Tillis says he consulted top NC GOP leaders before voting against Trump’s ‘Big, Beautiful Bill’

U.S. Sen. Thom Tillis says he knew his days in Washington were numbered the moment he realized how much President Donald Trump’s signature legislation — known as the “One Big Beautiful Bill Act” — would hamper North Carolina’s Medicaid program and transfer costs to state taxpayers. 

In his new book, “How to Lose Friends and Antagonize Presidents,” the senator says it was his breaking point. He described his thought process in the book, offering new insight into how he arrived at his decision to reject the bill — a choice that led Trump to seek a primary opponent against Tillis, effectively ending his reelection efforts. 

Tillis voted against the bill in June 2025, citing his concerns over the future of rural hospitals and people on Medicaid. It ultimately passed, cutting spending on Medicaid, the healthcare program that insures more than 25% of North Carolinians, by $1 trillion to pay for new tax cuts. 

“What I didn’t like was an enormous squeeze on the provider-tax system that many states — mine included — use to finance Medicaid,” Tillis wrote. “Among other things, these provisions would have shifted costs from the federal government to states, which would place an enormous strain on many rural hospitals. I knew that because, unlike the president — or, more specifically, his think-tank hacks who have never run a business — I went and spoke with some people who knew what the hell they were talking about.”

Tillis said his first calls were to state House Speaker Destin Hall, R-Caldwell, and state Senate leader Phil Berger, R-Rockingham. 

“The news they gave me wasn't good,” wrote Tillis, himself a former speaker of the state House. “The cuts would result in a nearly $2 billion shortfall every year for ten years.” 

As many as 250,000 North Carolinians could be kicked off Medicaid when the cuts go into effect in January, and one study predicted the fallout could lead to tens of thousands of layoffs in the healthcare industry, WRAL reported earlier this year.

The longtime Republican lawmaker said he later consulted Democratic Gov. Josh Stein’s administration and the North Carolina Healthcare Association — a hospital lobbying group led by former Republican politician Josh Dobson which was heavily opposed to the bill. Tillis said he had several virtual meetings with White House staff to voice his concerns over the bill in the weeks leading up to the vote on the bill. He said Berger and Hall were included in calls with White House staffers and healthcare policy officials “so they would have a front-row seat in the analysis and working with the administration,” Tillis wrote. 

“After running through the data, taking special care to note that no matter what we did, the fiscal fallout from this bill was going to be disastrous, I asked [White House personnel] to prove me wrong. In fact, I begged them to prove me wrong. I said I was willing to accept any data they had that would make my team’s analysis look stupid.

“I got nothing,” Tillis wrote.

Spokespeople for Berger and Hall didn’t respond to multiple requests for comment on Tillis’ claim. Berger and Hall have publicly celebrated the passing of the bill. “President Trump’s Big Beautiful Bill: roots out waste, fraud and abuse; promotes school choice; backs ICE,” Hall wrote in a post on X in late July 2025. “Now it’s the state legislature’s turn. [The House budget proposal] puts us in the best position to implement the President’s America First agenda.” 

Berger, who was endorsed by Trump in his failed 2026 primary campaign, also recognized the bill’s passage. “Congrats to @realDonaldTrump on the One Big Beautiful Bill passing Congress! This bill will unleash a new era of growth and opportunity in the US,” Berger said in a social media post in July 2025.

Tillis found more support for his position from across the aisle. Stein wrote a letter to Congress before it passed, urging lawmakers to vote against the proposal. He warned that hundreds of thousands of North Carolinians could lose their Medicaid coverage, and the bill would effectively eliminate a state program aimed at propping up rural hospitals. Tillis echoed many of those same concerns in a speech on the Senate floor, where he wouldn’t support the bill.

"I owe it to the people of North Carolina to withhold my affirmative vote until it's demonstrated to me that we've done our homework,” Tillis said in that speech. “We're going to make sure we fulfill the promise. Then I can feel good about a bill that I'm willing to vote for."

Trump called Tillis shortly after the speech and tried to sway the senator to change his mind, Tillis writes in the book. But Tillis declined, saying Trump was getting “bad advice from some of the idiots he’d hired to run healthcare policy.”

A White House spokesperson didn’t respond to a request for comment.

