Senate Republicans’ plan to pass President Donald Trump’s “One Big, Beautiful Bill” by their self-imposed July 4 holiday deadline is facing a major setback.
Last week, the Senate Finance Committee released the tax and healthcare parts of the bill, which included a provision that would limit provider taxes. States levy taxes on health care providers like hospitals and nursing homes to raise the money to receive federal matching dollars for Medicaid.
Immediately, hospitals denounced it, saying it could decimate rural hospitals, which led to Republican Sens. Josh Hawley of Missouri, Thom Tillis of North Carolina and Susan Collins of Maine to criticize the provision.
To get this massive bill over the finish line, Republicans plan to sidestep the 60-vote threshold known as the filibuster through the process of budget reconciliation, wherein they can pass a bill with a simple majority as long as it relates to taxes and spending.
But on Thursday, the Senate parliamentarian, Elizabeth MacDonough, said the Republicans’ plan to cap a tax that states use to raise money for Medicaid did not pass the narrow rules of budget reconciliation, known as the “Byrd rule,” which determines what can be included in a reconciliation bill.
To make matters worse for Republicans, MacDonough’s office struck key parts of the immigration provisions in the bill. Specifically, she killed a $1,000 fee for anyone applying for asylum, a $100 minimum fee to advance a continuance in an immigration court, a $250 minimum fee to apply for the diversity visa lottery, a mandatory $400 processing fee for the same visa, a $5,000 minimum fee to sponsor a child who comes to the United States unaccompanied and money to expand the expedited removal of noncitizen immigrants arrested for crimes.
The parliamentarian serves as the nonpartisan rules arbiter in the Senate. Going back to the 1974 Budget Control Act, the parliamentarian determines which parts of a reconciliation bill comply “the Byrd Rule.” Named for late Senate majority leader Robert Byrd, the rule determines whether legislative text directly relates to the budget, does not involve Social Security, produces a change in outlays or revenues, increase the deficit beyond the years described in the bill, or is “merely incidental” to spending, which is to say the policy changes would outway any budgetary effects.
Trump said on Friday that the July 4th deadline is “It's important,” but added “We can go longer.” Republicans might not have a choice.
“We have no idea what's going to happen here,” Hawley told The Independent afterwards. “I mean we’ve got to work on some kind of a fix. Hopefully their fix will involve protecting rural hospitals.”
Hawley said that he spoke to Trump about the legislation when the president flew back from the NATO summit in the Hague earlier this week.
“He likes the house framework, because he helped negotiate it,” Hawley said. “Yeah, that's a pretty good framework, and I said, ‘Yeah, I agree with that.’ So, we'll see”
In addition, the parliamentarian ruled against a provision to reduce the federal share of Medicaid expansion coverage under the Affordable Care Act from 90 percent to 80 percent for states that provide health care to undocumented immigrants, another to restrict Medicaid dollars to states that provide health care to certain immigrants who are not citizens and a provision that would have banned Medicaid from covering gender-affirming care for transgender people.
“There was a technical issue with it, and we think we got a technical fix, but that has that's not been done yet,” Sen. John Hoeven of North Dakota told The Independent.
Trump has called for the Senate to pass the bill that the House of Representatives passed last month by a narrow margin by July 4th. He has specifically said that the Senate should not go on vacation until the bill passes.
“I'm not planning to leave until this is done,” Sen. Bernie Moreno of Ohio told The Independent.
But the setback with the parliamentarian means Republicans will need to rewrite the text of the bill for Medicaid to make it comply with the Byrd Rule.
The bill poses a limited opportunity to pass most of Trump’s domestic policy agenda, including extending the 2017 tax cuts he signed his first term and increasing spending for the military, immigration enforcement and oil exploration.
Sen. Jeff Merkley of Oregon, the top Democrat on the Budget Committee, said the parliamentarian’s rulings symbolized how Republicans had run roughshod over the process.
“It's designed to be only for deficit reduction,” he told The Independent. “They're using it to increase debt massively.”
In response, some Republicans called for the firing of the MacDonough, whom has been in the office since 2012.
“I don't think anyone should stay here that long and have power where she doesn't answer to anybody,” Sen. Roger Marshall of Kansas told The Independent. “I think that her rulings have very much would look like politically, that she's leading to the left, and I think we should have a term limit.”
MacDonough came into her position when Democrats controlled the Senate. But she also irritated Democrats in the past, such as when she did not allow them to include a $15 minimum wage increase in the American Rescue Plan signed by President Joe Biden in 2021.
But Collins, a swing vote, disagreed with the idea of firing the parliamentarian.
“She is doing her job, they are doing their jobs, and people should remember that what comes around goes around when it comes to the parliamentarian,” Collins told The Independent.
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