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Senate Parliamentarian Elizabeth MacDonough dealt a blow to President Trump’s agenda bill Thursday, rejecting a key Medicaid provision that was central to GOP efforts to cut federal spending.

Republicans had planned to cap states’ use of health care provider taxes to collect more federal Medicaid funding as a means of offsetting the costs of making Trump’s tax cuts permanent.

The Hill’s Alexander Bolton reports:

“The cap on health care provider taxes in both states that expanded Medicaid and did not expand Medicaid under the Affordable Care Act was projected to save hundreds of billions of dollars over the next 10 years, but it would have forced states to shoulder substantially more of the cost for Medicaid coverage.”

MacDonough does not decide what goes into legislation, but determines whether the text adheres to Senate rules around the filibuster.

The GOP hopes to pass the reconciliation bill with a 51-vote majority, but MacDonough’s ruling means that if the Medicaid provision is included, the bill would need 60 votes to overcome a Democratic filibuster. At the moment, Republicans are having a hard enough time scrounging up a simple majority.

The Medicaid provision was divisive and had received strong pushback from a handful of Senate Republicans, who warned it would lead to rural hospital closures.

The ruling sent Republicans scrambling for additional federal spending cuts, with fiscal hawks in both chambers vowing to oppose the bill over debt levels.

Senate Majority Leader John Thune (R-S.D.) said he would not overrule the parliamentarian.

“No, that would not be a good outcome for getting a bill done,” Thune told reporters, saying he believes they’ll be able to suss out additional savings elsewhere.

“These are … short-term setbacks,” he added. “Speed bumps, if you will. We’re focused on the goal.”

REPUBLICANS FUME

Not all Republicans reacted with Thune's level of restraint.

“The WOKE Senate Parliamentarian, who was appointed by Harry Reid and advised Al Gore, just STRUCK DOWN a provision BANNING illegals from stealing Medicaid from American citizens," Sen. Tommy Tuberville (R-Ala.) posted on X. "This is a perfect example of why Americans hate THE SWAMP.”

“Unelected bureaucrats think they know better than U.S. Congressmen who are elected BY THE PEOPLE," he added. "Her job is not to push a woke agenda. THE SENATE PARLIAMENTARIAN SHOULD BE FIRED ASAP.”

Hardline conservatives in the House joined in the criticism, urging the Senate to overrule the parliamentarian, which would be a major departure from protocol.

“It is time for our elected leaders to take back control,” Rep. Greg Steube (R-Fla.) posted on X. “@JDVance should overrule the Parliamentarian and let the will of the people, not some staffer hiding behind Senate procedure, determine the future of this country.”

The White House declined to address the parliamentarian’s ruling, although Trump is expected to address it this evening at an event meant to pressure lawmakers to back the “big, beautiful bill.”

Trump will host “everyday Americans” at the White House to highlight how the bill will help working class people and law enforcement, including tipped workers and border patrol agents.

The White House said the setback shouldn’t alter the timeline for passage.

“We expect that bill to be on the president’s desk for signature by July 4,” press secretary Karoline Leavitt said.

“This is part of the process, part of the inner working of the United States Senate, but the president is adamant about seeing this bill on his desk here at the White House by Independence Day.”

💡Perspectives:

• HuffPost: Republicans rush to pass a bill they don’t like.

• Ro Khanna: Congress must take back its war powers.

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© The Hill