Illustration: Allie Carl / Axios
A set of surprisingly sweeping parliamentary rulings is motivating Senate Republicans to try to rework major pieces of the reconciliation bill, with little time to spare to meet their self-imposed July 4 deadline.
Why it matters: The Senate parliamentarian's invalidation of limits on the Medicaid provider tax, in particular, removes a provision that could have delivered more than $100 billion in savings.
Driving the news: Senate Republicans say they are not giving up and are going to try to rework the language addressing the taxes that states levy on providers to help fund their share of Medicaid costs. Other provisions, including limits on health coverage for certain immigrants, could also be redone.
- "We'll continue our work and find a solution to achieve the desired results," said a source familiar.
- There were already concerns on policy grounds with the stricter provider tax limits in the Senate Finance section of the bill, leading some Senate Republicans to endorse the House's provider tax framework, which would freeze rates at current levels.
- Sen. Josh Hawley posted on X on Wednesday night that President Trump told him during a phone call to "Stay with the House!" on the Medicaid measures.
What's next: The combination of parliamentary challenges and policy disputes among Senate Republicans cast a cloud over hopes for a Friday vote on the package.
- Leadership is likely to keep pressing forward, with input from the Trump administration.
By the numbers: Senate Finance Ranking Member Ron Wyden said in a statement that the parliamentarian's rulings collectively removed $250 billion in health care cuts from the Senate draft.
- That puts the Senate GOP on the spot to find other sources to pay for tax cuts.
- The House's provider tax moratorium saved about $89 billion, per CBO.
- The Senate Finance text hadn't been publicly scored yet, but previous CBO scores had found that reducing the provider tax safe harbor could generate tens of billions more in savings.
Between the lines: The parliamentarian didn't explain publicly how the provider tax section violated the Byrd Rule, though it's possible it would have improperly influenced state-level policy choices.
- "There were meaningful portions of the section as written that were fundamentally about telling states what they can and can't do," said Bobby Kogan, a former Senate Budget Committee staffer now at the Center for American Progress.
- "Possible they're able to cure some of this in a redraft, but absolutely some of what they want to do on provider taxes is quintessentially Byrdable."
- It's also possible that because individuals' health policy coverage was being affected, the Senate provisions became more of a policy change than a budget change.
