Senator Thom Tillis (R-NC) says he will vote against moving forward with President Donald Trump’s One Big Beautiful Bill, warning that the legislation in its current form would gut Medicaid funding for his state.

“I will always do what is in the best interest of North Carolina, even when that puts me at odds with my own party,” Tillis wrote in a statement published on X. “I did my homework on behalf of North Carolinians, and I cannot support this bill in its current form. It would result in tens of billions of dollars in lost funding for North Carolina, including our hospitals and rural communities. This will force the state to make painful decisions like eliminating Medicaid coverage for hundreds of thousands in the expansion population, and even reducing critical services for those in the traditional Medicaid population.”

Tillis urged Senate leaders to return to the House’s Medicaid reforms, which include work requirements for some able-bodied adults and anti-fraud measures. He praised the rest of the bill, including the extension of the Trump Tax Cuts, expansion of the child tax credit, historic border security investments, and efforts to end wasteful spending. “We can and must accomplish this without hurting our rural communities and hospitals,” he said.

Tillis has played a central role in shaping the legislation up to this point. One provision he inserted has sparked fierce backlash from conservatives and consumer advocates. That provision would impose a new tax on profits earned by third-party entities that finance civil litigation. Consumers’ Research launched a campaign targeting Tillis, accusing him of doing the bidding of the Chamber of Commerce and major corporations. The group warned that the measure would make it harder for everyday Americans to fight back against powerful companies. Executive Director Will Hild contended that the provision is “needlessly broad” and undermines “one of the few tools the average American consumer has to fight back against corporate political activists.” A mobile billboard condemning Tillis circled the Capitol on Thursday as pressure builds on Senate leaders to strike the language before a vote.

Democrats have seized on the Medicaid debate to amplify talking points from left-wing groups and industry-paid advocates. Their claims that the bill would lead to mass rural hospital closures rely on questionable studies and deeply partisan sources. One often-cited report comes from the University of North Carolina’s Sheps Center, whose leadership promotes radical gender ideologies and has a long track record of support for Democrat priorities. Other studies funded by Manatt Health Strategies include projections about cuts to coverage for illegal aliens and able-bodied adults who refuse to work. Critics note that only 4.9 percent of Medicaid inpatient hospital spending currently goes to rural hospitals. They argue that the bill would actually strengthen Medicaid by focusing resources on the most vulnerable and ending funding for illegal immigrants and fraudulent programs.

Tillis’s opposition comes as the Senate parliamentarian struck several major Medicaid provisions from the bill, including the provider tax used to pay for the Trump Tax Cuts. The ruling also removed language that would block Medicaid coverage for transgender procedures and benefits for illegal aliens. These decisions complicate how Republicans plan to offset the cost of the bill and limit what can be included under reconciliation rules. Senate Majority Leader John Thune told – News Saturday that Republicans expected many of the challenges and have prepared backup plans. He emphasized the goal remains to pass a final version that reflects the House’s priorities while advancing Trump’s agenda.