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A vulnerable Senate Republican put his foot down against President Donald Trump’s “big, beautiful bill” over concerns of deep Medicaid cuts inside the megabill.
Sen. Thom Tillis, R-N.C., told Fox News Digital that he would not support the measure through a procedural hurdle necessary to kick off a marathon of debate and amendment voting that would eventually culminate in the measure’s final passage.
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President Donald Trump speaks during a press conference in the James S. Brady Briefing Room at the White House, on June 27, 2025, in Washington. (MEHMET ESER/Middle East Images/AFP via Getty Images)
Tillis, who is up for reelection in 2026, said after exiting the Senate GOP’s closed-door lunch that he has a “great relationship” with his colleagues, but that he couldn’t support the colossal bill.
“We just have a disagreement,” he said. “And, you know, my colleagues have done the analysis, and they’re comfortable with the impact on their states. I respect their choice. It’s not a good impact in my state, so I’m not going to vote on the motion to proceed.”
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Sen. Thom Tillis (Photo by Anna Moneymaker/Getty Images)
He also won’t support the bill during the final stretch. Tillis is part of a cohort of Senate Republicans who have expressed reservations over the Senate GOP’s changes to the Medicaid provider tax rate.
Tillis’ resistance to the bill is a bad sign for Senate Majority Leader John Thune, R-S.D., who can only afford to lose three votes. So far, Sen. Ron Johnson, R-Wis., has vowed to vote against the procedural test, and Sen. Rand Paul, R-Ky., is expected to follow suit.
Trump was meeting with Johnson and Sen. Rick Scott, R-Fl., another possible holdout, during the lunch.
Lawmakers are expected to vote to advance the bill at 4 p.m. on Saturday.
The mounting resistance could force Thune to go back to the drawing board. Further complicating matters is Collins, who is also up for reelection in 2026, who said that while she would support the bill through the first step, she was leaning against voting to pass the bill in the final stretch unless the legislation was “further changed.”
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Sen. Ron Johnson, R-Wis., in Hart Building on Tuesday, July 11, 2023. (Tom Williams/CQ-Roll Call, Inc via Getty Images)
The latest version of the bill, which dropped near the stroke of midnight, included tweaks to the Senate’s offering that would push back the provider rate crackdown by one year, and also added another $25 billion for a rural hospital stabilization fund.
While others in the group, like Sens. Susan Collins, R-Maine, and Josh Hawley, R-Mo., are on board to at least see the legislation move through the first key procedural hurdle, Tillis has argued that his state would be harshly affected by the crackdown.
Indeed, during a closed-door lunch earlier this week, the lawmaker reportedly warned that North Carolina could lose as much as $40 billion in Medicaid funding if the changes were codified.
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For now, Tillis is unlikely to budge, even after conversations with Trump. He is also planning to unveil further analysis on the impact of Medicaid cuts on his state that he said no one in the “administration or in this building” has been able to refute.
“The president I have talked, and I just told him that, ‘Look, if this works for the country, that’s great. And if my other colleagues have done extensive research and concluded it’s different in their states, I respect that,’” he said. “We just have a disagreement based on the implementation in our respective states.”
