Tillis Opposes Trump’s Budget Bill Over Medicaid and Hospital Concerns

U.S. Senator Thom Tillis, a Republican from North Carolina, has publicly announced he will not support President Donald Trump’s ambitious budget package, known as the “One Big Beautiful Bill Act.” The legislation, which is set to advance many of Trump’s top policy goals, has become a major point of contention in the Senate.

Tillis issued a statement explaining his decision, highlighting what he called “unacceptable impacts” on North Carolina’s healthcare system. Specifically, he warned that the bill would eliminate tens of billions of dollars in federal funding for Medicaid and rural hospitals across the state.

“I did my homework on behalf of North Carolinians, and I cannot support this bill in its current form,” Tillis said. “It would result in tens of billions of dollars in lost funding for North Carolina, including our hospitals and rural communities.”

The senator emphasized that, if passed, the legislation could force North Carolina to make difficult decisions, such as removing Medicaid coverage for hundreds of thousands of people who gained it through Medicaid expansion. In addition, essential services for those who rely on traditional Medicaid coverage could be reduced or eliminated.

Tillis’s opposition to the bill represents a notable break from President Donald Trump. Throughout this year, he has generally avoided high-profile disagreements with the president. However, this budget measure became a clear dividing line.

After Tillis voted against a procedural motion to advance the bill on Saturday night, Trump responded quickly and sharply on Truth Social, the social media platform he owns. “Thom Tillis is making a BIG MISTAKE for America, and the Wonderful People of North Carolina!” Trump wrote.

The Senate plans to consider the bill in detail over the weekend. Since Republicans hold a 53-seat majority, every vote will be critical in deciding whether the measure advances.

Tillis, who lives in Huntersville and previously served as speaker of the North Carolina House of Representatives, has represented North Carolina in the U.S. Senate since winning the election in 2014. Although he has occasionally broken with Trump on specific issues, this vote may become one of the most consequential of his tenure.

On Sunday, Tillis also made a significant political announcement: he will not seek reelection in 2026.