Why Three Republicans Voted Against Their Party

The three most unpopular GOP senators in the White House right now are Susan Collins of Maine, Rand Paul of Kentucky, and Thom Tillis of North Carolina. They were the only Republicans to vote against the tax and spending package that cleared the Senate on Tuesday to pay for President Trump's agenda. Their nay votes led to a 50-50 tie, but Vice President JD Vance cast the tie-breaking vote in favor of the legislation. Their reasons:

• Collins: "My vote against this bill stems primarily from the harmful impact it will have on Medicaid, affecting low-income families and rural health care providers like our hospitals and nursing homes," Collins said in a statement cited by the Penobscot Bay Pilot. Senate Republicans boosted the size of a fund to help rural hospitals from $25 billion to $50 billion to appease Collins, but that fell short of her proposal for a $100 billion increase, per the Hill. Collins is up for reelection in 2026 and could have a tough fight.

• Tillis: Like Collins, the North Carolina senator voted no because he fears the impact of Medicaid cuts on his constituents. "It is inescapable this bill will betray the promise Donald Trump made," Tillis said in a floor speech on Monday. "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." (After raising the ire of Trump over his opposition, Tillis announced he would not seek reelection next year.)
• Paul: He has said for weeks now that he thinks the legislation will send the national deficit soaring, per Axios. "Even using the math, even using the formulas that the supporters of the bill like, the deficit will grow by $270 billion next year," he said on the Senate floor before the final vote. "That doesn't sound at all conservative to me, and that's why I'm a no." Trump also went after Paul over his opposition, though the Kentucky senator is not up for election until 2028.