Senate Republicans were dealt a significant blow Thursday when Senate Parliamentarian Elizabeth MacDonough advised that major pieces of the GOP megabill’s Medicaid policy can’t pass with a simple majority.

Much of the savings in the bill come from Medicaid cuts, and the ruling impacts several of the largest and most controversial ones, including a plan to slash states’ use of health care provider taxes as well as several measures related to health care for immigrants.

That provider tax proposal would have generated hundreds of billions of dollars in savings to offset the cost of the legislation, and MacDonough’s decision is sending Republicans back to the drawing board.

The provider taxes were the second largest Medicaid cut in the House bill, after work requirements. The cuts would have been even larger under the Senate design.

Senators will need to rewrite the provision to satisfy the complex legislative rules that will allow them to bypass the filibuster and pass their bill on a party-line vote — or scrap it altogether and find........

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