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8h ago

Senate Parliamentarian Blocks Medicaid Cuts, Jeopardizing Passage of Trump’s One Big Beautiful Bill

Byrd Rule rulings on healthcare provisions have forced Republicans to scramble revisions ahead of a self-imposed July 4 deadline for the bill’s passage.

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Senate Majority Leader John Thune, R-S.D., center, joined at left by Sen. John Barrasso, R-Wyo., the GOP whip, speaks to reporters after Republican senators met with Treasury Secretary Scott Bessent and worked on President Donald Trump's tax and immigration megabill so they can have on his desk by July 4, at the Capitol in Washington, Tuesday, June 24, 2025. (AP Photo/J. Scott Applewhite)
The U.S. Capitol in Washington. The Senate parliamentarian advised that a Medicaid provider tax overhaul central to U.S. President Donald Trump’s tax cut and spending bill does not adhere to the chamber’s rules.

Overview

  • Senate parliamentarian Elizabeth MacDonough ruled that core Medicaid provider tax changes and restrictions on eligibility for non-citizens and gender-affirming care violate reconciliation rules, forcing their removal from the package.
  • Eliminating those provisions removes $200 billion to $300 billion in planned savings, complicating Republican efforts to offset permanent extensions of the 2017 tax cuts.
  • Gaps over Medicaid cuts have exposed fractures within the GOP, with moderates like Senators Susan Collins and Josh Hawley warning of rural hospital closures and fiscal conservatives demanding deeper spending cuts.
  • The One Big Beautiful Bill would make Trump-era tax cuts permanent, introduce new deductions for families and seniors, and fund a $350 billion immigration enforcement operation with 100 000 detention beds.
  • The Congressional Budget Office projects the package could add $2.4 to $3.4 trillion to the national debt over a decade, prompting Democrats to denounce it as a “big, ugly betrayal” that hurts vulnerable Americans.