Sen. Thom Tillis (N.C.), one of the most vulnerable Senate Republican incumbents facing re-election in 2026, warned Senate Majority Leader John Thune (R-S.D.) bluntly in a private meeting Tuesday that deep cuts to Medicaid could cost Republicans control of the House and Senate, according to a person familiar with the conversation.
Tillis, who has kept relatively quiet about the hundreds of billions of dollars in Medicaid cuts proposed by the Senate Finance Committee, blasted his leadership’s plan to forge ahead during a Republican luncheon on Capitol Hill.
“Thom Tillis got up and he had a chart on what the Senate’s provider tax structure will cost different states, including his. His will lose almost $40 billion. He walked through that and said ‘this will be devastating to my state,’” said a person familiar with Tillis’s blunt exchange with Thune behind closed doors.
The proposal to cap the health care provider tax rate is a major cost cutter in President Trump’s “big, beautiful bill,” but it is also among the most controversial provisions. Several key GOP senators have expressed alarm about the Medicaid cuts in the Senate’s version of the legislation.
Tillis’s chart, which he also showed to colleagues, showed that North Carolina would lose $38.9 billion in federal funding and that more than 600,000 North Carolinians would be at risk for losing Medicaid coverage.
“Tillis said this is going to be like ObamaCare. He said just like ObamaCare led to huge losses for Democrats in 2010 and 2012, he said this could be the same thing for us because hundreds of thousands of people in his state, millions around the nation are going to be kicked off of Medicaid — working people, who are Trump voters,” the source told The Hill.
Tillis warned “it could cost us majorities in both houses” of Congress, the source added.
The North Carolina Republican called on the GOP leadership to abandon the Senate Finance Committee’s language on capping health care provider taxes, which would dramatically restrict states’ ability to draw more federal funding, and return to the Medicaid language passed last month by the House.
“Thune didn’t like that very much,” the source added of the GOP leader’s reaction.
Tillis told The Hill that he has a tendency to be “blunt,” especially when he thinks something might be going in the wrong direction.
“I’m generally very blunt so I don’t think it was any more than normal,” he said of his candid comments to GOP leaders at the meeting.
He’s worried that Republican colleagues have become so fixated on cutting Medicaid as a way to pay for Trump’s agenda that they may be losing sight of the bigger political picture.
Tillis said he sees some similarities to the political pitfalls that Democrats suffered in 2010 after zealously pushing the Affordable Care Act into law under former President Obama despite growing political opposition from around the country.
“The Democrats became so obsessed with passing ObamaCare, they kept on moving. They made the promise, ‘If you like your health care, you can keep it. If you like your doctor, you can keep it.’ Exactly the opposite proved to be true,” Tillis said.
Tillis recalled that he defeated former Sen. Kay Hagan (D-N.C.) in the 2014 election by highlighting during the campaign that she and other Democrats made promises about ObamaCare that didn’t hold up.
He’s worried that Republicans could wade into trouble by pledging that Trump’s megabill won’t cut Medicaid benefits if hundreds of thousands of people wind up losing coverage.
“Now we’re saying we’re going after waste, fraud and abuse but we’re not going to affect beneficiaries. And there’s going to be 600,000 in North Carolina and some 3 million [people] nationwide” who are going to lose Medicaid coverage, he said.
“It almost reads identically to what was being said in 2009 and 2010,” he said.
Tillis said he supports cutting federal spending but cautioned “I want to cut in a way that states can absorb.”
Thune appeared to take the criticism in stride when he held a press conference immediately after the Republican lunch meeting.
“Everybody having fun yet?” Thune quipped to the assembled reporters. “Join our lunches, it’s very stimulating.”
Thune insisted the massive bill is still on track to pass the Senate by the end of the week.
“We are making good headway on the reconciliation bill. As you all know, this is the legislation we believe implements the president’s agenda. It makes our country safer, stronger and more prosperous,” he said.
“We feel very good about the path that we’re on and getting this across the finish line by the end of the week,” he said.
Republican senators have become increasingly concerned about the political fallout of cutting hundreds of billions of dollars from Medicaid, even though their leaders have pledged that people won’t see their benefits cut.
“We had a meeting last night, I’d say there were a handful of senators who raised the issue of politics, the political consequences of Medicaid, and tried to make certain that people who are marching forward know there’s a hazard,” a GOP senator who requested anonymity said.
“Changes in Medicaid lend themselves toward the political ads that we see in today’s politics,” the senator warned.
The senator said the Senate’s language on capping states’ use of health care provider taxes would lead to significantly deeper cuts to federal Medicaid funding than the House language.
Senate Republicans are talking about setting up a $100 billion health care provider relief fund for rural hospitals, nursing homes and community health centers, but that may not solve their political problems.
“Even if that were to be incorporated, which I very much hope it will be, the Senate cuts are so much deeper than the House that the Medicaid provisions remain a problem for me,” said Sen. Susan Collins (R-Maine), who faces a competitive re-election race next year in a state that former Vice President Kamala Harris carried in 2024.
Senate Democratic Leader Chuck Schumer (N.Y.) is vowing that Republicans will pay a political price in 2026 if their Medicaid cuts become law.
“The public is overwhelmingly against these Medicaid cuts and anyone who votes for them is going to have real trouble in their states,” he declared.
He said the Medicaid cuts would have severe impacts “in as many Republican states as Democratic states.”
He said Democrats have compiled a list of rural hospitals that would close because of federal funding cuts and pointed out that Kentucky — which is represented by Sens. Mitch McConnell (R-Ky.) and Rand Paul (R-Ky.) — could lose more hospitals than any other state.
“We have a list of rural hospitals that would close. Do you know which one has the highest? Thirty-five in Kentucky,” he said.
“It’s political disaster for them,” he said.
