Overview

• Senate Parliamentarian Elizabeth MacDonough ruled that the Medicaid provider tax overhaul and related cost-saving measures violate reconciliation rules, stripping out roughly $200 billion to $300 billion in projected savings.
• Disqualified provisions include caps on Medicaid eligibility for noncitizens and bans on gender-affirming care under Medicaid.
• GOP leaders are drafting alternative offsets, including a proposed rural hospital stabilization fund, to satisfy Senate procedure and fund the bill’s tax cuts.
• Majority Leader John Thune described the ruling as a “speed bump” and said contingency plans aim to keep the legislation on track for votes this weekend.
• CBO analysis projects the bill could add up to $3.4 trillion to the national debt over the next decade while extending major tax cuts for high earners and imposing stricter work requirements on low-income households.