In a significant blow to Republican lawmakers, the Senate parliamentarian ruled on Thursday that several proposed health care cuts and savings in their ambitious domestic policy bill do not qualify for the party-line path they are attempting to utilize. This ruling, delivered by Senate parliamentarian Elizabeth MacDonough, has disqualified key provisions that would have enabled Republicans to bypass the Senate's 60-vote threshold.
The disqualified provisions include important Medicaid regulations, changes to pharmacy benefit manager (PBM) reimbursement contracts, restrictions on provider taxes aimed at saving federal funds, and new limitations surrounding eligibility for funding under the Affordable Care Act. According to health care policy expert Matthew Fiedler from the Brookings Institution, these provisions represent a potential loss of savings ranging from $200 billion to $300 billion over the next decade.
This setback poses a substantial challenge for Republicans, who are striving to pass their “One Big Beautiful Bill” aligned with President Donald Trump's agenda in the Senate shortly. The legislation, which has already been projected to add $2.4 trillion to the national debt over the next ten years, now faces heightened scrutiny and apprehension among GOP members regarding the final product.
Senate Majority Leader John Thune of South Dakota acknowledged the difficulties posed by the ruling, calling them “speed bumps.” He indicated that the timing of the votes on the bill remains uncertain, stating, “We have contingency plans — plan B, and plan C, and we’ll continue to litigate it.” Republican leaders are still hopeful to have the legislation on Trump's desk by the Fourth of July.
Senator Ron Johnson from Wisconsin referred to the parliamentarian's decision as a “hand grenade,” highlighting the potential for increased debt as a concern. Despite the rulings delaying the voting timeline, Republican aides maintain that the overall bill is not in jeopardy. They plan to revise certain provisions, particularly those related to the Medicaid provider tax, to ensure compliance with budgetary constraints.
Republicans are employing the budget reconciliation process to pass the bill with a simple majority, thereby sidelining Democrats and circumventing the filibuster. However, only specific types of legislation are eligible for this procedure. On a positive note for Republicans, new work requirements for able-bodied adults to access Medicaid were deemed compliant with Senate rules, contributing significantly to the proposed health care spending cuts.
Democrats expressed relief over the removal of the provider tax, which they argue would have negatively impacted hospitals, especially in rural areas. Senate Minority Leader Chuck Schumer from New York emphasized that while they appreciate the ruling, Republicans should not attempt to introduce equally detrimental provisions to the health care system.
The decisions made by MacDonough have added to a complex set of disputes that Republicans must navigate. Ongoing debates regarding Medicaid and tensions within the party, particularly among House conservatives like Representatives Andy Harris and Chip Roy, threaten to derail the revised bill, especially concerning clean energy funding cuts and the state and local tax deduction cap.
Some conservatives have vocally criticized MacDonough, calling for her to be either overruled or dismissed from her position. Senator Tommy Tuberville from Alabama condemned her ruling regarding Medicaid and labeled her as a “WOKE Senate Parliamentarian.” He and others have expressed frustration, calling for accountability regarding her extensive influence.
MacDonough, who was appointed by former Senate Majority Leader Harry Reid, has maintained respect across party lines despite the current backlash. Some GOP senators, including Susan Collins from Maine, have opposed calls for her removal, suggesting that her job is to interpret Senate rules impartially.
As the debate continues, Democrats are poised to challenge the provisions within the legislation, framing the proposed cuts as a means to fund “tax breaks for billionaires.” Senator Jeff Merkley from Oregon characterized the bill as a “Big, Beautiful Betrayal” that could harm families and workers while violating Senate rules.
The evolving scenario surrounding this health care legislation underscores the complexities of Senate procedures and the intricate dynamics within the Republican party as they strive to advance their agenda amid significant hurdles.
