Medicaid tales

Tillis and Berger split over health care. Democrats should take notice.

Danielle Battaglia of McClatchy has a great article about how Thom Tillis and Phil Berger split over the Big Beautiful Bill, which guts Medicaid expansion in North Carolina. Thom Tillis ended up announcing his retirement after fighting against the measure while Phil Berger lent his support to it. U.S. Senate candidate Michael Whatley had a role in the dispute even before he was a candidate for Senate. It’s also a reminder to Democrats that they need to make health care the central conversation in the 2026 election.

According to the article, Tillis did his due diligence. He had the research divisions from the legislature, Gov. Josh Stein’s administration, and the North Carolina Healthcare Association, which represents hospitals, give analyses on the bill’s impact. All came back with devastating results, at least $26 billion in cuts.

And this is where the article gets interesting. Phil Berger says he came out publicly in support of the bill at the request of Michael Whatley, who was then Chair of the Republican National Committee. Tillis says everybody had the same information about the impact so Berger and Whatley knowingly supported a bill that would strip access to health care from hundreds of thousands of North Carolinians and probably end up closing hospitals in rural parts of the state.

Tillis, for his part, also made a very illuminating statement. According the article, “Tillis explained his initial objection to Medicaid expansion, in his speech on the Senate floor, saying he believed one day ‘we would be here’ — put in this position of taking health insurance coverage away from people who desperately needed it.” In other words, Tillis opposed providing health care for people who “desperately needed it” because he knew that one day Republicans would take it away from them.

That’s a statement of values: Republicans put more emphasis on tax cuts than the well-being of people who need support. It’s not like they’re cutting the deficit. They’re just shifting where money goes and refusing to ask the richest people in the world to help the poorest people in the country.

As the article points out, both Berger and Tillis were facing elections. For Tillis, the bill was the last straw. He was unable to reach the balance he sought between common sense compromise and fealty to MAGA so he got out of the race. Berger has a primary from the popular sheriff of Rockingham County, Berger’s home county. He may have made the calculation that supporting Trump’s bill was more politically important than protecting health care of the beneficiaries of Medicaid expansion.

Democrats need to double down. Health care is a big deal and it’s going to be a bigger one once people start losing their insurance. The legislature is about to start kicking people off of Medicaid in North Carolina because they can’t reach a budget. People are already taking notice even though the federal cuts aren’t scheduled to take place until 2028.

It’s a salient issue that resonates with voters Democrats need to reach. A short documentary of Bernie Sanders traveling through West Virginia highlights the opportunity. He meets with hardcore Trump voters who are clearly disillusioned. Access to health repeatedly comes up. Democrats need to respond with plans to protect Medicaid and reduce costs that might get their attention.

Health care was the driving factor in the most successful Democratic elections of the 21st century. In 2006, Democrats won a wave election that focused on reforming our health care system. In 2008, the Democratic primary was decided after a series of debates between Barack Obama and Hillary Clinton over how to deliver health care to more Americans. Obama’s fall campaign centered around health care reform even if it was quickly overshadowed as the impact of the Great Recession became apparent in the fall of 2008.

If Democrats want to win elections, they need to focus more on the things important to the people who have been left behind. Health care is central. It’s tangible and emotional. People know that if they or their loved ones can’t get to a doctor, they are in trouble. Democrats should offer them a solution.