Washington — The Republicans encountered a significant setback on Thursday after the Senate referee ruled that multiple health care cuts and savings in their ambitious domestic policy legislation are disqualified for the party-line process being employed to circumvent the Senate’s 60-vote threshold.
Senate parliamentarian Elizabeth MacDonough, responsible for resolving procedural conflicts between the two parties, determined that specific provisions were ineligible. The provisions disqualified include rules related to Medicaid that would prohibit funding without the verification of immigration status, changes in reimbursement tied to pharmacy benefit managers (PBMs), restrictions on provider taxes designed to save federal funds, and new eligibility limitations concerning funding under the Affordable Care Act.
These disqualified measures could amount to savings of between $200 billion and $300 billion over a decade, according to health care policy expert Matthew Fiedler from the Brookings Institution.
This decision presents a dilemma for Republicans who are striving to pass the One Big Beautiful Bill, which aligns with President Donald Trump’s agenda, through the Senate in the imminent days. As it stands, the House-passed version of the legislation is already set to add $2.4 trillion to the national debt over the next ten years. The potential for additional financial burdens may further complicate Republicans’ ability to secure sufficient votes for the final bill.
Senate Majority Leader John Thune, R-S.D., acknowledged the challenges posed by the ruling, referring to them as “speed bumps.” He assured reporters that the party has “contingency plans,” including plan B and plan C, to address these issues.
Despite the setbacks, Republican aides expressed confidence that the current rulings, while delaying the timeline for Senate votes, are not inimical to the overall bill’s success. They indicated that in certain areas, they plan to reword the contentious provisions to meet budget rules, particularly concerning the Medicaid provider tax. In other instances, they are prepared to accept the removal of certain provisions, which is considered a routine facet of the legislative process under this party-line method.
Utilizing the “budget reconciliation” approach allows Republicans to advance the bill in the Senate with a simple majority, effectively excluding Democrats and evading a filibuster. However, only specific types of legislation can qualify for this process under Senate rules.
In a bit of good news for Republicans, the parliamentarian ruled that new work requirements for able-bodied adults to access Medicaid are compliant with Senate regulations. This provision represents the largest contribution to health care spending cuts in the proposed legislation.
On the flip side, Democrats expressed relief regarding the parliamentarian’s ruling concerning the provider tax, a provision viewed by many from both parties as detrimental to hospitals, especially in rural areas. Senate Minority Leader Chuck Schumer, D-N.Y., underscored this sentiment by stating, “The provider tax is devastating to our hospitals, particularly our rural hospitals, and so I’m glad it’s gone.” He urged Republicans not to introduce an alternative that could be as harmful or worse.
The recent decisions by MacDonough compound an already extensive list of challenges Republicans must navigate. Medicaid remains a contentious issue for numerous GOP lawmakers. Some House conservatives, such as Reps. Andy Harris, R-Md., and Chip Roy, R-Texas, have signaled their intention to derail the revised bill over concerns it may soften cuts to clean energy funding. Meanwhile, the expansion of the cap on state and local tax deduction, referred to as “SALT,” is a contentious topic that poses difficulties for both blue-state House Republicans and their Senate counterparts.
In response to the parliamentarian’s rulings, some conservatives criticized MacDonough, demanding that she either be overruled by the Senate or dismissed by Thune. Senator Tommy Tuberville, R-Ala., used social media to express his discontent with the parliamentarian, asserting, “The WOKE Senate Parliamentarian, who was appointed by Harry Reid and advised Al Gore, just STRUCK DOWN a provision BANNING illegals from stealing Medicaid from American citizens. This is a perfect example of why Americans hate THE SWAMP.”
Tuberville called for MacDonough’s immediate dismissal, declaring, “THE SENATE PARLIAMENTARIAN SHOULD BE FIRED ASAP.”
MacDonough, who was appointed by former Senate Majority Leader Harry Reid, D-Nev., in 2012, has earned respect from leaders across the political spectrum. However, Senator Roger Marshall, R-Kan., echoed Tuberville’s call for her removal and advocated for term limits for parliamentarians, questioning why anyone should hold such power for an extended period without accountability.
Thune refrained from directly addressing the possibility of ousting MacDonough, acknowledging the understanding that the parliamentarian could rule against certain bill provisions as Republicans sought to push boundaries to achieve their legislative goals.
A number of Republican senators, including Lindsey Graham of South Carolina, Bill Cassidy, and John Kennedy of Louisiana, expressed their opposition to overruling the parliamentarian. Given the GOP’s slim 53-47 majority, there appears to be insufficient support to proceed with such a course of action.
Senator Susan Collins, R-Maine, who chairs the Appropriations Committee, rejected calls from Tuberville and others for MacDonough’s dismissal. She argued that the parliamentarian’s work is impartial and can affect both parties: “What comes around goes around when it comes to the parliamentarian. She may rule a way you like one day, the way you don’t the next. She has a job to do.”
As the situation develops, Democrats remain vigilant, signaling their intention to continually challenge provisions within the legislation based on Senate rules. They frame the proposed cuts as measures designed to benefit “tax breaks for billionaires.” Senator Jeff Merkley, D-Ore., the ranking member of the Budget Committee, condemned the bill, stating, “Democrats are continuing to make the case against every provision in this Big, Beautiful Betrayal of a bill that violates Senate rules and hurts families and workers.”
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