Trump responded to Tillis’ opposition by threatening to back a challenger against him in this year’s March primary election. Tillis announced he wouldn’t seek reelection, and Trump endorsed Michael Whatley, the Republican National Committee’s chairman at the time, for the seat.  Tillis wrote that he started considering retiring well before the summer of 2025, but the bill solidified that decision. He later referred to the president’s key legislative victory as the “Big, Beautiful Blunder” and predicts throughout the memoir that it will doom Republicans in the upcoming midterm elections.

“I had no interest in sticking around long enough to see the political explosion I knew was coming if — or, rather, when — this thing became the law of the land,” Tillis wrote. “I certainly don't envy my Republican colleagues who … have to go out and explain to their constituents why they were suddenly feeling so much economic pain. I wouldn't quite know what to say if a member of my staff handed me a speech defending the ‘Big, Beautiful Bill.’” 

He added: “If I had to deliver that speech, I don't think I'd be able to stop my thoughts from dwelling on all the people who'd been summarily booted off Medicaid through no fault of their own. I'd get all tongue-tied as I thought about the people who were now living next to subpar hospitals out in the country, where good emergency medical care matters a great deal.” 

Tillis predicts a midterm ‘bloodbath’ 

Tillis doesn’t foresee the upcoming elections going well for Republicans — a scenario that he calls “totally avoidable.”

“We have chosen the proverbial chainsaw shed time and time again, kowtowing to the White House’s every demand, even when we know the end result is going to be a bloodbath,” Tillis wrote.

Tillis says he started warning Republican colleagues that they were headed down a dangerous path shortly after Trump returned to office in 2025.

In a text that Tillis said he sent the president, he scolds Trump, telling the president he “took advice from some [expletive] on healthcare policy that is going to harm North Carolina and kill Whatley’s chances.”

At a clean energy conference in Raleigh on Thursday, Tillis said Republicans need to show they’re willing to break from the White House to win in a state like North Carolina. He said his party often caves to the executive branch when in power.

“What we have to do in the state is resonate with unaffiliated voters and have some separation from the president when you legitimately have a difference of opinion,” Tillis told reporters.

Unaffiliated voters make up the state’s biggest voting bloc. A WRAL/WSOC Poll, released last week, showed that only 26% of independent voters approved of the job Trump was doing in office. Independents were also gravitating toward the Democratic nominee in the race for the state’s open U.S. Senate seat, the poll showed.

The WRAL/WSOC Poll shows Whatley trailing Democratic nominee, former North Carolina Gov. Roy Cooper. A major Republican political action committee and the Whatley campaign have each paused TV ads as the race reaches its final weeks.

Tillis regrets Hegseth, Kennedy and Noem votes. 

Tillis argues throughout his book that his main issues are not with the president. Rather, he is highly critical of the people who surround Trump and offer advice.

“While there are many good people currently employed in the West Wing, too many others are cynical, shameless, boot-licking sycophants who shouldn’t be allowed to tour the White House, let alone work there,” Tillis says in the book.

Tillis is largely responsible for Republicans flipping control of the state legislature, for the first time in more than a century, during the 2010 Tea Party wave. He served as speaker of the state House of Representatives as the GOP cut spending, cut taxes and enacted new conservative policies on gay marriage, abortion and guns. But he has clashed with Trump and his cabinet officials at times, leading many Trump loyalists to criticize Tillis as a RINO, an acronym for “Republican in name only.”

In the book he defended his conservative record. Tillis said that his outbursts directed toward the White House were in the interest of protecting the president and the president’s legacy.

“I truly believe Donald Trump is an amazing political talent, and he gets things done like no president I’ve ever seen,” Tillis wrote. In my mind, he’s a CEO with bad advisors.” 

Tillis describes a series of moments supporting his belief throughout the memoir. The first of which, he wrote, came when the president nominated former Florida U.S. Rep. Matt Gaetz for U.S. Attorney General. He references an ethics investigation into allegations of sexual misconduct and illegal drug use that eventually led to Gaetz’s resignation from Congress. Gaetz refuted those accusations many times while in office.

Tillis later described his vote for Secretary of Defense Pete Hegseth as the biggest regret of his career. In an appearance on NBC’s “Meet The Press” last week, he stood by his position.

“I made a mistake,” Tillis said. “I’ve admitted I made a mistake, and now I want to try to put someone in place who will help the president’s legacy and make Americans safer.  That is not Pete Hegseth.”

