Senate Parliamentarian Blocks Major Medicaid Changes in Big Beautiful Bill

The Senate parliamentarian on Thursday advised the Medicaid provider tax could not be included in the Big Beautiful Bill, which could upend how the bill could offset the Trump tax cuts.

Senate Parliamentarian Elizabeth MacDonough (pictured) ruled the Medicaid provider tax would require 60 votes in the Senate to be included in the Big Beautiful Bill. The Senate parliamentarian’s ruling complicates the offsets for enhancing and extending the Trump tax cuts.

The potential loss of the Medicaid provider tax would force Senate Republicans to find other potential spending cuts to pay for the Big Beautiful Bill. The parliamentarian also struck down provisions that would bar the use of Medicaid funds for transgender healthcare services and to prevent illegal aliens from receiving Medicaid or CHIP healthcare coverage.

However, it remains possible that Senate Republicans could change the language of the Medicaid provider tax to be eligible in the Big Beautiful Bill.

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,” Sen. Jeff Merkley (D-OR), the ranking member of the Senate Budget Committee, said in a statement.

“Democrats are fighting back against Republicans’ plans to gut Medicaid, dismantle the Affordable Care Act, and kick kids, veterans, seniors, and folks with disabilities off of their health insurance,” the Democrat added.

Republicans are using budgetary reconciliation to pass the Big Beautiful Bill through the Senate using only a simple majority, or 51 votes. While it can avoid the Senate’s 60-vote filibuster threshold, a reconciliation bill cannot make policy changes or things that are considered “extraneous” to spending.

Breitbart News explained the use of reconciliation for the Breitbart Fight Club.

Republicans remain frustrated with the Senate parliamentarian.

Rep. Greg Steube (R-FL) wrote on X:

How is it that an unelected swamp bureaucrat, who was appointed by Harry Reid over a decade ago, gets to decide what can and cannot go in President Trump’s One Big Beautiful Bill?

The Senate Parliamentarian is not elected. She is not accountable to the American people. Yet she holds veto power over legislation supported by millions of voters. It is time for our elected leaders to take back control.

@JDVance should overrule the Parliamentarian and let the will of the people, not some staffer hiding behind Senate procedure, determine the future of this country.

Sean Moran is a policy reporter for Breitbart News. Follow him on X @SeanMoran3.