Jennifer Balkcom: The One Big Beautiful Bill Threatened To Reverse North Carolina’s 2023 Medicaid Expansion, Garnering Opposition From Republican Senator Thom Tillis

The One Big Beautiful Bill Risked Triggering The Reversal Of North Carolina’s Medicaid Expansion

June 2025: North Carolina Health News Headline: “‘Big Beautiful Bill’ Could Unravel NC’s Medicaid Expansion: Officials Say Proposed Changes Would Set Off A Trigger Law, Potentially Ending Coverage For Hundreds Of Thousands Of Residents.” [North Carolina Health News, 6/27/25]

North Carolina’s 2023 Medicaid Expansion Law Contained A Provision That Would Automatically End The Program If The Federal Government Stopped Covering 90% Of Its Cost. “Tillis explained in a floor speech Sunday evening that he’d reached out to North Carolina legislators, the N.C. Healthcare Association, and Gov. Josh Stein's administration to gather estimates on the bill’s Medicaid impact locally. He said all agreed that the bill’s cuts to Medicaid funding would mean more than 600,000 people in his state would lose healthcare. That’s because when the Republican-led state legislature enacted Medicaid expansion in 2023, it included a provision that would automatically end the program if the federal government stops covering 90% of its cost. Tillis warned his fellow Republicans that the move could damage their party’s election prospects. He argued that a broken promise on Medicaid would be similar to former President Barack Obama’s claim that ‘if you like your health care plan, you can keep it’ under the Affordable Care Act. Tillis says Obama’s statement led to GOP victories.” [WUNC, 6/30/25]

June 2025: North Carolina Health News: The One Big Beautiful Bill Would “Effectively Kill” North Carolina’s Medicaid Expansion And Strip Coverage From Hundreds Of Thousands Of People Who Only Recently Became Eligible. “More than 670,000 North Carolinians have enrolled in Medicaid since the state expanded access to the government-funded health insurance program in December 2023. Medicaid expansion, which passed with bipartisan support after years of resistance from most Republicans in the N.C. General Assembly, raised the state’s strict income threshold for Medicaid. That opened up the program to many working adults with lower incomes who previously made too much money to qualify. The measure has been hailed as a landmark policy change that is reshaping North Carolina’s health care landscape and closing long-standing coverage gaps, particularly in rural and underserved communities. Now, state health officials are warning that President Donald Trump’s so-called One Big Beautiful Bill, a version of which is expected to go before the U.S. Senate for a vote as early as this weekend, would effectively kill North Carolina’s expansion — stripping coverage from hundreds of thousands of residents who only recently became eligible for it.” [North Carolina Health News, 6/27/25]

North Carolina Republican U.S. Senator Thom Tillis Said He Voted Against The One Big Beautiful Bill Because It Would Effectively End North Carolina’s Medicaid Expansion

June 2025: WUNC Headline: “Senate Megabill Could Kill NC’s Medicaid Expansion, Prompting Tillis Opposition.” [WUNC, 6/30/25]

June 2025: WUNC: “U.S. Sen. Thom Tillis Says The Senate’s Current Megabill Would Effectively End Medicaid Expansion In North Carolina — And That’s The Main Reason He’s Opposing The Bill.” “U.S. Sen. Thom Tillis says the Senate’s current megabill would effectively end Medicaid expansion in North Carolina — and that’s the main reason he’s opposing the bill. Tillis’ decision to vote against the bill triggered a primary threat from President Donald Trump, which was followed by the senator’s Sunday announcement that he won’t run for re-election next year. Tillis explained in a floor speech Sunday evening that he’d reached out to North Carolina legislators, the N.C. Healthcare Association, and Gov. Josh Stein's administration to gather estimates on the bill’s Medicaid impact locally. He said all agreed that the bill’s cuts to Medicaid funding would mean more than 600,000 people in his state would lose healthcare. That’s because when the Republican-led state legislature enacted Medicaid expansion in 2023, it included a provision that would automatically end the program if the federal government stops covering 90% of its cost.” [WUNC, 6/30/25]

• Tillis Voted Against The Passage Of The One Big Beautiful Bill. “North Carolina Senator Thom Tillis announced Sunday afternoon that he will not be seeking reelection in 2026. This comes after receiving backlash from President Donald Trump for voting against the ‘One Big Beautiful’ bill, which passed 51-49 overnight Saturday. Tillis released a Sunday statement, saying in part: ‘In Washington over the last few years, it's become increasingly evident that leaders who are willing to embrace bipartisanship, compromise, and demonstrate independent thinking are becoming an endangered species.’” [ABC7 Eyewitness News, 6/29/25]

NOTE: In April 2026, NC lawmakers approved legislation to fully fund the state’s Medicaid program through the end of the fiscal year. Balkcom voted for the legislation.