The Senate’s rewritten domestic policy bill encounters fresh obstacles as the parliamentarian alerts senators that certain provisions violate the chamber’s strict rules for budget reconciliation bills.
Parliamentarian Rulings and Budget Reconciliation Challenges
The recent rulings, disclosed in a memo from Democrats on the Senate Budget Committee, coincide with Senate Republicans’ efforts to secure sufficient votes for the bill’s final approval.
Among the recent additions to the legislation, tailored to enhance Medicaid payments for Alaska and Hawaii, two provisions have been deemed in breach of the Senate’s Byrd rule. This limitation dictates what can proceed through reconciliation with a simple majority.
Republican leaders had pinned their hopes on these Medicaid modifications, particularly those benefiting non-contiguous states like Alaska, to sway Sen. Lisa Murkowski’s vote. She had expressed reservations regarding substantial cuts to Medicaid and the Supplemental Nutrition Assistance Program (SNAP).
After causing some suspense among committee chairs and leadership, Murkowski ultimately voted in favor of advancing the bill on Saturday night.
Key Provisions and Rulings
Elsewhere, Senate Republicans sought to broaden an exemption on Medicare drug-price negotiations for ‘orphan’ drugs to encompass medications treating multiple rare diseases. However, the parliamentarian’s decision deems it non-compliant and potentially jeopardizes the bill’s passage with a simple majority. While the House-approved bill included the orphan drug provision, the initial Senate Finance Committee proposal did not.
The parliamentarian also invalidated provisions aiming to impede the implementation of two Biden-era regulations facilitating Medicaid enrollment for older adults and individuals with disabilities.
Additionally, a provision blocking a Biden Administration rule on nursing facility staffing, anticipated to reduce federal Medicaid spending by $23 billion over a decade, was flagged.
Outlook and Controversies
Ranking Member Jeff Merkley (D-Ore.) emphasized the ongoing scrutiny of the bill, criticizing it as a ‘Big, Beautiful Betrayal’ that flouts Senate regulations. Despite these setbacks, Democrats continue to challenge every contentious provision.
Amidst the rulings, Senate Republicans received positive news as certain tweaked provisions secured compliance with the rules. Notably, a proposal delaying scheduled cuts to provider taxes supporting state Medicaid obligations passed without requiring a supermajority vote. Changes will gradually reduce the permissible provider tax in Medicaid expansion states from 6 percent to 3.5 percent, commencing in 2028, a year later than planned.
Another approved proposal bars Medicare coverage for non-citizen immigrants, preventing refugees, asylum seekers, and individuals with temporary protected status from enrolling in Medicare. Similarly, provisions excluding non-citizens from qualifying for tax credits and cost-sharing reductions in Affordable Care Act marketplaces were deemed compliant.
Review Pending and Conclusion
Yet to be assessed by the parliamentarian is a provision restricting Planned Parenthood from receiving federal Medicaid funds. The bill’s fate hinges on forthcoming decisions.
