June 26, 2025

Sources include Politico, The Hill, Modern Healthcare:

Senate Majority Leader John Thune said today that the Senate will not move to overrule its parliamentarian after she advised that including key provisions in the GOP’s domestic-policy megabill would expose it to a fatal Democratic filibuster.

The measures the parliamentarian ruled against include:

• Restrictions on provider taxes states levy to help finance their share of Medicaid costs.
• A ban on PBMs charging Medicaid managed care plans more for drugs than the prices they negotiate with pharmaceutical companies, a practice known as “spread pricing.”
• The restoration of cost-sharing reduction payments to health insurance companies that cover the lowest-income exchange enrollees.
• A ban on cost-sharing reduction payments to insurance plans that cover abortion.
• A Medicaid funding penalty on states such as California, Illinois and Minnesota that use state money to cover undocumented immigrants, along with a slew of other provisions related to Medicaid and exchange coverage of immigrants, including those lawfully present in the U.S.
• A prohibition against Medicaid and Children’s Health Insurance Program coverage of gender-affirming care.

The GOP employed what’s known as budget reconciliation to advance the measure, which subjects it to parliamentary review.  The upside of the reconciliation process is that it doesn’t allow the minority party in the Senate to obstruct legislation with filibusters. The downside is that budget reconciliation bills must be written to alter federal revenues and spending, not primarily to enact new policy. Any senator can object to elements of a reconciliation bill under what’s the “Byrd rule,” named after late Sen. Robert Byrd (D-W. Va.).

The parliamentarian is still weighing some parts of the bill, and more changes could be in store.

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Latest Developments as of 3:30 pm (In short, Trump has pulled out the big guns to lobby Congress that it must stick to the schedule – to pass a bill in the Senate by July 4.).

The White House is forging ahead with its demand that Congress pass its sweeping megabill by July 4, insisting that the legislative effort remain on track despite mounting doubts about its viability on Capitol Hill.

Trump administration officials on Thursday downplayed a fresh set of rulings by the Senate parliamentarian that appeared to jeopardize core elements of the bill, casting it as a minor setback that lawmakers were already working to remedy.

“We expect that bill to be on the president’s desk for signature by July 4,” White House press secretary Karoline Leavitt said Thursday, acknowledging the parliamentarian ruling setback. “This is part of the inner workings 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.”

The White House pressure campaign comes as the administration enters a key stretch that could determine the fate of its legislative ambitions — and shape the critical first year of Trump’s term.

The president and his advisers have warned in a flurry of calls and meetings with lawmakers in recent days that a failure to push through the legislation could deal a major blow to the White House’s agenda and damage the party’s chances in the midterms.

“Run against the president on anything, you’re in trouble — but if it’s his No. 1 priority, you’ve got a real problem,” said one longtime Trump ally, granted anonymity to characterize the administration’s message. “If I were advising a United States senator who’s teetering on the precipice of opposing, I would definitely tell them to think twice on this.”

White House officials expressed confidence that congressional Republicans would be able to rewrite the portions of the bill now under threat, ruling out — at least for now — a more combative effort to overrule the parliamentarian’s decisions.

Leavitt on Thursday punted on directly saying whether Trump would support such a move, which Senate Majority Leader John Thune has already ruled out. Some close Trump allies in Congress are nevertheless pushing to ignore or remove the parliamentarian, with Sen. Tommy Tuberville (R-Ala.) writingThursday that she “SHOULD BE FIRED ASAP.”

In private, the setbacks have further dismayed some Trump advisers as well who were already frustrated by Senate Republicans’ inability to coalesce behind a final version of the megabill. A handful of senators refuse to back the bill over Medicaid policies projected to cut coverage for millions of people and damage the finances of rural hospitals.

Some others, meanwhile, have pushed for deeper health care cuts to help fund the bill’s tax breaks. Trump earlier this week met privately with some of those hardliners, including Sens. Rick Scott (R-Fla.) and Mike Lee (R-Utah).

But Sen. Josh Hawley (R-Mo.), who has raised alarms about the bill’s impact on rural hospitals, later claimed that Trump expressed support in his own one-on-one conversation for a more moderate version of the cuts.

“Trump needs to be more engaged directly,” Stephen Moore, an outside economic adviser to the president, said of the effort to get the holdouts to fall in line. “Failure is not an option. We have to get this done.”

Otherwise, Moore warned, “it would be a political disaster for Republicans — and an economic disaster for the country.”