Another top Senate Republican sends party warning over megabill cuts to Medicaid

Sen. Thom Tillis (R-NC) isn't happy about the proposal for cuts to Medicaid that would disproportionately affect rural America.

Tillis, who is up for reelection in 2026, told Punchbowl News senior congressional reporter Andrew Desiderio on Wednesday that he wants more money for states to fund the proposed regulations.

The existing Senate proposal would cut the federally matched medical provider tax. The move would reduce the amount of money that states can use to fund their own Medicaid programs.

GOP senators believe that such a cut would heavily impact rural hospitals, which have been propped up due to Medicaid expansion in the Affordable Care Act. Hospital executives have been sounding the alarm to their leaders.

The GOP solution to the cuts is to directly fund rural hospitals from the federal government.

"A fund for rural hospitals that would be impacted by the changes to the provider tax structure in the party-line domestic policy package, according to three people granted anonymity to discuss private negotiations," Jordain Carney and Robert King reported for Politico.

Tillis told Desiderio on Wednesday that the proposal to throw $15 billion to fund hospitals was woefully inadequate.

He noted, "The Department of Health and Human Services designates 1,000 hospitals in the U.S. as rural." He favors "Sen. Collins’ $100B idea Collins’ plan [which] mirrors an amendment she successfully added to the Bush tax cuts in 2003."

Collins is now pitching the idea to Republicans, Desiderio said.

"Rural hospitals in states that have not adopted the Affordable Care Act Medicaid expansion were more likely to have negative margins than rural hospitals in expansion states. Among rural hospitals, negative margins were more common among those in the most rural areas, while positive margins were more common among those that had more beds, higher occupancy, were affiliated with a health system, and were not government-owned in 2023," the Kaiser Family Foundation said in an April report.