Understanding Tillis’ Estimate of the Massive $32 Billion Medicaid Cut

Plus, my failed amendment to protect Medicaid in the State Senate

Just over a week ago, President Donald J. Trump signed into law a bill that will have a massive and devastating effect on hundreds of thousands of North Carolinians.

Prior to the passage of the so-called Big Beautiful Bill, North Carolina Senate Leader Phil Berger posted this on social media.

With the passage of what I would call the Big Ugly Bill (I’ll refrain from calling it the Big Bull@#@ Bill as some have), more than 650,000 Medicaid recipients are now at risk of losing health care coverage.

That’s not my opinion. That’s the opinion of the most prominent Republican in our state - United States Senator Thom Tillis. His office estimated a $32 billion impact to the North Carolina budget and hospitals over the next decade.

A former management consultant and Speaker of the House of the North Carolina House of Representatives, Tillis analyzed information from the North Carolina General Assembly’s nonpartisan Fiscal Research Division, the North Carolina Department of Health & Human Services, the North Carolina Healthcare Association, and the North Carolina Medicaid program.

As Senator Tillis’ points out, there are two devastating impacts on Medicaid expansion: (1) increased administrative cost and the provider tax phase down; and (2) the 3.5 percent provider tax cap that eliminates all or most of the Healthcare Access and Stabilization Program (HASP), a system of state directed payments.

Senator Tillis also said he talked to Centers for Medicaire and Medicaid Services Director Mehmet Oz and presented his findings that showed the best-case scenario was a $26 billion cut in federal support. “After three different attempts for them to discredit our estimates, the day before yesterday they admitted that we were right,” Tillis said on the floor. “They can’t find a hole in my estimate.”

“It is inescapable this bill will betray the promise Donald Trump made,” Tillis said. “I’m telling the president that you have been misinformed. You supporting the Senate mark will hurt people who are eligible and qualified for Medicaid.”

Here’s a breakdown by North Carolina counties.

Recognizing the pending threat of the Big Beautiful Bill, this past May I offered an amendment to protect Medicaid expansion recipients during the State Senate budget debate, but the governing Republican majority defeated the amendment, thereby putting our citizens at risk of losing healthcare.

So, here we are: We’re now confronting a health care system that doesn’t improve people’s lives of our state. It will make them sicker. It will bankrupt them. And, we’re now confronting unimaginable pressure to address the loss of $32 billion over the next decade to our state budget.