(The Center Square) – Thom Tillis wants the president to keep his promise on health care.
For if he doesn’t, the Republican U.S. senator says, surely a sea tide of change will be on the way for their party. He’s seen it before, as has all his constituents back home in North Carolina.
As much as the headlines grab attention that the two are in a monstruous riff, Tillis has pleaded compassionately, all in an effort to spare harm to the party and Donald Trump. He voted against the reconciliation budget proposal known as One Big Beautiful Bill on Tuesday afternoon, leading to a tie at 50 broken by Vice President J.D. Vance. The manuever gets the Senate’s proposal back to the House of Representatives for concurrence.
Medicaid is Tillis’ bone to pick – and even within that, there is much he likes. Provider taxes, however, is not one of them. And his experience as speaker of the state House from 2011-14 testifies he knows of what he speaks.
The advisors to Trump, he said, are merely amateurs.
“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 because the funding is not there anymore?” Tillis said.
The 64-year-old, who said Sunday he would not seek reelection in the 2026 midterms, said the president’s advisors are not telling their boss the bill breaks a promise.
“And you know the last time I saw a promise broken around health care?” Tillis continued. “With respect to my friends on the other side of the aisle, is when somebody said, ‘If you like your health care you can keep it. If you like your doctor, you can keep it.’
“We found out that wasn’t true. And that made me the second speaker of the House since the Civil War. We betrayed the promise to the American people. Three years later, it made me a U.S. senator.”
Democrats, a party that in 2008 claimed 30 of 50 seats in the state Senate and 68 of 120 in the House, had drawn the maps that Republicans won in at the 2010 midterms. Grand Old Party majorities in both chambers of the state Legislature was a first since Reconstruction and the Civil War 140 years prior.
Voters even sent a Republican to the governor’s mansion in 2012, just the third since 1900.
And Tillis took a state with a $2 billion shortfall on a $20 billion revenue fund, he said, and in six months balanced the budget. The state’s surplus was more than $5 billion prior to Hurricane Helene last fall. And they did it, he said, with what seemed an unthinkable 12% cut to the state’s public university system budget.
“The Medicaid proposal bears no resemblance to that kind of discipline and due diligence,” Tillis thundered in his Sunday evening speech on the Senate floor. “It has no insights to how these provider tax cuts are going to be absorbed without harming people on Medicare. Even worse, most of my colleagues do not even understand on either side of the aisle the interplay of state-directed payments and the devastating consequences of the funding flows that are going to be before us.”
Accounting and consulting experience he accumulated at Price Waterhouse and IBM, and his time leading the state House delivered fruits to his knowledge and a no to the bill proposal.
Tillis said he asked the staff of the Republican leaders in the General Assembly, Senate President Pro Tempore Phil Berger and House Speaker Destin Hall, and Democratic Gov. Josh Stein to see how the Senate’s proposal would impact the state budget back home. He also got an estimate from congressional fiscal research.
And that wasn’t all. He got analysis from three different groups within the hospital association industry – one each aligned to Democrats, Republicans and independents. For all, instructions were to not share and only report back to Tillis.
He found the best-case scenario was a $26 billion cut. Another report says $32 billion, and some published reports expect North Carolina to be closer to $40 billion.
In three separate meetings with the “brilliant” Dr. Mehmet Oz, Trump’s administrator for the Centers for Medicare & Medicaid Services, Tillis said staff couldn’t prove him wrong.
They genuinely tried. It never happened, the last coming on Friday hours before the mercurial president and steadfast senator exchanged texts. Tillis told the president it was time for him to find a replacement, he would vote no; Trump let loose on social media.
“Republicans are about to make a mistake on health care and betray a promise,” Tillis said.
Both chambers are enacting work requirements for ages 19 to 64 able-bodied adults. The Senate also includes parents of children ages 14 and older. If not working, they could volunteer, enroll in school or participate in job training at least 80 hours a month.
For expansion states’ provider taxes, there’s no increases in the House version and the Senate lowers them. For new directed payments, the House caps at different rates pending whether states have expanded Medicaid; the Senate has a cap for all.
The Senate added a $50 billion relief fund for rural hospitals. The House version did not have it.
Each body also has prohibitions on gender affirming care in Medicaid and the Children’s Health Insurance Program.
The Senate only banned Medicaid funds to Planned Parenthood for one year; the House did not have a time restriction on its similar ban.
Regarding immigration, and people in the country illegally, the Senate has restricted eligibility for certain immigrants and refugees and penalizes expansion states using state taxpayer money to offer health coverage to people illegally in the country. The House’s sanctuary state measure would reduce matching funds for states using their money to offer health coverage to people illegally in the country.
The White House, in a release, said the votes against the bill were against “protecting Medicaid for American citizens who need it.” This strengthens Medicaid for Americans who rely on it – like pregnant women, children, seniors, people with disabilities, and low-income families – while eliminating waste, fraud and abuse.
“I passed a law that made it illegal to expand Medicaid,” Tillis said of his state House days. “Why did I do that? Because I was convinced that someday we would be here.”
Meaning, where’s the money?
Tillis said he would have preferred a way to get more people on Medicaid through the standard Federal Medical Assistance Percentage rather than having a 90/10 match, watching it disappear, and “taking away desperately needed health care.” The 90/10 match means the federal government covers 90% of certain Medicaid-related activities and states do 10%.
“I believe that we can make sure that we do not break the promises of Donald J. Trump, that he’s made to the people who are on Medicaid today,” Tillis said.
He called the July 4th deadline “just another day” and pleaded for Congress to take the time to get it right. The House either concurs or the bill goes into a stall.
“We owe it to the states to understand how these proposals are going to affect them,” he said. “How hard is it? I did it. If there’s no negative impact, what’s wrong with daylight? What’s wrong with actually understanding what this bill does?
