Senate Republican Thom Tillis has refused to support President Donald Trump’s healthcare bill, citing concerns over Medicaid provider tax rate changes that would harm North Carolina. Tillis, a vulnerable senator up for reelection in 2026, told Fox News Digital that he cannot support the measure through a procedural hurdle necessary to start debate and amendment voting. His refusal is a significant setback for Senate Majority Leader John Thune, who can only afford to lose three votes.
Other Republicans, including Sen. Ron Johnson and Rand Paul, have also signaled they may oppose the bill. Trump was meeting with Johnson and Sen. Rick Scott, 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 Sen. Susan 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.’
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 Collins and Josh Hawley, are on board to 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. 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.