Medicaid changes in budget bill run afoul of Senate rules

Senate Parliamentarian Elizabeth MacDonough on Thursday advised lawmakers that several provisions related to Medicaid in the One Big Beautiful Bill Act violated rules for the budget reconciliation process. The sections at issue include those that would disqualify noncitizen immigrants from Medicaid and tax credits, a ban on Medicaid funding for gender transitions, and changes to thresholds for taxes on healthcare providers. President Donald Trump and GOP-controlled Congress are seeking to pass the budget bill by July 4.

The Senate’s Byrd rule says that any nonbudgetary provisions in a reconciliation bill can be challenged or stricken from the bill. If Republican lawmakers want to keep the Medicaid provisions in the budget bill, each must pass a 60-vote threshold, McDonough ruled. Republicans currently have only 53 votes in the Senate. The parliamentarian on Monday said other sections of the bill that would make federal lands available for sale also violated the Byrd rule.

MacDonough on Thursday reviewed other sections of the bill that might also be subject to the Byrd rule, including one that would prevent Planned Parenthood from receiving federal Medicaid funds.

What does the Senate parliamentarian do? The unelected official advises lawmakers on the legislative body’s rules and procedures. MacDonough has held the position since 2012, according to the Bipartisan Policy Center.

Dig deeper: Read Lauren Canterberry’s report on the Supreme Court’s decision to let states cut funding to Planned Parenthood.