North Carolina Sen. Thom Tillis says President Donald Trump's sweeping tax and spending bill — also known as the "One Big Beautiful Bill" — would effectively end Medicaid expansion in North Carolina and strip coverage from hundreds of thousands of residents.
Tillis voted against the bill on Tuesday, joining two other Republicans and all Senate Democrats. The vote came days after the senator announced on Sunday that he would not run for re-election next year, in part because Trump threatened to back a primary opponent over the vote.
Tillis said the bill’s cuts to Medicaid funding would mean more than 600,000 people in the state would lose healthcare. That’s because when the state legislature enacted Medicaid expansion in 2023, they included a provision that would automatically end the program if the federal government stops covering 90% of its cost.
"So what do I tell 663,000 people in two years or three years, when President Trump breaks his promise by pushing them off of Medicaid?" Tillis said.
Tillis said he's also concerned that funding cuts could harm rural hospitals in North Carolina.
North Carolina Sen. Ted Budd voted for the bill, saying in a statement that it delivers tax relief to families and farmers, and boosts spending for the military and border security.