WILLIAMSTON, N.C. — Two years after her brother’s death, Debra Pierce still wonders whether Stanley Sears, 50, might have survived if their local hospital had remained open. Emergency crews from a neighboring town worked on Sears for about 30 minutes but could not revive him before the long drive to the nearest hospital. Pierce stands outside the mobile home where she last hugged him and flips through photos on her phone, stopping at a smiling selfie. “Bless him,” she says. “We’ll never know if he could have been saved that night.”
Martin County, home to roughly 22,000 people in eastern North Carolina, has been living that uncertainty since Martin General Hospital abruptly closed in 2023. The shuttering left a stretched and fragile health system: ambulances without paramedics, longer travel times to emergency rooms that are often full, and a community dependent on distant regional hospitals. County leaders and residents describe a healthcare desert where basic and emergency care are harder to reach — and where lives may have been lost that otherwise could have been saved.
The county’s struggles expose the limits of a new $50 billion national rural health fund that Republicans added to last year’s One Big Beautiful Bill Act. The fund was marketed as a way to shore up rural services after the bill reduced federal Medicaid spending by hundreds of billions over a decade. Although North Carolina is set to receive $213 million in the program’s first-year distribution, that money is being funneled through existing health and social service organizations and cannot be used freely to reopen closed hospitals. Federal rules also place caps on how much of the funds can be used for construction and renovations. County officials say the new dollars won’t fix Martin County’s most pressing needs.
“The $50 billion is not something that is specifically going to help our situation,” County Manager Drew Batts said during a recent walk through the darkened hallways of the shuttered facility. Since the closure, Martin County taxpayers have covered maintenance, utilities and other costs — an estimated $2.9 million — in hopes of reviving operations. Local leaders are now weighing a plan to spend at least $1.5 million to create two higher-level paramedic units with rapid-response vehicles equipped for advanced life support, including ECG equipment. But reopening the hospital or restoring full local inpatient services would require far larger investments.
The state’s approach to the federal fund illustrates how the money will be deployed: North Carolina applied to receive the funds in a competitive process and created a hub-and-spoke model that awards large regional lead organizations — including nonprofit affiliates of major health systems — the bulk of the first-year payout. Those hubs then distribute grants and coordinate broad initiatives like strengthening primary care, building workforce pipelines and developing digital tools. One of the recipient organizations, Access East, an affiliate of ECU Health, won a share of North Carolina’s allocation. But those awards cannot be used to reopen Martin General.
ECU Health, the region’s dominant system with nine hospitals, has taken on many of the patients displaced by Martin General’s closure. The system’s Greenville hospital is the only Level 1 trauma center east of Raleigh and has become a de facto safety net for nearly 30 counties. ECU Health signed a letter of intent to reopen Martin General as a rural emergency hospital providing outpatient care and an emergency room, with Martin County responsible for refurbishment costs and the state legislature asked to allocate hundreds of millions to associated construction projects. But federal rural fund dollars allocated to the system cannot be used to revive inpatient operations at the old county hospital, officials say.
The result is overcrowded emergency departments, long waits and frustrated patients. ECU Health reported a 132% increase in daily ER visits since the local hospital closed. Federal data show the Greenville hospital’s median ER wait and treatment time is nearly four and a half hours — longer than 96% of hospitals nationwide. Hospital officials say long waits are driven by shortages of inpatient and behavioral health beds and by the complexity of care many rural patients require.
Stories from the region underscore the strain: Eleisa Ann Evans drove two and a half hours so her 79-year-old aunt could be seen at ECU Health in Greenville, where staff told her to leave the waiting room and wait outside because of capacity limits. Tonya Miles reported waiting six hours with her mother for a possible blood clot. Olivia Lewis said she and her mother once waited from 10:30 p.m. until 7 a.m. before leaving without care; her mother tore off her hospital bracelet and walked out. Vannessa Little recalls her 6-year-old daughter suffering severe burns that required a 30-mile ambulance trip and an airlift more than 100 miles to Chapel Hill — a journey she says would have been very different if the county hospital had been open. Little says she hadn’t heard about the rural health fund and doubts that the changes she’s seen amount to progress: “The only changes that people are making is they’re taking away everything.”
The rural fund has also become a political flashpoint in a competitive U.S. House race that includes Martin County. Republican candidates and campaigns have touted the program as a lifeline promised by former President Trump after Republicans added the $50 billion pot to win votes for the larger bill. Opponents point out, however, that the One Big Beautiful Bill simultaneously cuts Medicaid spending by more than $900 billion over a decade — reductions that many rural health leaders warn will inflict deep harm on hospitals and clinics that already operate on thin margins.
Rep. Don Davis, a Democrat who represented the district when Martin General closed and is seeking re-election, signed a letter supporting North Carolina’s rural fund application and has introduced legislation to increase Medicaid reimbursements for rural hospitals, though that bill has not advanced. His Republican challenger, Laurie Buckhout, has criticized Davis for opposing the larger bill that created the rural fund. U.S. Sen. Thom Tillis, who voted against the bill, warned of devastating consequences for health care in the state.
Locally, leaders continue to pursue multiple tracks to restore services. ECU Health executives and county officials have lobbied state and federal lawmakers and presented plans to reopen some services at Martin General. The county has considered converting part of the facility into a rural emergency hospital and investing in higher-level pre-hospital care by adding paramedics and better-equipped response vehicles. But reopening a closed hospital and reestablishing inpatient capacity often requires regulatory approvals, staffing pipelines and sustained funding — challenges that the federal rural fund, as currently structured and distributed through regional hubs, may not directly resolve.
For families like Pierce’s, those technical distinctions offer little comfort. On the day of his death, Sears’s last moments and whether faster, closer advanced care could have changed the outcome are still unknown to those who loved him. Across Martin County, residents say what they want is simple: a hospital nearby so that when emergencies strike, people don’t face hours-long trips, crowded ERs and the agonizing question of whether help might have arrived too late.
KFF Health News contributed reporting to this story.
