU Health proposal. Reopening Martin General is part of the solution for better living in Martin County — but it has to reopen the right way, he said.

Jeremy Collins, founder, president and CEO of Blackacre

Centering community

Those disparities discourage Collins and give pause to Karida Giddings, access to health care program coordinator for North Carolina Black Alliance.

“You have to take it back to the community and understand, ‘OK, what are the health care needs that need to be fulfilled at the end of the day?’” Giddings said “If you have actual community members that require health care that needs inpatient care, which means longer stays, observations, a little bit more time with a doctor and not that 24-hour turnaround that comes with a rural emergency health center, then I think you have to make the decision that’s in the best interest of the community.”

No money, no hospital.

“The challenging part that we’re realizing right now is funding resources for health care are under attack,” Giddings said. “It doesn’t matter if it’s Martin County, Caswell County, or Anson County. It’s across the state. So what we’re seeing trickle down — not only from the federal level [but also] folks in North Carolina’s legislature following suit — is really a redetermination of how much money Medicaid is going to get. And for rural communities like Martin County, Medicaid is a core financial resource that holds up their health care infrastructure.”

Across the country, elected officials on both sides of the political aisle are worried about the impact Medicaid cuts could have on their constituents, as well as their political futures. Rural politicians should be really concerned, to hear Giddings tell it.

“There is a greater percentage of Medicaid beneficiaries in our rural communities,” Giddings said. “Prior to Medicaid expansion, a lot of these [rural] hospitals were struggling financially because they were providing uncompensated care. And you can only go on providing uncompensated care for so long before you start to get reimbursed or compensated for some of those services.”

No money, no hospital.

“It’s a business at the end of the day,” Giddings said.

On Thursday, March 14, the North Carolina Black Alliance and NC Budget and Tax Center celebrated everyone’s favorite mathematical constant, Pi Day. Joined by our new 10 BetterNC Fellows and NC House Representative Vernetta Alston,  we took a moment to reflect on what Pi Day truly means to NC and how we can advocate for fair taxation policies in our communities. 

Reflecting on Fair Taxation and Economic Equity

Sure, it was an excuse to indulge in some delicious pies, but it was also a time to ponder some important matters – like our budget priorities and the state of taxation in our communities and our state. Pi Day is about growing the pie – not just the mathematical one, but also the economic pie that sustains our communities.

One crucial aspect of growing our state’s economic pie is ensuring everyone, including corporations, pays their fair share in taxes! By making sure that everyone contributes their dues, we can ensure that our communities have the resources they need to thrive. Imagine what we could accomplish if we redirected some of those funds towards education, healthcare, infrastructure, transit, HBCU funding, and other essential services. We could make our communities stronger, more resilient, and more equitable for everyone.

Let’s work together to ensure that the economic pie is shared more equitably among all members of our society. After all, what better way to celebrate Pi Day than by making sure that everyone gets a fair slice of the pie?

Cheers to Pi Day, math, pie, and building a better, more equitable world for all. Keep calculating (and advocating)!

In collaboration with the NC Budget & Tax Center, the NC Black Alliance hosts the Better NC Fellowship, an opportunity for individuals to deepen their engagement and understanding of fiscal and economic policies in relation to the work they are doing in their communities. The fellowship aims to create connections across communities where leaders are working to advance budget decisions at the local and state levels to improve well-being and include the public in the process.

From February 2024 to December 2024, the Better NC Fellowship offers a comprehensive series of workshops designed to equip fellows with both theoretical knowledge and practical experiences, enabling them to forge deeper connections with key advocacy issues and their respective communities, all through an economic lens. Each fellow will complete a project that connects what they learn to an advocacy effort or initiative

Meet the 2024 Better NC Fellows

We are delighted to join forces with these outstanding leaders who are committed to fostering opportunities for all North Carolinians—regardless of race or background, hailing from rural or urban settings—to actively engage in the budgetary discourse and ensure their voices resonate.

• Traletta Banks, Founder & Executive Director of Erika’s Closet, Mecklenburg County
• Mirella Cisneros Perez, Curriculum and Program Specialist at LatinxEd, Alamance County
• Keisha Dobie, Community Actucator (Activist & Educator) in Elizabeth City, NC, Pasquotank County
• Nichel Dunlap-Thompson, Organizer at Jobs with Justice, Mecklenburg County
• Cindy Fink, Executive Director at Meals on Wheels Rowan, Rowan County
• Kelby Hicks, Board Member of A Better Chance A Better Community, Northampton County
• Brookyn Nelson, Voter Engagement Manager at North Carolina Asian Americans Together, Durham County
• Makayla Johnson, Director of Diversity & Inclusion at A Better Chance A Better Community, Halifax County
• Dr. Lashaundon Perkins, Founder and CEO of Renovating Lives Inc. and Reestablishing YOU Consulting Group, Wayne County
• Tamika Williams, Founder of Cartwill Empowerment Solutions, Mecklenburg County

Learn More About Our Fellows