Trump ignored GOP warnings to gamble on a politically risky bill

Sen. Thom Tillis (R-North Carolina) told President Donald Trump he was making a mistake.

In a tense Saturday night phone call, the vulnerable senator from a purple state told the president that the legislation’s cuts to Medicaid would cause Republicans to lose the House majority and haunt Trump in much the same way that President Barack Obama was dogged by his promise that, under the Affordable Care Act, anyone who liked their doctor could keep them.

Trump pressed ahead anyway. “I hope he remembers the warnings and the advice that I gave him last night,” Tillis told reporters Sunday. “Because if this bill gets passed in its current form, I’ll remind him next year when we lose the majority in the House.”

Against the warnings of GOP moderates, Trump and congressional Republicans on Thursday managed to pass a $3.4 trillion bill that cuts taxes and spending and sets aside hundreds of billions of dollars for border security, detention centers and the Pentagon, once again showing the president’s firm grasp on Republicans.

But in Trump’s eagerness to score a signature legislative win and extend the tax cuts he put into place nearly 10 years ago, he also walked away from the campaign promise he made not to touch health care — risking Republicans’ majority in Congress.

To get his bill over the line in time for a self-imposed Friday deadline, Trump pressured Republican lawmakers to set aside their concerns about the political consequences of yanking benefits from voters while adding trillions to the federal deficit. He often brushed away lawmakers’ concerns about the ins and outs of the policy and did not acknowledge that the bill would result in people losing Medicaid. In a Wednesday meeting with House moderates and pragmatic conservatives, the president said Republicans shouldn’t touch entitlements if they want to win elections. A lawmaker pointed out that this bill does touch Medicaid, according to two people familiar with the exchange.

Sen. Susan Collins (R-Maine) and Tillis, the two most vulnerable Senate Republicans up for reelection next year, voted against the bill. Tillis announced Sunday that he would not run for reelection. Rep. Brian Fitzpatrick (Pennsylvania), one of three House Republicans who represent districts that Kamala Harris carried last year, also voted against the bill Thursday.

Other vulnerable House Republicans swallowed their concerns and voted for it. Rep. Richard Hudson (North Carolina), the chairman of the National Republican Congressional Committee, has predicted the Medicaid changes in the bill will be popular and has encouraged Republicans to run on them.

This account of how Trump and Hill Republicans passed a bill that so deeply divided them is based on interviews with more than two dozen lawmakers and aides, some of whom spoke on the condition of anonymity to disclose private deliberations.

The White House did not respond to a list of specific questions about Trump’s involvement. But White House press secretary Karoline Leavitt credited the president for getting it done. “Despite the doubters and the panicking, President Trump delivered win after win for the American people.”

As Trump began urging Congress to extend his tax cuts shortly after taking office, he stressed one point: He wanted no cuts to Social Security, Medicaid or Medicare to pay for the tax breaks.

“We’re not going to touch it,” Trump told reporters in February about Medicaid. “Now, we are going to look for fraud.”

Republican leaders in the House coalesced around a plan to implement work requirements for Medicaid as a way to cut federal spending on the program while arguing that truly needy people would still be able to access it.

Republicans also placed new limits on the taxes that almost all states charge health care providers as part of a strategy to win more Medicaid funding from the federal government.

After the bill passed the House in late May, some Republican senators raised grave objections to the cuts, including Josh Hawley (Missouri), a close ally to Trump who said the president agreed with him that the cuts were too steep. Sens. Lisa Murkowski (Alaska), Collins and Tillis also raised objections to those provisions.

But instead of moderating the Medicaid cuts, Senate leaders made them steeper, in part because they needed to find more savings to make tax cuts for businesses permanent — a top priority of Majority Leader John Thune (R-South Dakota). Speaker Mike Johnson (R-Louisiana) began to hear from worried House lawmakers. Many of them said they would vote against the bill if the deeper Medicaid cuts stayed in.

But Thune was also under pressure from Republicans who were threatening to withhold their votes if they did not win more spending cuts, including GOP Sens. Mike Lee (Utah), Ron Johnson (Wisconsin) and Rick Scott (Florida).

The Senate strengthened the House’s work requirements to qualify for Medicaid, expanding its application to apply to include people who have children 15 years or older. It also further reined in the providers tax that most states use to wring more Medicaid funding from Washington, while setting up a fund to help hospitals that some lawmakers feared would be forced by the bill to close.

Those changes will not take effect until after next year’s midterm elections, but they are expected to have a profound impact. By 2034, 11.8 million Americans will have lost their health insurance because of the Senate version of the bill, about 1 million more than would have lost coverage under the House measure, the nonpartisan Congressional Budget Office estimated. Still, many of those changes won’t take effect until after the midterm election, potentially blunting their political impact.

These changes enraged Tillis, who warned his colleagues that the changes would be politically disastrous and devastating for his state, which expanded Medicaid in 2023.

“It is inescapable this bill will betray the promise Donald Trump made,” Tillis said on the Senate floor. “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.”

As Trump trashed Tillis on social media, moderates in the House who shared the senator’s fears of the bill’s political impact began to worry. Vulnerable Republicans in the House were stunned to see how Trump and the administration admonished Tillis for their shared concern that Medicaid provisions would shutter hospitals and strip Americans of their health insurance. Several said they realized that Trump would rather notch a win than fight to keep the House majority in the midterms.

