Senate Parliamentarian Elizabeth MacDonough dealt major blows to President Donald Trump’s broad tax and spending package, determining that several important sections breach Senate rules and cannot be advanced through budget reconciliation. Her decisions challenged the Republicans’ plans to approve the sweeping legislation by the July 4, 2025 deadline.
MacDonough informed senators that some parts of the updated domestic policy bill conflict with the Senate’s strict Byrd rule, which restricts what can be approved through reconciliation by a simple majority vote. The parliamentarian’s memo, released by Democrats on the Senate Budget Committee, identified numerous violations that forced Republicans to revise and/or abandon sections entirely.
Two of the most notable losses were measures designed to increase Medicaid funding for Alaska and Hawaii. Republican leaders had included these provisions for the non-contiguous states, along with other Alaska-focused changes, to win the support of Senator Lisa Murkowski, who had raised concerns about major reductions to Medicaid and the Supplemental Nutrition Assistance Program.
The parliamentarian also rejected a key plan to reform Medicaid provider taxes, which Republicans had relied on to help pay for sweeping tax cuts. This measure would have limited how much federal Medicaid money states could receive through taxes on healthcare providers, amounting to hundreds of billions in possible savings that would have supported much of the bill’s reductions in taxes.
Other rejected measures included broader exemptions from Medicare drug price negotiations for orphan drugs that treat several rare diseases, restrictions on Biden-era rules that make it easier for older adults and people with disabilities to sign up for Medicaid, and bans on minimum staffing requirements for nursing homes, which were projected to cut federal Medicaid spending by $23 billion over ten years.
MacDonough also struck down proposals to end Medicaid eligibility for non-citizen adults and children, reduce Federal Medical Assistance Percentage funding for states that offer health coverage to non-citizens, and prevent federal funds from covering gender-transition care under Medicaid and the Children’s Health Insurance Program.
The rulings prompted fierce criticism from Republican senators. Senator Tommy Tuberville described MacDonough as the “WOKE Senate Parliamentarian” and called for Senate Majority Leader John Thune to “fire her ASAP.” Representative Greg Steube raised concerns about how an unelected official, appointed by former Senate Majority Leader Harry Reid, had the authority to decide what should go into Trump’s legislation.
Despite the criticism, Thune has consistently opposed overruling the parliamentarian, viewing such action as equivalent to abolishing the 60-vote filibuster. Several Republican senators, among them Lindsey Graham and John Kennedy, opposed the notion of overturning MacDonough’s rulings.
The parliamentarian did allow certain Republican priorities to move forward. A measure to postpone scheduled reductions to provider taxes that support the state’s Medicaid responsibilities passed the review, though the delay was extended by an extra year. Rules blocking Medicare coverage for immigrants without citizenship, including refugees and asylum seekers, were also found to comply with Senate guidelines.
Most notably, MacDonough determined that a provision blocking Planned Parenthood from receiving federal Medicaid funds could remain in the legislation. But Republicans changed the ban from lasting ten years to just one year to help ensure it would be followed.
In the early hours of July 1, 2025, the U.S. Senate approved the “One Big Beautiful Bill” by a narrow 51–50 margin, with Vice President JD Vance breaking the tie.
The bill now returns to the House of Representatives for a final vote to approve the Senate’s changes, which include removing or revising several provisions struck down by the parliamentarian.
If the House passes the amended version by a simple majority, the legislation will proceed to President Trump’s desk for his signature. However, if the House rejects the Senate’s revisions, a conference committee will be formed to reconcile differences between the chambers, requiring both the House and Senate to vote again on a compromise bill.
House Speaker Mike Johnson has indicated that he aims to schedule a swift vote within days to meet the administration’s July 4 deadline. However, Republican leaders face potential opposition from hard-line conservatives critical of the Medicaid provisions retained in the final package.
According to the Congressional Budget Office, the version passed by the House would increase the federal deficit by up to $3 trillion over the next ten years, even though Republicans had previously promised $1.6 trillion in spending reductions.
House Speaker Mike Johnson said the Senate’s recent Medicaid decision “doesn’t make it easier” to hit the July 4 deadline, but remained hopeful that the bill would still pass.
Democratic senators hailed the parliamentarian’s rulings as important wins against what they viewed as damaging measures. Ranking Member Jeff Merkley criticized ongoing attempts to defend elements of what he called the “Big, Beautiful Betrayal of a bill,” arguing that it breaks Senate rules and harms families and workers.
The parliamentarian’s review, known as the “Byrd Bath” process, continues to examine more sections of the bill. If any part is found to violate Senate rules, it must be removed, or else the entire bill would need to meet a more difficult 60-vote requirement—something Republicans can’t reach with their current numbers.
