Senate Parliamentarian Blocks Key Medicaid Provisions in Major Healthcare Bill

The push to pass a comprehensive healthcare and spending bill faced a setback after the Senate parliamentarian ruled that several provisions related to Medicaid would require 60 votes to pass, rather than the simple majority the GOP aimed for. This decision likely prevents hundreds of billions of dollars in potential Medicaid savings from being included in the legislation.

Elizabeth MacDonough, the Senate parliamentarian, determined that certain Medicaid reforms—such as federal funding adjustments for provider taxes and eligibility changes for non-citizens—violated Senate rules and could not be approved through reconciliation. These excluded provisions also included reductions in federal matching funds for states that provide healthcare coverage to non-citizens and an end to federal funding for gender-transition medical care under Medicaid and CHIP.

Reaction from Republicans was swift. Senator Tommy Tuberville called the ruling a “woke” decision by a bureaucrat appointed by Harry Reid, asserting that it undermines the legislative process and fuels discontent with the Senate’s procedural gatekeeping.

Senate Majority Leader John Thune labeled it a “speed bump,” emphasizing that the bill remains a priority and expecting it to reach the President’s desk by July 4th. However, the ruling highlights the restricted power of overrule, given that an unelected official’s decision requires 60 votes to overturn, which is impossible under the current Senate split.

Democrats, meanwhile, praised the ruling, with Senator Jeff Merkley criticizing the bill as a violation of Senate rules that could harm families and workers. The Congressional Budget Office has projected the bill could add up to $3 trillion to the federal deficit over a decade, despite previous claims of significant spending cuts.