Senate GOP dealt major blow on Medicaid cuts in megabill
Senate Republicans are facing major new issues with their domestic policy megabill after the chamber’s parliamentarian advised senators that several provisions they are counting on to reap hundreds of billions of dollars in budget savings won’t be able to pass along party lines.
Those include major pieces of Medicaid policy, including a politically explosive plan to hold down Medicaid costs by cracking down on a state provider tax — a provision that is expected to have a nine-figure impact on the bill. Republicans now will have to try to rewrite major sections of their Finance bill or potentially leave out key policies.
The decisions were detailed in a Thursday morning memo from Democrats on the Senate Budget Committee. Other provisions now at risk include several GOP proposals to exclude undocumented residents from Medicaid, including by withholding federal funds from states that make them eligible for benefits.
The rulings come at a critical time for Senate Majority Leader John Thune and other GOP leaders, who are already facing a revolt inside their conference from members wary of the practical and political impacts of the Medicaid changes. Some GOP members have proposed reverting to a less drastic House plan, which would merely freeze the existing provider taxes, though it’s unclear if that provision could also pass muster under Senate rules.
Even though the ruling is a setback for Republicans — and to their timeline for taking an initial vote on Friday — they were aware based on private conversations with parliamentarian Elizabeth MacDonough that parts of their initial plan were at risk of running aground of the chamber’s rules. Republicans view the hurdle right now as “technical” and are optimistic they will be able to get modified language into the bill. The revised language will still have to be blessed by the parliamentarian as complying with the chamber’s rules.
“We knew that it was going to be an interesting conversation and we didn’t know for sure how she was going to come down on it. But there are things that we can do, there are other ways of getting to that same outcome,” Thune said on Thursday morning, adding that Republicans might not ultimately get “everything that we want” on the provider tax but will hopefully be able to salvage “most of the reforms.”
Some Republicans are calling for Senate leadership to overrule MacDonough: “The Senate Parliamentarian is not elected. She is not accountable to the American people,” Rep. Greg Steube (R-Fla.) posted on X. “Yet she holds veto power over legislation supported by millions of voters.”
Senate GOP leadership has repeatedly shot down that idea, and Thune reiterated Thursday morning that they wouldn’t overrule the MacDonough.
Democrats took a victory lap after the ruling, noting the rulings blew a $250 billion hole in the megabill’s savings.
“Democrats fought and won, striking healthcare cuts from this bill that would hurt Americans walking on an economic tightrope,” said Senate Finance Committee Ranking Member Ron Wyden (D-Ore.) in a statement.
The parliamentarian also ruled early Thursday against a Republican proposal to prohibit plans from getting certain Obamacare payments if they cover abortion. There are 12 states that currently require such coverage and insurers have worried they don’t have enough time to implement the payment change before the start of open enrollment.
There remain some outstanding policies, such as Republicans’ effort to defund Planned Parenthood and removal of a nursing home staffing rule.
Republicans still aren’t closing the door to taking a first vote on Friday. One person granted anonymity to discuss the schedule insisted that the parliamentarian’s decision is “not as fatal as Dems are portraying it to be” and that “Friday still not off the table."