Sen. Thom Tillis warned his colleagues during a closed-door meeting Wednesday that he would not vote to take up the party’s sweeping domestic policy bill without further clarity on Medicaid changes, a person granted anonymity to disclose private discussions said.
“He said he wouldn’t vote for a motion to proceed until he got some clarity on what’s going to happen with the provider tax,” the person said, referring to a funding mechanism Senate GOP leaders are hoping to curtail. Tillis has been trying to get details on how the Senate language will impact North Carolina, the person added.
Tillis wasn’t alone.
Multiple other Republican senators warned Majority Leader John Thune during the lunch that they were not ready to vote to launch floor debate on the megabill, according to three attendees. But it’s Tillis, who is up for reelection next year, who has emerged as a key vote to watch as Thune moves to try and meet a July 4 target for final passage of the bill.
Tillis told colleagues he spoke recently with CMS Administrator Mehmet Oz about the provider tax’s impact on North Carolina but said he believed the numbers provided by Oz and his team underplayed the impact. Tillis handed out a document to his colleagues earlier this week that estimated his state’s losses at more than $38 billion.
“He said just now in this meeting, … ‘If you proceed on this provider tax like you’re going to do right now, you won’t have a member from North Carolina sitting at this table after next year,’” the person added. (Though North Carolina has two Republican senators, Tillis appeared to be referring to his own endangered re-election bid.)
It was just the latest instance of Tillis raising concerns privately about the Senate’s Medicaid proposal. While the House-passed bill freezes existing provider taxes, the Senate’s bill incrementally rolls back an existing federal cap.
Senate leaders made their opening offer on a rural hospital relief fund Wednesday morning. But that figure, $15 billion, is sparking pushback publicly and privately from Tillis and others.
Sen. Susan Collins (R-Maine), who is undecided on the reconciliation bill, told reporters Wednesday that “any money is helpful, but, no, it is not adequate.” She floated a $100 billion fund but added, “I don’t think that solves the entire problem.”
On the other end of his conference, Thune is facing GOP senators who want the rural hospital fund to be shrunk further. He’s not just facing pushback over health care provisions; a clutch of deficit hawks also still aren’t on board with the bill.
The ongoing negotiations have some of his members openly questioning whether they will be able to meet his goal of passing the bill in the Senate this weekend. Thune can lose three GOP senators and still have Vice President JD Vance break a tie.
“Well, I mean, everybody’s got their vote,” Thune said when asked about the holdouts. “We’re working with all of their members to try to get people comfortable with the bill, and hopefully in the end, they’ll be there.”
Other Republicans are banking that their colleagues’ rhetoric is a negotiating tactic and that they will ultimately fall in line — potentially with leadership agreeing to changes to assuage their concerns.
“All of our guys are going to keep advocating for what they want until we pass it,” said Sen. John Hoeven (R-N.D.), predicting that GOP leaders will ultimately get votes to proceed with the bill.
