Trump Tillis rural hospitals Medicaid tax bill.

An empty hospital in Williamston, North Carolina, offers an evocative illustration of why Republican Sen. Thom Tillis would buck his party and its leaders to vote down President Trump’s signature domestic policy package. It’s one of a dozen hospitals that have closed in North Carolina over the last two decades. It’s a problem that hospital systems and health experts warn may only worsen if the “One Big Beautiful Act,” passes with its $1 trillion cuts to the Medicaid program and new restrictions on enrollment in the coverage. Across the country, 200 hospitals have shut down or reduced their services over the last two decades. Many of these closures occur in red states that have declined to expand Medicaid coverage, the health insurance program for the poorest Americans.