Senate Parliamentarian Elizabeth MacDonough, an unelected official with massive influence over the fate of President Donald Trump’s domestic policy agenda, continues to reduce the size of the Senate version of his “one big, beautiful” bill.
MacDonough has advised Senate Republicans that major reforms to Medicaid will have to be struck from the president’s landmark bill to comply with stringent budget rules. MacDonough has thus far flagged 47 provisions that must be stripped from the bill or revised to comply with Senate rules, effectively forcing Senate Republicans to go back to the drawing board to rewrite major sections of the bill.
Healthcare-related provisions that MacDonough struck from the bill include prohibiting federal Medicaid funding for sex change procedures, denying federal Medicaid funding to states for coverage of certain noncitizens and reducing federal Medicaid expenditures for the Obamacare expansion population in states that offer free healthcare to illegal immigrants.
The parliamentarian’s rulings have infuriated conservatives who pushed for these provisions to be incorporated into the bill. Republican Alabama Sen. Tommy Tuberville became the first GOP senator to call for MacDonough’s ouster Thursday after he accused her of undermining the president’s agenda on the social platform X.
MacDonough is an appointee of the late former Senate Democratic Leader Harry Reid and previously advised former Vice President Al Gore on Senate procedure. As a purported nonpartisan arbiter of Senate rules, she plays an outsize role in the so-called budget reconciliation process, which allows GOP senators to steer around Democratic opposition by passing tax and spending legislation by a simple majority vote.
Provisions that MacDonough determines violate budget rules would be subject to a 60-vote threshold, effectively forcing Republicans to strike those proposals from their budget bill.
Despite nearly 50 adverse rulings against the Senate bill, Senate Majority Leader John Thune is holding firm against challenging the parliamentarian’s authority to nix provisions from the upper chamber’s proposal that she determines violate budget rules.
“That would not be a good outcome,” Thune said Thursday morning regarding whether Senate Republicans would move to overrule MacDonough’s rulings regarding key Medicaid proposals. The majority leader previously told reporters at the outset of the so-called budget reconciliation process that he would not overrule MacDonough in the event she issued an adverse ruling against Senate Republicans.
The parliamentarian’s adverse rulings could also force Senate Majority Leader John Thune to delay holding a vote on the president’s landmark bill as early as Friday. Senate GOP leadership is racing to put a final Senate bill on the floor to meetTrump’s self-imposed deadline of signing his landmark budget package into law by July 4.
Senate Republicans have already submitted a number of revised proposals to the parliamentarian for review and will rework Medicaid reform language in order to pass muster with the parliamentarian, a person granted anonymity to share internal strategy within the conference told the Daily Caller News Foundation.
Thune told reporters Thursday that Senate Republicans anticipated the parliamentarian would not initially sign off on all their proposals within the budget bill, but said the conference has backup plans to address provisions that she has ruled against.
“These are speed bumps along the way, we anticipated those and so we have contingency plans,” Thune said. “Obviously, you have to adjust the timing and schedule a little bit, but we’re moving forward.”
MacDonough’s decision to strike nearly 50 provisions from the president’s landmark tax and immigration-focused bill could also complicate Senate Republicans’ goal of achieving $1.5 trillion in cuts to mandatory spending.
One provision that MacDonough nixed, a crackdown on provider taxes that states enact to receive additional federal Medicaid funding, could have yielded hundreds of billions in savings.
Thune suggested to reporters Thursday that Senate Republicans would rewrite the provider tax language for it to pass muster with the parliamentarian.
“There are things that we can do,” Thune said. “There are other ways of getting to that same outcome.”
Senate Democrats have continued to take a victory lap over MacDonough’s rulings striking key provisions from the Senate’s budget bill.
“Republicans are scrambling to rewrite parts of this bill to continue advancing their families lose, and billionaires win agenda, but Democrats stand ready to fully scrutinize any changes and ensure the Byrd Rule is enforced,” Democratic Oregon Sen. Jeff Merkley wrote in a statement Thursday.
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