Senate Parliamentary Blocks Medicaid Cuts From "The Big Beautiful Bill"

{Axios}

Photo: Jakub Porzycki/NurPhoto via Getty Images

The Senate parliamentarian ruled out the Medicaid provider tax provision in the "one big, beautiful bill," according to Senate Democrats.

Why it matters: This complicates the GOP's math on the spending cuts it needs to pass the package, as well as threatening the careful negotiations between the party's factions on reaching a final deal.

• For Senate Majority Leader John Thune (R-S.D.), it removes a thorny political problem for Republicans, with a handful of GOP members deeply opposed to the provisions.
• But it will also force the Senate to find additional spending cuts to pay for the tax cuts that are the centerpiece of Trump's one "big, beautiful bill."

Zoom in: The parliamentarian also struck down provisions meant to block the use of Medicaid funds for gender-affirming care and to prevent unauthorized immigrants from receiving Medicaid or CHIP coverages.

Driving the news: Democrats seized on the ruling as evidence that their fight against Trump's agenda was having some success. 

• "Democrats are continuing to make the case against every provision in this Big, Beautiful Betrayal of a bill that violates Senate rules and hurts families and workers," said Sen Jeff Merkley (D-Ore.) the ranking Democrat on the Senate Budget Committee.  

• Peter Sullivan

22 mins ago

Senate parliamentarian scraps Medicaid provider tax limits

Illustration: Annelise Capossela/Axios

The Senate parliamentarian has ruled that Republicans' proposed restrictions on the Medicaid provider tax violate the Byrd Rule, according to Senate Budget Democrats — dealing a huge blow to GOP plans for the megabill they're trying to pass. 

Why it matters: The restrictions on the provider tax were a major source of savings for the GOP bill, and had been the subject of intense haggling over the extent of the limits. 

Driving the news: Now it appears that the section may be thrown out for violating the rules of reconciliation, unless Republicans can come up with changes to satisfy the rules. 

• Other provisions that violate the Byrd Rule include a provision lowering the federal share of Medicaid costs from 90% to 80% for states that cover undocumented immigrants with state funds. 
• Cutting off Medicaid funding for gender-affirming care was also ruled to violate the budget rules.
• Other scrapped provisions include banning "spread pricing" by pharmacy benefit managers in Medicaid and restrictions on certain immigrants receiving ACA subsidies. 
• Defunding certain abortion providers, including Planned Parenthood, is still under review, per Senate Budget Committee Democrats.  

• Stephen Neukam, 
• Stef W. Kight

Updated 18 hours ago - Politics & Policy

Trump's "big, beautiful bill:" What's in, what's out

Senate Majority Leader John Thune speaks during a news conference at the U.S. Capitol on June 17. Photo by Anna Moneymaker/Getty Images

Senate Republicans have managed to revise provisions of President Trump's "big, beautiful bill" so that they pass muster with the chamber's parliamentarian ahead of a planned weekend of make-or-break votes. 

Why it matters: Getting the green light from Parliamentarian Elizabeth MacDonough should help ease the path to Senate passage — as well as efforts to meet Trump's July 4 deadline to have the mega tax and spending cut package on his desk. 

Go deeper (1 min. read)

• Stef W. Kight, 
• Hans Nichols

Updated Jun 16, 2025 - Politics & Policy

Senate unveils trickiest text of Trump's "big, beautiful bill"

Majority Leader John Thune, along with Sens. John Barrasso and Mike Crapo, speak to members of the media following a meeting outside the White House. Photo: Eric Lee/Bloomberg via Getty Images

Senate Finance Committee Republicans published their text of President Trump's "one big, beautiful bill" Monday evening, which includes major tax reforms and even steeper Medicaid cuts than the House called for. 

Why it matters: This is the trickiest part of the GOP's marquee legislation, which also includes raising the debt ceiling as well as border and military funding.