In a significant setback for the swift progress of President Donald Trump’s tax cut and spending bill, the Senate parliamentarian has determined that a planned revamp of a Medicaid provider tax central to the bill does not comply with the Senate’s procedural rules. This development forces Republican leaders to reconsider their strategy as they rush to finalize the package while also attempting to deliver sweeping cuts to Medicaid and other programs to offset the tax breaks proposed in Trump’s plan.
The parliamentarian’s guidance is seldom disregarded, leaving Republicans with tough decisions. The Senate’s chief rules adviser has also signaled against GOP measures designed to exclude certain immigrants from healthcare programs, intensifying the challenges faced by the legislation’s proponents.
In response to the parliamentarian’s advice, Republicans scrambled to find solutions, with some voicing extreme measures such as challenging or replacing the parliamentarian. However, senior Republican leaders chose to focus on revising proposals in order to align with procedural mandates. Senate Majority Leader John Thune expressed confidence in their ability to adapt, despite the possibility of delays to planned votes.
Meanwhile, Democrats, who are united in their opposition to the bill, argue that these procedural outcomes critically undermine the GOP’s legislative ambitions. According to Sen. Ron Wyden, a prominent Democrat, the proposed Republican Medicaid reductions could strip $250 billion from the program, affecting many vulnerable groups, including seniors and children.
As senate Republicans hasten to push the bill back to the House with an aim to meet Trump’s ambitious deadlines, the president gathered lawmakers at the White House to press for action. Trump emphasized the necessity of unity within the GOP, highlighting the multitude of beneficial provisions in the revised bill.
Fundamentally, the legislation looks to extend $3.8 trillion in tax cuts initially established during Trump’s initial term. However, failure to act could result in tax hikes. Revenue losses are intended to be mitigated through substantial trims to healthcare and food assistance programs alongside new charges for immigrants.
Republican leaders already faced challenges rallying support for sweeping Medicaid modifications, with the nonpartisan Congressional Budget Office highlighting the potential loss of healthcare coverage for over 10 million people under the House bill. Senate Republicans proposed even deeper cuts before the parliamentarian’s intervention.
As the legislative process continues, there are efforts to modify key provisions, such as the changes to the Supplemental Nutrition Assistance Program, to meet procedural standards. Despite these challenges, Republican leaders have few alternatives, as they rely heavily on health care budgetary constraints to balance the substantial tax cut costs.
Even as GOP senators like Lindsey Graham dismiss calls to dismiss the parliamentarian, indicating a commitment to navigating procedural complications, internal party disagreements persist over Medicaid cuts. The provider tax issue is particularly divisive, with its potential impact on rural hospitals raising alarms among some Republican senators.
Republican proposals include consideration of a substantial fund to support rural hospitals, but debates continue on the optimal level of such a fund, with opinions ranging significantly among GOP senators.
The parliamentarian’s role is pivotal in reviewing whether legislation adheres to rules prohibiting policy changes within reconciliation bills. Any breach could necessitate a difficult-to-achieve 60-vote threshold. Recent advisories have questioned a myriad of GOP proposals, ranging from student loan-related changes to limitations on health care access for certain immigrant populations.
Additionally, Republicans conceded another potential revenue stream by agreeing to remove the so-called revenge tax in response to Treasury Secretary’s intervention, due to separate international agreements. Despite these setbacks, key Republican figures like Sen. Kevin Cramer uphold the integrity of the parliamentary process, indicating no intent to defy the institution.