Senate Republicans have encountered a significant setback in their efforts to push through a sweeping domestic policy bill. The Senate parliamentarian has ruled that several GOP-backed Medicaid provisions cannot advance through the budget reconciliation process, derailing a key strategy to achieve billions in federal savings.
The ruling directly impacts multiple provisions in the Senate Finance Committee’s version of the bill, including controversial measures designed to curb Medicaid spending. As the GOP scrambles to revise its legislation, political tensions within the party continue to escalate.
Parliamentarian Rejects Key Medicaid Provisions
A Thursday morning memo from Senate Budget Committee Democrats revealed that several high-impact Medicaid proposals fail to meet reconciliation rules. Chief among them is a measure to limit states’ ability to use provider taxes to draw down additional federal Medicaid dollars—a tactic many states rely on to finance health care.
The ruling threatens to strip hundreds of billions in projected savings from the legislation. Republican lawmakers must now decide whether to rework the bill or abandon critical components altogether.
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Plan to Exclude Undocumented Immigrants Also Blocked
Other proposals rejected by the parliamentarian include GOP plans to prevent undocumented immigrants from receiving Medicaid benefits. These measures sought to penalize states that offer Medicaid access to undocumented residents by withholding federal funds.
The parliamentarian’s decision significantly narrows the GOP’s options for pursuing Medicaid restrictions within the framework of a budget reconciliation bill, which allows certain legislation to pass with a simple majority but imposes strict rules limiting what can be included.
GOP Faces Internal Revolt Over Health Care Cuts
The ruling comes as Senate Majority Leader John Thune and GOP leadership already face dissent within their ranks. Some Republican senators have voiced concern over the political fallout of slashing Medicaid, especially ahead of the 2026 midterms.
In response to internal pressure, party leaders floated the idea of replacing the rejected policy with a more modest House version, which would freeze existing provider tax schemes instead of changing them outright. However, it remains unclear whether this compromise would pass procedural scrutiny in the Senate.
Republicans Hope to Revise and Reintroduce Policy
Despite the setback, GOP lawmakers aren’t backing down. According to two individuals familiar with the internal discussions, Republicans are preparing revised legislative text aimed at complying with Senate rules while preserving the policy’s core goals.
One source characterized the parliamentarian’s objections as “technical,” expressing optimism that adjustments can be made to meet procedural standards. “We’ll continue our work and find a solution to achieve the desired results,” the individual said.
Pressure Mounts to Overrule Parliamentarian
Frustration over the parliamentarian’s rulings has triggered calls from some Republicans to override her decisions—a dramatic and highly unusual move.
“The Senate Parliamentarian is not elected. She is not accountable to the American people,” Rep. Greg Steube (R-Fla.) posted on X (formerly Twitter). “Yet she holds veto power over legislation supported by millions of voters.”
While Senate norms make such an override unlikely, the push reflects deepening divisions within the GOP over how to proceed.
Democrats Celebrate Major Policy Victory
Democrats wasted no time declaring victory. They emphasized that the parliamentarian’s decision invalidates Medicaid cuts that would disproportionately affect low-income Americans.
“Democrats fought and won, striking healthcare cuts from this bill that would hurt Americans walking on an economic tightrope,” said Sen. Ron Wyden (D-Ore.), the top Democrat on the Senate Finance Committee.
According to the memo, the invalidated provisions create a $250 billion shortfall in the GOP’s projected savings from the bill, throwing its fiscal foundation into question.
Additional GOP Proposals Also Rejected
The parliamentarian also ruled against another GOP initiative that aimed to block insurers from receiving certain Affordable Care Act (ACA) payments if they cover abortion services. This proposal could have disrupted the individual insurance market in the 12 states where abortion coverage is mandated.
Insurers warned that the timing of the change—just before open enrollment—could cause confusion and instability in the market.
Meanwhile, other elements of the GOP’s megabill remain unresolved. Proposals to defund Planned Parenthood and eliminate a new federal nursing home staffing rule are still under review.
What’s Next for the Megabill?
Despite the parliamentarian’s ruling, Republican leaders are not abandoning the legislation. Some lawmakers are still eyeing a first vote as soon as Friday.
A GOP source familiar with the Senate schedule downplayed the severity of the setback, stating, “This is not as fatal as Democrats are portraying it to be. Friday is still not off the table.”
With time running short and internal disagreements intensifying, Senate Republicans must either quickly amend the legislation or risk losing momentum on one of their most ambitious domestic policy efforts to date.
Frequently Asked Questions
What is the Senate parliamentarian’s role?
The parliamentarian advises the Senate on whether proposed legislation complies with procedural rules, particularly those tied to budget reconciliation.
Why is budget reconciliation important?
It allows certain bills to pass with a simple majority, bypassing the 60-vote filibuster threshold in the Senate.
What is the provider tax loophole?
States use provider taxes to draw more federal Medicaid funds. The GOP aimed to limit this tactic to reduce federal spending.
Can Republicans override the parliamentarian?
Technically yes, but it would require 51 votes and break with Senate norms, making it politically risky.
What does the ruling mean for Medicaid recipients?
The ruling protects access to Medicaid for millions, particularly those in states that expanded eligibility or support undocumented residents.
What’s at stake for GOP leadership?
Their ability to unify the party around domestic policy and achieve budget savings could be severely compromised.
How are Democrats responding?
They’re framing the ruling as a win for healthcare access and a blow to Republican efforts to cut social programs.
Is a vote still expected this week?
Republicans haven’t ruled out a vote, but ongoing revisions and internal debate could delay proceedings.
Conclusion
Senate Republicans are facing a critical moment after the parliamentarian’s decision invalidated key Medicaid provisions in their megabill. As the party scrambles to revise its legislation, internal divisions and procedural hurdles could determine whether this sweeping policy package survives. While some lawmakers remain optimistic, the GOP’s path forward is increasingly uncertain—and the political consequences could echo into next year’s elections.