Trump rural – Two years after Martin General Hospital closed in 2023, families in rural Martin County, North Carolina, say they’re living with higher-stakes delays—while a $50 billion rural health fund tied to President Donald Trump’s signature One Big Beautiful Bill Act re
When Stanley Sears died after a heart attack in Martin County. North Carolina. emergency crews worked on him for a half hour—but couldn’t revive him for the drive to the closest hospital. Debra Pierce, his sister, still keeps his memory close. In the yard where she last saw him renovating a mobile home. she holds up a photo of Sears and tries to make sense of what happened.
“ The sad thing is we’ll never know if he could have been saved that night or not, because we don’t have a higher level of care in this county,” Pierce said.
For Pierce, the wound is not just loss. It’s the everyday consequence of a healthcare system that narrowed and then disappeared: Martin General Hospital closed a year before Sears died. leaving a gutted healthcare landscape for a county of about 22. 000 people. Martin County does not have paramedics on its ambulances. and it can be 20 miles or more to the nearest—and often overcrowded—emergency rooms.
The human stakes are colliding with federal promise. The healthcare gaps in Martin County illustrate how far the $50 billion rural health fund Republicans drafted to strengthen support for President Donald Trump’s signature One Big Beautiful Bill Act can reach—and how unevenly it can land when local infrastructure is missing. The money has not been distributed yet. but in competitive midterm contests. Republican candidates are casting the fund as a lifeline that will strengthen rural health services across America.
In North Carolina, where most residents live in rural counties, the fund is highly anticipated. On paper. Martin County looks like a top contender to receive at least some of the $213 million earmarked for the state. Pierce is placing her faith in the political promise. A Republican, she said she believes Trump will help.
“Old man’s doing his job up in there,” Pierce said.
But Martin County officials say the money won’t solve the immediate emergency.
County Manager Drew Batts walked into the shuttered hospital in April and said the $50 billion is not built to reopen places like his.
“The $50 billion is not something that is specifically going to help our situation,” Batts said. “It’s not going to help us get this place reopened.”
That limitation matters because Martin County won’t get direct relief from the rural health fund simply because its hospital is no longer operating. North Carolina is distributing the money among existing health and social service organizations. and federal regulators set limits on how much can be spent on construction and building renovations.
The closure itself still cuts through local politics and local memory. Martin General Hospital closed abruptly in 2023. surprising employees and shocking patients who had to be wheeled out on stretchers and transported elsewhere to finish treatment. Local elected leaders say Quorum Health—the company operating the county-owned hospital—did not notify them it intended to shut down operations and file for bankruptcy.
A Quorum spokesperson, Lisa Anderson, said the company had told county commissioners about the hospital’s ongoing financial challenges.
What has followed is a struggle to keep medical access alive in a county where the basic route to care has become longer and more uncertain. Politicians have spent years trying to reopen the hospital. and county taxpayers have poured an estimated $2.9 million into maintenance. utilities. and other costs. Batts said. The county is now considering spending at least $1.5 million to create two higher-level paramedic units with quick-response vehicles equipped with electrocardiogram equipment or other “advanced lifesaving support.”.
Pierce said she is praying the county can add paramedics and reopen the hospital.
“There’s some answered prayers happening every day,” she said. “So, we can only pray and hope, you know?”
For many residents, the disappointment isn’t theoretical. It is measured in wait times, in doors guarded by security, and in families who leave and then return.
ECU Health, connected to East Carolina University, has become a de facto safety net for 29 counties, and its leaders have been pressing state and federal lawmakers as Martin General remains shut. Brian Floyd, ECU Health’s chief operating officer, said the crisis has already cost lives.
“It’s a real healthcare crisis that has already proven itself to have lost lives that perhaps didn’t have to be lost,” Floyd said. “They just want to not die because there’s nowhere to go when you have an emergency.”
In Greenville, ECU Health ER capacity problems translate into rules that families describe as humiliating and exhausting. Eleisa Ann Evans drove 2½ hours from a small town near the Outer Banks so her aunt could get care at an ECU Health ER in Greenville. Once there. Evans said staff told her to leave her 79-year-old aunt in the waiting room and wait outside because of capacity issues.
Evans said she was outraged at the way the staff treated her. She said she had been standing behind her aunt’s wheelchair while inside and “wasn’t using nobody’s chair.”
Across Martin County, the fear is that surrounding areas are sliding toward the same kind of medical desert. Floyd said with Martin General gone, all the surrounding counties are also “in jeopardy.” He said no one knows what to do with the scale of a healthcare “desert.”
What healthcare remains in Martin County includes one urgent care center run by a private company and a nonprofit health clinic operated by Agape Health Services. The nonprofit accepts patients from five counties and plans to build another primary care clinic to meet demand.
There is also a plan—promising, but constrained by the same limits that keep money from reopening a closed hospital. ECU Health signed a letter of intent last year to reopen Martin General as a rural emergency hospital providing outpatient care as well as an ER. Under the terms of the deal. Martin County would pay to refurbish the hospital. and the North Carolina General Assembly would have to give ECU Health $210 million. including $150 million for the construction of a new inpatient tower at ECU’s Beaufort Hospital.
Floyd said federal money from the rural health fund can’t be used to reopen Martin General.
