❓WHAT HAPPENED: The Senate Parliamentarian, Elizabeth MacDonough, has ruled that several significant provisions in President Donald J. Trump’s “One Big Beautiful Bill” violate the Byrd Rule and are thus subject to a 60-vote threshold to overcome a filibuster. This means the provisions must be rewritten to be Byrd rule compliant or scrapped, unless Senate Republicans move to overrule the Democrat-appointed official.
👤WHO WAS INVOLVED: Elizabeth MacDonough, Senate Majority Leader John Thune (R-SD), Senate Republicans, and Vice President J.D. Vance.
📍WHEN & WHERE: MacDonough issued her Byrd Rule determinations on portions of the “One Big Beautiful Bill” on Thursday, June 26, 2025.
🎯IMPACT: The rulings by the Parliamentarian jeopardize President Trump’s agenda and the passage of the reconciliation bill unless Senate Republicans are able to quickly rewrite the measures to be Byrd Rule compliant or circumvent MacDonough.
The Senate Parliamentarian, Elizabeth MacDonough, has struck a number of critical provisions from President Donald J. Trump’s budget reconciliation legislation, dubbed the “One Big Beautiful Bill.” Weilding the Byrd Rule as a cudgel, MacDonough—an unelected advisor appointed by the late Senator Harry Reid (D-NV)—determined on Thursday that a number of changes that would prevent noncitizens and illegal immigrants from receiving Medicaid, rein in pharmacy benefit managers, and roll back significant portions of Obamacare, all require 60 votes to overcome a filibuster rather than the 51 votes typically needed in reconciliation bills.
Her rulings mark a major setback for the “Big Beautiful Bill,” leaving the Senate GOP needing to either quickly rewrite the provisions in question, move to overrule or fire MacDonough, or scrap the provisions altogether—with the latter likely being the only path to passing the bill before a July 4 deadline set by Trump. The National Pulse has put together a rundown of the key provisions struck by the Parliamentarian, and what Senate Republicans can do about it.
WHAT WAS STRUCK?
A bulk of the provisions ruled to be in violation of the Byrd Rule by MacDonough pertain to Medicaid changes that would bar illegal immigrants and noncitizens from receiving benefits from the federal healthcare program. Other key provisions that were struck include changes to Obamacare’s Medicaid expansion funding through provider taxes, changes to Obamacare‘s Medicaid expansion federal medical assistance percentage, and a measure aimed at reining in pharmacy benefit managers.
According to the Parliamentarian, the reconciliation bill’s language prohibiting the participation in Medicaid and CHIP of individuals whose citizenship status cannot immediately be verified violates the Byrd Rule. Notably, the Byrd Rule only prohibits reconciliation bills from including measures that do not produce a change in outlays or revenues, increase deficits beyond the 10-year budget window, change Social Security, are outside the authoring committee’s scope, or only tangentially impact the budget. The Medicaid and CHIP participation changes do not appear to trigger any of these stipulations.
Similarly, a provision barring federal funding of Medicaid for illegal immigrants does not appear to violate the Byrd Rule despite MacDonough determining that it does. Likewise, a struck provision that bars federal Medicaid funding for so-called gender-affirming care does not appear to substantively violate the rule. And again, it isn’t clear how changes to provider taxes—a provision enacted under Obamacare, which was passed through budget reconciliation—fall afoul of the Byrd Rule either.
In fact, the only measure struck by MacDonough that arguably falls under the Byrd Rule is the provision requiring Medicaid contracts to stipulate that pharmacy benefit managers must pass on reimbursements directly to pharmacies. The policy change here is arguably tangential to the impact on the budget, though a bipartisan coalition of lawmakers has tried to enact this change for some time.
WHAT CAN BE DONE ABOUT IT?
There are a handful of options for Senate Republicans to deal with MacDonough’s rulings. The most expedient solution would be for the President of the Senate, U.S. Vice President J.D. Vance, to simply overrule the Parliamentarian—effectively dismissing the Byrd Rule objections and requiring only a 51-vote majority to adopt the bill, including the provisions in question. Such a move has been incredibly rare, with the notable instances being Vice Presidents Nelson Rockefeller and Hubert Humphry overruling the Parliamentarian on votes making changes to the Senate’s filibuster rules.
The second option would be for the Republican Senate to vote to overrule the Parliamentarian’s determinations. This only requires a simple majority vote of the upper chamber—though it appears that Senate Majority Leader John Thune (R-SD) has ruled this out. Likewise, Thune says he will not move to fire MacDonough—the third option that Senate Republicans have to sidestep the Parliamentarian. “That would not be a good outcome for getting a bill done,” Thune said on Thursday regarding whether he’d fire or hold a vote to overrule MacDonough.
Without overruling or removing the Parliamentarian, Senate Republicans are left with either reworking the provisions to conform to MacDonough’s interpretation of the Byrd Rule or scrapping the measures entirely.
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