A Pentagon spokesperson didn’t respond to a request for comment.

During Hegseth’s nomination, Tillis was seen by many as the deciding vote on Hegseth. The New York Times reported in 2025 Tillis led a behind-the-scenes effort to kill Hegseth’s nomination but then voted to confirm him anyway, under pressure from Trump. In the book, he describes his skepticism, citing allegations of abusive behavior toward women and allegations of problem drinking.

Tillis wrote he started hearing rumors that millions of dollars worth of ad buys were being prepared in North Carolina. He assumed they would target him if he voted against Hegseth’s confirmation.

The senator described similar dilemmas while considering the nominations of Health and Human Services Robert F. Kennedy Jr. and former Director of National Intelligence Tulsi Gabbard. Tillis explained he had major concerns about both of their qualifications to lead their respective agencies, but he opted to vote for them anyway. He also expressed regret for voting to confirm U.S. Department of Homeland Security Secretary Kristi Noem, who he has criticized for her management of the Federal Emergency Management Agency and U.S. Customs and Border Patrol. 

On March 4, a day before Trump fired Noem, a FEMA spokesperson sent WRAL a statement defending her record of disaster aid, particularly for Western North Carolina in the aftermath of Hurricane Helene. “Secretary Noem is making sure this money is getting to communities that are working hard to rebuild, and it is happening faster than before,” the FEMA spokesperson said.  Noem is now a senior advisor in the State Department.

Tillis said he believes presidents are entitled to staff their administrations as they see fit.

“More often than not, my beef with 47 is not the ‘what.’ It is the ‘who’ and the ‘how,’” Tillis wrote in his book, using the number of Trump’s presidency to refer to him in shorthand.

While supporting the president, Tillis said he won’t blindly follow him. He referenced a purported exchange with Trump in May 2026 after the president called him a “nitpicker” and a “quitter” in a Truth Social post. 

Tillis shared a lengthy text he said he sent the president shortly after: “I still want to help, but I don’t take [expletive] from anyone, including you, Mr. President. Save that [expletive] for the cowards who don’t care if you fail. I care if you fail, and right now we are failing.”

Tillis worries the US is approaching a dictatorship

In the book, Tillis describes a six-step process in which democracies turn into dictatorships. He argues the United States is in step four. He’s critical of the current administration and prior Democratic presidents for their roles leading the country to this point.

Tillis compares former President Barack Obama’s efforts to get the Affordable Care Act passed to the Trump administration’s success in getting the president’s tax and healthcare bill over the finish line. He says both administrations neglected Congress and claimed they had a mandate to do whatever they wanted.

He argues step four is about controlling the truth, writing that Trump positions himself as the one and only source of truth. He likened that to former President Joe Biden administration’s account of his health, despite public concern.

Tillis argues many presidents have tried reaching the next two stages: establishing a new society and ruling forever. Trump has repeatedly suggested he might run for reelection again in 2028 despite the U.S. Constitution limiting presidents to two terms.

Tillis also rails against adding more justices to the U.S. Supreme Court or removing the filibuster, an idea both parties have floated in recent years. Trump is currently pressuring the GOP-led U.S. Senate to kill the filibuster to pass new election laws over opposition from Tillis and a handful of other Republicans, as well as all Democrats. The senator warns against federalizing elections, something he believes the SAVE Act, a Trump-backed proposal to require proof of citizenship when registering to vote, would accomplish. He argues it opens the door for a future tyrant to try staying in power forever.

“I’m not saying this hypothetical tyrant is President Trump,” Tillis wrote. “I am saying that the president is acting a lot like he wants to rule forever — or at least set up his allies to do something similar in the future.”

Tillis spends a large portion of the book describing Jan. 6, 2021, when a group of Trump supporters stormed the U.S. Capitol. He recounts sitting alone on the Senate floor with a small knife gifted to him by a former security guard.

“I was angry, and I have to admit I wanted to go after the [people] who defiled our Capitol,” Tillis wrote.

Tillis called the riot an example of what happens when leaders sow distrust in elections, and he fears it may become a regular occurrence unless things change. He said he was disgusted when Trump pardoned people convicted for their role in the riots. 

WRAL State Government Reporter Will Doran contributed to this report