Senate parliamentarian blocks Medicaid changes in Trump’s bill — a blow to GOP

The Senate faced a major setback on Thursday morning as the Senate Parliamentarian ruled a key Medicaid provision in the “One Big Beautiful Bill Act” out of order. This provision aimed to crack down on states’ use of health care provider taxes to collect additional Medicaid funding. Senate Parliamentarian Elizabeth MacDonough found that this provision did not align with the rules governing such a legislative package.

The ruling dealt a blow to Senate Republicans, who are working to meet President Donald Trump’s Fourth of July deadline for the bill’s passage. The ruling means that Senate Republicans will need to either revise the provision or remove it entirely if they want to proceed with passing the bill using only GOP votes.

The provider tax credit provisions had already been a point of contention within the Senate GOP conference. Some members expressed concerns that the cuts to states’ Medicaid revenue could negatively impact rural hospitals in their states. MacDonough’s ruling may have come as a relief to this faction of Republicans.

However, the changes to the provider tax rate were a significant aspect of Republicans’ plans to reform Medicaid and reduce costs. Removing this provision could either increase the cost of the bill or require Senate Republicans to find alternative ways to cut costs, potentially alienating conservative members of the party.

The ruling puts pressure on Senate Republicans to make revisions quickly, with limited time before the Fourth of July deadline. Any changes made will be closely scrutinized, as they could be potential deal breakers for some key senators whose votes are crucial for the bill’s passage.

Senate Majority Leader John Thune has ruled out overruling the parliamentarian, citing his commitment to upholding Senate rules. Calls from some Republicans to challenge the ruling and overrule MacDonough with a simple majority vote may further complicate the situation.

It remains unclear how the ruling will impact the timeline for the bill’s advancement to the Senate floor. The Senate may face delays in its efforts to pass the “One Big Beautiful Bill Act” if revisions need to be made in light of the parliamentarian’s ruling.