Senate Referee Strikes Down Key Medicaid Reform Provision From GOP Megabill
The Senate parliamentarian has dealt a blow to Senate Republicans by rejecting a crucial Medicaid reform provision in the GOP’s One Big Beautiful Bill Act. This setback comes as Senate Republicans gear up to begin voting on the package in the coming days.
On June 26, Senate Parliamentarian Elizabeth MacDonough invalidated a GOP proposal to limit states’ use of a health care provider tax, a measure intended to generate significant savings to offset permanent business tax cuts included in the megabill. This ruling has forced Senate Republican leaders to reconsider and potentially rework key components of the bill as they rush to pass it before the July 4 deadline set by President Donald Trump and Republican leaders.
The parliamentarian’s decision was based on the Byrd Rule, which restricts reconciliation bills to provisions related to taxing, government revenue, and the national debt. The purpose of reconciliation is to allow the GOP to pass the One Big Beautiful Bill Act with a simple majority in the Senate, bypassing the 60-vote filibuster threshold.
In addition to the Medicaid reform provision, MacDonough also struck down other measures, including one preventing Medicaid and the Children’s Health Insurance Program (CHIP) from denying coverage to individuals whose immigration status is not immediately verified, as well as a provision blocking funding for states that provide Medicaid to illegal immigrants.
Furthermore, provisions prohibiting Medicaid and CHIP funding for transgender surgeries, blocking Medicare for illegal immigrants, and preventing illegal immigrants from enrolling in the Affordable Care Act were also deemed irrelevant under the Byrd Rule.
Senate Budget Committee Ranking Member Jeff Merkley (D-Ore.) criticized the GOP’s bill, labeling it a “Big, Beautiful Betrayal” that violates Senate rules and harms families, students, and workers. Democrats are determined to challenge any provisions that violate the Byrd Rule and advocate against increasing healthcare costs and restricting access to reproductive care.
While Republicans have the option to overrule the parliamentarian, Senate Majority Leader John Thune (R-S.D.) has expressed reluctance to do so, stating that it would not be conducive to passing the bill.
Some Republicans have called for the dismissal of the parliamentarian, with Sen. Tommy Tuberville (R-Ala.) and Sen. Roger Marshall (R-Kan.) suggesting that MacDonough should be fired for her decision.
The fate of the One Big Beautiful Bill Act now rests on potential revisions by Senate Republicans and its approval in the House, should the Senate pass a revised version. The road ahead is uncertain, but the repercussions of the parliamentarian’s ruling will undoubtedly shape the future of the GOP’s megabill.
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