Two years after her brother died, Debra Pierce still wonders whether Stanley Sears might have lived if Martin County’s hospital had been operating. Sears, 50, suffered a heart attack at his home; emergency crews worked on him for about 30 minutes but could not revive him before a long transport to the nearest emergency department.
Standing outside the mobile home where she last saw him, Pierce says the absence of higher-level care in her county leaves a haunting question: would a nearby hospital have made a difference? That uncertainty is common among residents of Williamston and other towns across Martin County, North Carolina, since Martin General Hospital abruptly closed in 2023.
The shuttering left a thin patchwork of services: one private urgent care, a nonprofit clinic serving multiple counties, and ambulance crews without paramedics on many calls. County leaders estimate the closed hospital once handled about 11,000 emergency visits a year; its closure has forced patients to travel 20 to 100 miles for specialized care. In some cases, families have waited through overnight ER crowds, or had loved ones airlifted hundreds of miles for treatment.
Local officials and the region’s largest health system, ECU Health, have pushed for help. ECU Health alone reports a surge in daily emergency visits in the area after the closure. Its 1,000-bed Greenville medical center—the only Level 1 trauma center east of Raleigh—now has among the longest median ER wait and treatment times in the country, partly because inpatient and behavioral health beds are scarce. Patients often face hours-long waits; some leave untreated and come back later.
Into that gap comes a centerpiece of the 2025 federal package pushed by Republicans: a five-year, $50 billion Rural Health Transformation Program. The money was folded into the One Big Beautiful Bill Act as a campaign-friendly promise to shore up rural care. States applied for annual $10 billion allocations, and North Carolina secured a $213 million first-year award that will be funneled through a state plan.
But the design of North Carolina’s rollout—and federal limits on how the funds can be used—mean the program will not directly reopen shuttered hospitals like Martin General. The state is distributing its allocation to six large regional “hub” organizations that will funnel grants and coordinate projects across networks of existing providers. Federal rules also place caps on construction and renovation spending, and the program emphasizes improving primary care, workforce initiatives, telehealth and other system-building efforts rather than paying to rebuild closed inpatient facilities.
County Manager Drew Batts says that reality makes the federal money unhelpful for his community. Martin County has already spent millions on maintaining the closed facility and faces additional costs to preserve the site while pursuing partners or plans to restore services. The county is now weighing at least $1.5 million to equip two rapid-response paramedic units—vehicles with ECGs and other advanced life-support gear—to improve emergency response speed and capabilities. But those fixes are different in scale and scope from reopening a full hospital.
ECU Health did sign a letter of intent to revive Martin General as a rural emergency hospital focused on outpatient care and an emergency department. That plan would rely on state funding as well: county leaders say ECU requested an injection of state dollars—roughly $210 million in one proposal, with a large share earmarked for construction at a different affiliated hospital—making any reopening contingent on legislative action.
The political backdrop complicates matters. The rural health fund was added to the larger federal bill that also includes Medicaid changes projected to reduce federal Medicaid spending by roughly $900 billion over a decade—cuts that critics say will hit rural hospitals and clinics especially hard. Supporters argue the fund is a once-in-a-generation opportunity; opponents and some health leaders say it won’t come close to offsetting the losses from reduced Medicaid funding.
In the closely watched U.S. House contest that includes Martin County, rural health access has become a campaign issue. Republicans who backed the federal bill point to the rural fund as proof they are delivering resources to places like eastern North Carolina. Opponents counter that the structure of the program and the Medicaid cuts that accompany it create long-term harm that a limited fund cannot fix.
Residents describe the everyday consequences. Families report hours-long waits in overcrowded emergency rooms; one woman said staff asked her to leave her elderly relative in the waiting area and wait outside because of capacity. Another parent recalled a child with severe burns who had to be transported dozens of miles by ambulance and ultimately airlifted over 100 miles for advanced care. For many, the promise of federal funds circulating through large regional hubs feels distant compared with the immediate needs of a town without a hospital.
Local officials and health system leaders stress that some benefits can come from the new program—expanded primary care access, workforce support, telehealth and coordinated regional planning—but they also argue those efforts are more of a long-term patch than a full restoration of inpatient services lost when hospitals close.
For grieving family members like Pierce, that distinction is cold comfort. “We’ll never know,” she says of whether her brother could have been saved. County leaders cling to smaller, practical fixes—more paramedics, partnerships with health systems, and continued lobbying for state support—while residents weigh election-year promises against the visible reality of a community with dwindling access to emergency care.