The fund, meanwhile, is tied to a longer blueprint. The five-year Rural Health Transformation Program is slated to be delivered in $10 billion annual increments to states that applied and competed for the money. North Carolina’s plan creates a hub-and-spoke structure with six large regional leads, including nonprofits such as Access East. Those hubs would distribute funds and coordinate initiatives such as improving primary care and strengthening the healthcare workforce. as well as developing “digital solutions. ” according to the state’s hub application.
If the structure is designed to build capacity over time, the people of Martin County live on a different schedule.
The gaps in emergency care have become a central talking point in a close U.S. House race between Rep. Don Davis, a Democrat, and Republican Laurie Buckhout. Davis represented the district when Martin General closed and is seeking his third term. Buckhout’s campaign has declined an interview.
This rural health fight is also tied to how the broader rural fund came to exist. The rural health fund was added at the last minute in 2025 to win votes for the One Big Beautiful Bill Act. which would reduce federal Medicaid spending by more than $900 billion over a decade. Cuts projected to hit rural hospitals and clinics especially hard have been part of the alarm raised by rural health executives. who say the fund won’t come close to offsetting those losses.
Matt Mercer. a spokesperson for the North Carolina Republican Party. called the rural fund a “once in-a-generation opportunity” for the state. U.S. Sen. Thom Tillis—one of three Republican senators to vote against the bill—warned of devastating consequences for healthcare in his state. Tillis announced shortly before the final vote that he plans to retire from Congress.
Buckhout plans to attack Davis for voting against the bill. Buckhout campaign spokesperson Stephen Gallagher said in a statement that Davis “lost its hospital on his watch” and still opposed the funding meant to help communities like it.
Davis. who signed a letter from lawmakers in support of North Carolina’s rural health fund application. said the money “is essentially putting a band-aid on a much. much broader situation that needs dire help.” He has introduced legislation that would increase Medicaid reimbursements for rural hospitals. though it has not moved forward.
During recent testimony on Capitol Hill in Washington, ECU Health CEO Michael Waldrum said his system expects to lose a billion dollars over the next 10 years from looming Medicaid cuts.
In Martin County’s region, the emergency department experience is stark enough to feel like an indictment of time itself. State data shows Martin General’s ER treated about 11,000 patients annually before it closed. A sign still hangs in a staff break room showing that 23 patients were seen in the ER the day it closed.
After the closure, ECU Health reported a 132% increase in its daily ER visits. Its nearly 1,000-bed hospital in Greenville—about 40 minutes from Williamston—is the state’s only Level 1 trauma center east of Raleigh.
Federal data show the Greenville hospital’s median patient ER wait and treatment time was nearly 4½ hours. That is longer than 96% of thousands of hospitals reporting nationwide. ECU Health spokesperson Brian Wudkwych said in an emailed statement that the wait times “don’t reflect poor care.” He said the system’s ERs treat nearly 300. 000 patients annually.
Floyd said the increase in Martin County patients is only part of the pressure. Wudkwych said wait times primarily stem from shortages of inpatient and behavioral health beds. Floyd said many rural patients who arrive at ECU Health’s ERs have multiple chronic conditions that require longer visits. with doctors often treating more than one problem once patients are evaluated—he described it as a cascade. starting with one issue and then discovering others like uncontrolled blood sugar and hypertension.
ECU staff encourage people who are not too sick to skip Greenville and instead seek care at one of the system’s community hospitals, which aren’t as busy.
In April, a security officer guarded the Greenville emergency department’s doors on two nights. A “capacity notice” sign near the entrance meant family members had to wait outside in cars or on benches.
Tonya Miles said she brought her mother for a potential blood clot in her leg and after only six hours she was still waiting. Olivia Lewis said she brought her mother two nights earlier and left without care after their wait stretched from 10:30 p.m. to 7 a.m. Lewis said her mother “tore off her hospital bracelet” and declared: “I’m out. I’m done.” Now, they were back.
In Martin County, the closure is also personal in ways that don’t fit neatly into statistics. On a recent Friday. Vannessa Little sat at a McDonald’s with her kids just down the street from the closed hospital. She pointed to one of her girls and wondered what care would have looked like if Martin General had been open.
Little said her daughter, then 6, suffered severe burns over 30% of her body in 2024. She described the journey to treatment as “just crazy.” An ambulance arrived at her Williamston home from neighboring Bertie County to transport them to ECU Health’s Greenville ER. Little said the drive was 30 miles and ultimately the girl was airlifted more than 100 miles to Chapel Hill.
Little said she hadn’t heard of Trump’s rural health investment and that the only changes people were making were negative.
“The only changes that people are making is they’re taking away everything,” she said. She voted against Trump in 2024 and said she didn’t think she would vote this year. “It’s a waste of my time.”
That sense of being left behind is the story Martin County keeps telling—whether the argument is about paramedic units, reopening a hospital, or a federal fund that arrives after the shutdown has already locked the county into a longer road to care.
There are plans in motion: the county is weighing paramedic units. ECU Health has a letter of intent to reopen Martin General as a rural emergency hospital under specific terms. and North Carolina is distributing rural health dollars through regional hubs tied to workforce and primary care improvements. But for Debra Pierce and the families still living through the aftermath, the question isn’t whether money is coming. It’s whether it can arrive early enough—or in the right form—to make sure they don’t have to watch another person wait for help while the closest hospital is too far away. too full. or simply not there.
Martin County North Carolina rural health fund Trump One Big Beautiful Bill Act Medicaid cuts Martin General Hospital ECU Health Don Davis Laurie Buckhout Thom Tillis