Senator Thom Tillis is breaking with Trump, warning the tax bill could end Medicaid coverage for thousands. Find out whoโs at risk.
GREENSBORO, N.C. โ As the U.S. Senate debates a sweeping tax cut plan dubbed “The One Big Beautiful Bill” by President Donald Trump, North Carolinaโs Republican Senator Thom Tillis is breaking ranks with his party.
Tillis says the bill could force more than 663,000 North Carolinians off Medicaid.
โSo what do I tell 663,000 people in 2 years or 3 years when President Trump breaks his promise by pushing them off of Medicaid because the fundingโs not there anymore?โ Tillis said on the Senate floor.
Why Tillis says Medicaid is at risk
The issue centers on a state law that expanded Medicaid coverage in North Carolina. That expansion brought insurance to thousands of low-income adults who previously didnโt qualify. But the law includes a trigger that if federal funding drops below a certain threshold, the expansion must be reversed.
Tillis says that could happen under Trumpโs new bill, which slashes federal spending including funding for Medicaid to pay for tax cuts. Tillis says heโs tried to raise the alarm with Republican leaders and Trumpโs policy team.ย
โWhat they told me is โyeah, itโs rough, but North Carolinaโs used the systemโthey’re gonna have to make it work,โโ Tillis said.
Weโve previously introduced you to families like Victoriaโs who were impacted by Medicaid expansion. Sheโs on disability, but before expansion, made just a little too much to qualify for Medicaid. That changed in 2023 when the expansion allowed coverage for people making under $20,000 a year.
According to North Carolina Justice Center’s Nicole Dozier, the people who could lose coverage now include “people who serve us every day in food and beverage, who are teacher assistants, people without kids in low earning jobs.”
Political Divide in North Carolina
While Tillis is opposing the Senate version of the bill, North Carolinaโs other Republican Senator, Ted Budd, is supporting it.
On social media, Budd wrote in part:
โNobody is voting to take away Medicaid benefits from patients for whom Medicaid was designed to serve. Senate Republicans are trying to slow the rate of exponential cost increases for a program we all agree must survive for future generations.โ
President Donald Trump has said he wants the bill passed in time to sign it on July 4.
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