A Senate Republican facing a tough political landscape made it clear he would not back President Donald Trump’s sweeping legislative proposal, citing concerns over significant Medicaid reductions included in the massive bill.
Senator Thom Tillis of North Carolina told Fox News Digital that he plans to oppose the bill at the crucial procedural stage needed to begin formal debate and amendment votes, a key step before any final vote can occur.
After stepping out of a closed-door Republican Senate luncheon, Tillis—who faces reelection in 2026—said he maintains good relations with fellow senators, but cannot endorse the bill due to the harmful effects it could have on his home state. “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.”
Tillis also stated he has no plans to support the bill at later stages either. He’s among a group of Senate Republicans raising alarms over provisions that adjust the Medicaid provider tax rate—changes he believes would hit North Carolina particularly hard.
His defection presents a challenge for Senate Majority Leader John Thune of South Dakota, who can only afford to lose three Republican votes. Senator Ron Johnson of Wisconsin has already pledged to oppose the procedural motion, and Senator Rand Paul of Kentucky is also expected to vote no.
During the lunch, Trump met with Johnson and Senator Rick Scott of Florida, another potential swing vote, in an effort to shore up support for the legislation.
The growing pushback may force Thune to reevaluate the current draft of the bill. Further complicating the effort is Senator Susan Collins of Maine, also up for reelection in 2026, who said she would vote to advance the bill initially, but might oppose its final passage if further revisions aren’t made. “Further changed,” she said, was her condition for full support.
The most recent version of the bill, unveiled just before midnight, includes modifications to delay the controversial Medicaid provider rate adjustment by one year and adds $25 billion for a rural hospital support fund.
While other senators such as Collins and Josh Hawley of Missouri are willing to move the bill forward through the early stages, Tillis remains firm in his objection, arguing that his state would suffer dramatically under the proposed Medicaid adjustments.
In fact, during a closed-door session earlier in the week, Tillis reportedly warned colleagues that North Carolina could see a $40 billion reduction in Medicaid funds if the bill becomes law.
Despite having spoken directly with Trump, Tillis seems steadfast in his stance. He also indicated that he intends to release additional data showing the negative consequences of the bill for North Carolina—data he claims no one in “the administration or in this building” has been able to challenge.
“The president and 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.”
