Senate Parliamentarian Elizabeth MacDonough has delivered significant blows to President Trump’s sweeping tax and spending legislation, ruling that multiple key provisions violate chamber rules and cannot pass through budget reconciliation with a simple majority vote.
MacDonough’s rulings, released Sunday in a memo from Democrats on the Senate Budget Committee, specifically targeted Medicaid provisions that Republicans had hoped would fund much of their tax cuts. The parliamentarian determined that GOP plans to cap states’ ability to collect more federal Medicaid funding through health care provider taxes violated the Senate’s Byrd rule, which limits what can pass through reconciliation.
The provider tax provisions represented the largest source of savings in the bill, and their removal forces Senate Republicans to either completely retool the legislation or scrap major components entirely. Most of the bill’s funding came from changes to Medicaid, making this ruling particularly damaging to Republican leadership’s timeline.
Among the casualties of what senators call the “Byrd bath” were two provisions specifically added to win Alaska Senator Lisa Murkowski’s support. These Medicaid carveouts for Alaska and Hawaii, designed to boost Medicaid payments to non-contiguous states, were ruled non-compliant with reconciliation rules.
MacDonough also struck down provisions that would have blocked implementation of two Biden-era regulations making it easier for older adults and individuals with disabilities to enroll in Medicaid. A provision prohibiting implementation of Biden administration nursing facility staffing rules, estimated to reduce federal Medicaid spending by $23 billion over 10 years, was similarly flagged.
The parliamentarian rejected Republican attempts to expand Medicare drug-price negotiation exemptions for orphan drugs treating multiple rare diseases. She also ruled against provisions eliminating Medicaid eligibility for non-citizen adults and children, along with measures blocking federal funding for gender-transition medical care through Medicaid and the Children’s Health Insurance Program.
Several Republicans expressed frustration with MacDonough’s decisions. Senator Tommy Tuberville called for Senate Majority Leader John Thune to fire the parliamentarian immediately, describing her as partisan and accusing her of undermining Trump’s mandate. Senator Markwayne Mullin suggested MacDonough made her rulings as part of a political decision, expressing concerns about her ability to make such determinations.
However, most Senate Republicans dismissed the idea of overruling the parliamentarian. Senator Lindsey Graham indicated the Senate had “no intention of overruling her” but suggested they would make another attempt at crafting compliant language. Senator John Kennedy stated clearly that they would never overrule the parliamentarian.
Thune has consistently opposed going against the Senate’s rule enforcer, viewing such action as tantamount to abolishing the 60-vote filibuster. Any attempt to overrule MacDonough would require 60 votes, impossible with the chamber split 53-47 in Republicans’ favor.
The rulings delivered some positive news for Republicans. MacDonough approved their proposal to delay planned cuts to provider taxes funding state Medicaid obligations, allowing incremental reduction of allowable provider taxes from six percent to 3.5 percent beginning in 2028. She also deemed compliant provisions barring Medicare coverage for non-citizen immigrants and blocking non-citizens from qualifying for tax credits through Affordable Care Act marketplaces.
Most significantly for conservative priorities, MacDonough ruled that a provision blocking Planned Parenthood from receiving federal Medicaid funds could remain in the legislation. Senate Republicans revised this provision Friday from a 10-year funding block to just one year to ensure compliance with reconciliation rules.
The White House maintains pressure on Congress to meet Trump’s July 4 deadline for passage. Press Secretary Karoline Leavitt told reporters Thursday that they expect the bill on the president’s desk by Independence Day. However, the parliamentarian’s rulings significantly complicate this timeline, requiring potentially major reworks with little time remaining.
Senate Budget Committee Ranking Member Jeff Merkley celebrated the rulings, stating that Democrats have been successful in removing parts of the bill that hurt families and workers. He described continued Democratic efforts to challenge provisions in what he termed the “Big, Beautiful Betrayal of a bill” that violate Senate rules.
The Congressional Budget Office estimated that the House-passed version would add up to $3 trillion to the federal deficit over the next decade. House Republicans previously claimed their version included as much as $1.6 trillion in spending cuts, though many of those savings depended on the Medicaid provisions now ruled non-compliant.
MacDonough’s role as the Senate’s nonpartisan referee on procedural matters places her at the center of Republican efforts to pass their signature legislation using only GOP votes. Her determination of what qualifies under budget reconciliation rules ultimately decides whether provisions can pass with a simple majority or require the 60-vote threshold Republicans cannot reach.
Sources:
https://www.politico.com/news/2025/06/29/megabill-byrd-alaska-megabill-parliamentarian-00431730
https://abcnews.go.com/Politics/senate-parliamentarian-deals-blow-republicans-medicaid-provisions-trumps/story?id=123232793
https://www.scrippsnews.com/politics/congress/parliamentarian-blocks-medicaid-provision-leaving-big-beautiful-bill-in-limbo
https://nypost.com/2025/06/26/us-news/senate-parliamentarian-scraps-gops-medicaid-reforms-in-big-beautiful-bill/
https://www.foxnews.com/politics/senate-parliamentarian-oks-ban-planned-parenthood-federal-funding-trump-megabill