But Thune wouldn’t budge on Medicaid. If he scaled back the Medicaid funding cuts to win over Tillis, he risked losing the votes of Lee, Johnson and Scott, who were already unhappy the bill did not include more spending cuts. Thune also believed the provider tax limits were good policy. Ultimately, Tillis was so dismayed by the situation that he announced he would not seek reelection — hurting Republicans’ chances of holding his seat.

Losing Tillis’s vote blindsided Senate Republicans, forcing them to try to win over either Sen. Rand Paul (R-Kentucky) — a fiery libertarian who had been bad-mouthing the legislation for weeks — or Murkowski, one of the chamber’s most independent-minded members, who had a long history of defying Trump on key votes.

In the days before the Senate was about to start voting on the giant package, Trump called Sen. Lindsey Graham (R-South Carolina), his longtime golfing buddy and the chairman of the Senate Budget Committee, to ask him to invite Paul to a game of golf at his Virginia club that coming Saturday, according to two people with knowledge of the plans. The libertarian from Kentucky had spent weeks blasting the bill’s price tag — saying in interviews that Republicans would forever “own” the political issue of the federal debt if they voted for it — and even getting himself temporarily uninvited from the White House picnic in June over his critiques.

Graham told the president that the ayatollah of Iran was more likely to recognize Israel than Paul was to vote for his bill — but that it was worth a shot.

The mood on the golf course started out testy, as Trump resented Paul’s recent vote with Senate Democrats to require him to seek congressional authorization to take further military action in Iran. But by the end of the round, Paul had agreed to vote to begin debate on the bill — but not necessarily vote to pass it — if GOP leaders took the $5 trillion debt ceiling increase out, recognizing that it could be added back later. That gave Republicans a Plan B in case they lacked the 50 votes necessary to start debate on the bill. (Paul’s vote was ultimately unnecessary, because Murkowski voted Saturday to start debate on the bill, though she did not commit to voting to pass it.)

Later, Johnson and other conservative senators joined the group at the club to talk about their concerns with the bill’s price tag. The Wisconsin Republican brought out charts about the ballooning federal debt as his colleagues ate chicken wings and chatted about the golf game.

“Ron, you just need to be more positive about life,” Trump said, as Johnson continued to fume over the debt, according to one of the people familiar with the gathering. “There’s a lot to be happy about. You should enjoy life.”

The comment was representative of Trump’s impatience with Congress’s fiscal hawks, whom he would often try to placate by pointing to the billions of dollars in revenue his new tariffs were bringing in.

“For all cost cutting Republicans, of which I am one, REMEMBER, you still have to get reelected. Don’t go too crazy!” Trump posted on Truth Social the next day.

As a marathon Senate vote began Monday morning, Thune did not yet have the 50 votes he needed to pass the bill — putting immense pressure on him to flip Murkowski. Thune and Sen. Dan Sullivan (R-Alaska) had worked to win her vote by adding Alaska-related goodies, including a special tax break for fisheries and whaling captains in the state. Sullivan’s goal, he said, “was to make this bill so strong for Alaska that our entire congressional delegation would be compelled to support it.”

As voting on amendments stretched late into the night, Thune and Murkowski were locked in a tense conversation on the Senate floor.

Senate leaders were so desperate over the situation that they briefly huddled with Paul, a notoriously stubborn member of the chamber, to sound him out. Paul would vote to pass the legislation if the debt ceiling increase was lowered to just a fraction of the $5 trillion Senate leaders wanted, he told them.

Around 4 a.m., the Senate parliamentarian — who was charged with deciding what could be included in the bill under the chamber’s rules — struck down Republicans’ latest attempt to deliver extra Medicaid funds to Alaska and a handful of other states, putting Murkowski’s vote further in doubt.

But Murkowski had an incentive to vote for the bill. She knew that if she did not, Republican leadership could strip the provisions meant to help Alaska from the bill and try to secure Paul’s vote instead. They started drafting a version of the bill around 7 a.m. meant to win over Paul. With that threat hanging over her, Murkowski and Sullivan negotiated with Senate leadership and administration officials to double the fund to help hospitals deal with Medicaid funding cuts from $25 billion to $50 billion. Murkowski ultimately agreed to vote yes.

“This has been an awful process — a frantic rush to meet an artificial deadline that has tested every limit of this institution,” she said in a statement. “While we have worked to improve the present bill for Alaska, it is not good enough for the rest of our nation — and we all know it.”

Republican leaders knew that persuading the House could be even harder.

Scores of moderate and pragmatic Republicans planned to vote against the legislation before the rural hospital fund was added, fearing that without it hospitals would close. Dozens within the ultraconservative House Freedom Caucus were irate that the Senate bill would add even more to the deficit. And Johnson could lose only three votes.

Trump, Vice President JD Vance and their teams worked to peel off the holdouts. Some Republicans laughed when asked if Trump was persuasive, privately noting his tendency to veer off topic. But others described Trump’s explanation of the bill as “masterful” and crucial to clinching their support. “That was a meeting where clearly there were fewer no votes coming out of the White House than there were going in,” said Rep. Dusty Johnson (R-South Dakota).

In the end, he seems to have promised them executive orders — though details are scarce. “We came to significant agreements with the administration overnight on executive actions, both inside and outside, of the bill that will make America great again,” Freedom Caucus Chair Andy Harris (R-Maryland) said, without elaborating.

Trump was expected to sign the bill Friday. “My friends, the president of the United States is waiting with his pen,” Johnson said Thursday. “Let’s finish the job for him.”

Matt Viser contributed to this report.