Some critical rulings from the Senate parliamentarian have greatly complicated the GOP’s already complicated reconciliation bill, with plans for the Senate to vote on Friday now in doubt.
Republicans are scrambling to rewrite key provisions in the bill after the Senate parliamentarian on Thursday struck down a number of Medicaid provisions. Those provisions, essential to the cost-savings in the reconciliation package, were among the most controversial elements of the legislation, but they were also an important selling point for conservatives.
Included among the nixed provisions were proposals to cut the Medicaid provider tax, a state-imposed fee that helps states fund their share of Medicaid. While the provider tax cut was unpopular with more moderate Republicans, it was a major component for limiting the cost of the legislation and getting conservatives on board.
The parliamentarian also ruled against provisions that would revoke eligibility for some noncitizens, ban the use of Medicaid funds for gender-affirming medical care and language to restrict the coverage of abortions in some Affordable Care Act plans.
“That’s a big problem,” Sen. Ron Johnson said of the nixed cost-savings. “That’s a big old grenade.”
The latest changes to the bill have raised major questions about getting the legislation done by the GOP’s self-imposed July 4 deadline.
Republicans are planning to go back to the parliamentarian to rework some of the language for the vetoed provisions. But with so many provisions, and those submissions taking a good deal of time, plans to get started on the reconciliation bill by Friday night seem overly optimistic.
Not only does the bill have to get through a lengthy vote-a-rama on amendments in the Senate, but it also needs to go back to the House for final approval. And with so many items up in the air, and so many Republicans angry about what’s been cut from the bill — as well as some who are upset at certain provisions being included — GOP leaders have a real problem on their hands.
Many conservatives are irate that Medicaid cuts didn’t pass muster with the parliamentarian. A dedicated group of House Republicans from blue states — the so-called SALT Caucus — refuse to budge substantially on the state and local tax deduction cap. And Republicans in the House and Senate have plenty of random objections, too.
Rep. Marjorie Taylor Greene, for instance, posted on X that she is “currently a NO.”
Greene pointed to the Senate parliamentarian “stripping out many of our good provisions and the special interest lobbyists sneaking in dirty poison pills like 10 year state moratoriums on AI” as her reason for opposing the bill.
“We do not need to pass a One Big Beautiful Bill that continues to fund sex changes on kids, Medicare and Medicaid for illegals, and destroys federalism,” she said.
When Sen. Susan Collins was asked Thursday if getting a bill done by July 4 was still possible, she said “yes.” Then she shrugged and said “something,” indicating the bill might not end up being all that Republicans had hoped for.
Other senators were similarly perplexed Thursday. Sen. Josh Hawley told reporters that Republicans “have no idea what’s going to happen here.”
“We’ve got to work on some kind of a fix,” he said of GOP leaders. “Hopefully their fix will involve protecting rural hospitals.”
Hawley, one of the most vocal opponents of the Senate’s Medicaid provisions, said going back to the House’s language would be “a lot better than what’s currently on offer here.”
Even the House’s language, which Hawley and, apparently, Trump, had been pushing for, has a problem. The parliamentarian nixed the entire provider tax changes section, ruling out the House-passed freeze of the provider tax cap at its current 6%, as well as the Senate’s proposed gradual decrease to 3.5%.
But some conservatives are plainly opposed to the Medicaid provider tax. Sen. Rick Scott called it a “scam the states are using to not have to put up their money.”
Meanwhile, a group of more moderate House Republicans have told Speaker Mike Johnson and Senate Majority Leader John Thune that they won’t support the reconciliation bill if it reduces the provider tax.
Trying to strike a compromise on the provider tax is just one of a lengthy list of issues Republicans still need to settle. While the Medicaid cuts may be the most politically tricky, the SALT issue is proving just as vexing.
The SALT deduction currently allows homeowners to write off up to $10,000 of their state and local taxes on their federal bill. SALT Caucus House Republicans — mostly from high-tax states like New York, New Jersey and California — have been unwilling to move off the $40,000 cap they negotiated in the House bill.
But Senate Republicans, who don’t represent any of those states, think a $40,000 SALT deduction is a steep price to pay for just a handful of votes in the House. (The House’s SALT provisions would cost more than $300 billion over the next decade.)
As Senate Republicans have some of their Medicaid cuts removed from the bill, they’re in search of more savings — and a more restrained SALT cap is a key item. Senate Republicans at least want the SALT Caucus to compromise in some way. But the group has thus far insisted that they won’t accept anything less than the deal they already made.
The negotiations are going so poorly at the moment that Rep. Nick LaLota, one of the key GOP members of the SALT Caucus, told reporters he wouldn’t be attending “faux‑negotiations” like the one scheduled for Thursday afternoon “until my Senate colleagues get more serious.”
Sen. Markwayne Mullin, who’s been serving as a liaison between the House and Senate on SALT negotiations, told reporters Thursday that no one will be perfectly happy with the final result.
“The Senate’s not going to love the position we’re in,” Mullin said. “SALT Caucus isn’t going to love the position we’re in.”
In short, Republicans seem further away from a final product than they did Wednesday — and they appear a good distance from language that could pass both chambers.
Still, Senate GOP leaders say they will keep members in town until the bill is passed, with hopes that the Senate can still vote within the next few days. Speaker Johnson has told his conference he will keep them on standby, too.
But Thursday afternoon, as Republicans sifted through the parliamentarian’s legislative language, the usually positive speaker sounded just as doubtful as many of his most negative colleagues about the bill’s chances of final passage this week.
“I don’t see how it gets done,” Johnson told reporters.
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Ursula Perano is a reporter at NOTUS. Helen Huiskes is a NOTUS reporter and an Allbritton Journalism Institute fellow.