Medicaid changes don’t meet Senate rules in ‘big, beautiful bill’ says parliamentarian

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Senate Republicans hit a major setback in their race to pass a massive tax and spending package on Thursday, as a chamber official ruled against a key Medicaid provision, putting in doubt plans for a vote by the end of the week.

The nonpartisan Senate parliamentarian, who plays a key role in determining what provisions can stay in the fast-tracked bill, said the GOP change to how states can tax Medicaid providers does not adhere to rules for passing the bill with a simple majority. This was a key provision to help offset the costs of the bill’s tax cuts.

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Senate Republicans a day earlier had proposed a $15 billion rural health stabilization fund to address the slashing of a provider tax that is a critical source of funding for many states.

Democrats, who are making arguments before the parliamentarian to slash key sections of the bill, called the ruling a win.

“With more decisions to come, this guidance results in more than $250 billion in health care cuts removed from the Republicans’ big bad bill,” said Sen. Ron Wyden, D-Ore., and the top Democrat on the Senate Finance Committee. “Democrats fought and won, striking health care cuts from this bill that would hurt Americans’ walking on an economic tightrope.

“This bill is rotten to its core, and I’ll keep fighting the cuts in this morally bankrupt bill until the end,” Wyden added.

Multiple Republican officials familiar with the discussions told NPR that Republicans will continue to rework some provisions to address the parliamentarian’s guidance. Republicans are also downplaying the significance of the setback and the framing by Democrats.

Medicaid provisions have been among the most complicated provisions to negotiate in the bill. One issue is a directive Senate Republicans added that states cut and freeze the tax they impose on Medicaid providers from the 6% in the House bill down to 3%, effectively halving the amount that states will receive in tax revenue from those providers. Critics say the change will result in major challenges for rural hospitals that rely on that money because it becomes part of a big pot of tax revenue for states that plays into the complex formula that determines how much federal funding is received as part of the joint program run with states.

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Other provisions were flagged by the parliamentarian, including one barring Medicaid from covering gender affirming care and denying coverage to some Medicaid recipients who are not U.S. citizens.

Senate Republicans had hoped to begin voting on the legislation this week, but it’s unclear if they’ll meet their deadline to send it to President Trump’s desk by the July 4th deadline. They are also facing intense pressure from Trump to pass the bill this week, and several members of the conference are due for a White House meeting today.

Despite the new guidance from the parliamentarian, Press Secretary Karoline Leavitt told reporters that Trump’s July 4th goal remains in place.

“The President is adamant about seeing this bill on his desk here at the White House by Independence Day,” she said during a briefing at the White House Thursday afternoon.

When asked whether Trump thinks the parliamentarian should be removed, Leavitt said she had not spoken with the president about that and would “let him speak on it.”

“He knows this is part of the process and the inner workings of the Senate,” she added. “He remains very much engaged in these conversations and in this process with lawmakers in both the Senate and the House side, and the whole White House does as well.”

The stakes are high for both Trump and Republicans on Capitol Hill, given that the legislation carries the bulk of the president’s domestic agenda. The GOP leaders have has struggled to resolve major sticking points. While Senate committee leaders have made several significant changes to the bill in recent days, the issue of funding for rural hospitals emerged as a major roadblock.

The new Medicaid language was added to the House-passed bill in the Senate, drawing objections from Sen. Susan Collins, R-Maine, Sen. Josh Hawley, R-Mo. and Sen. Thom Tillis, R-N.C. On Wednesday, the Senate Finance Committee put out the compromise stabilization fund that would direct $15 billion over a 5-year period to states in need. However, that fell short of what other senators say was needed.

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Collins has said the fund needed to be closer to $100 billion, and warned colleagues from racing to a vote this week without carefully resolving the issue. Hawley has argued the Senate changes would force drawn-out negotiations with the House, delaying final passage of the legislation. Tillis, who is running for reelection in 2026, served in the state house in his home state before coming to Congress and warned states wouldn’t be able to make up the gap in funding due to the new cuts in the bill.

After the GOP conference discussed the setback from the parliamentarian during a luncheon on Thursday, Hawley said leaders are reconsidering their options.

“I think that Senate leadership is trying to decide what direction exactly they want to go in,” he told reporters.

But when asked for more details, Hawley wasn’t sure.

“I don’t think they know, it sounded to me like it was very fluid,” he said.

Sen. John Hoeven, R-N.D., told NPR that he believes there is a path to keeping a provider tax in the spending bill.

“[The parliamentarian] had a technical issue with it. And we’ve got a technical response,” he said, although he did not specify what was modified. “We think it’ll be addressed. It could change timelines a little bit. So you may see some change to it, but generally we think it was a technical issue with a technical fix.”

Hoeven also said that he believes the floated stabilization fund for rural hospitals will be upwards of $15 billion.

Senate GOP leaders are also waiting for a determination of whether major tax provisions in the bill meet the strict rules for what can be included. The parliamentarian is still reviewing those elements to make sure each has a direct impact on the budget, among other regulations. Several other provisions in the House version, such as one barring nationwide judicial injunctions, have already been cut in that review.

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There is also lingering debate over the fate of energy tax credits in the bill, changes to the safety net program for low-income families known as the Supplemental Nutrition Assistance Program or snap and a provision on public lands.

Senate Republicans are also navigating differences with House GOP lawmakers who represent districts in New York and California who insist they need to preserve a state and local tax break, known as SALT. That section of the bill was negotiated with House Speaker Mike Johnson for their constituents who pay high state and local taxes.

Senate Majority Leader Thune can only afford to lose three GOP votes in order to pass the bill.

Fiscal hawks in the Senate, such as Sen. Ron Johnson, R-Wisc., and Sen. Rand Paul, R-Ky., have raised concerns about new deficit spending and could both potentially vote against the plan as a result.

However, even if Thune is able to resolve all of the issues in his chamber, several different factions of House Republicans are warning they will oppose the latest bill that’s emerging from the Senate. Thune has repeatedly called Trump the “closer” for the massive legislation, and he’s betting political pressure from the White House will force Republicans to back the package.

NPR’s Elena Moore contributed to this report.

Senate Republicans’ changes to ‘big beautiful bill’ tee up clash with House

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Senate Republicans are considering adjustments to the bill that’s a cornerstone of President Trump’s second-term agenda, with new provisions that could set up a collision course in the House.

The Senate Finance Committee released the highly-anticipated legislative text Monday, which tackles issues like Medicaid and clean energy tax credits.

“This bill prevents an over-$4 trillion tax hike and makes the successful 2017 Trump tax cuts permanent, enabling families and businesses to save and plan for the future,” said Chairman Mike Crapo, R-Idaho., in a statement.

Senate Democrats blasted the proposal, but their criticism is essentially moot, since Republicans are using a budget tool called reconciliation that would enable them to pass the bill along party lines.

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Senate Finance Committee Ranking Member Ron Wyden, D-Ore., said in a statement that “the biggest winners here are wealthy corporations who would get hundreds of billions of dollars in additional tax breaks.”

The Finance Committee plan was unveiled a day before the nonpartisan Congressional Budget Office released a long-awaited alternate estimate for a version of the bill that passed the House in May. The updated figure, which includes projections for both economic growth and added costs from interest accrued on the nation’s debt, estimates the House bill would add roughly $2.8 trillion to the deficit over a decade— more than originally projected.

House GOP leaders narrowly overcame internal divisions to pass that bill with some members concerned about the impact on the debt and deficit. The new score, combined with the Senate changes, could threaten the delicate coalition leaders amassed to pass the bill in the first place.

Both chambers have narrow majorities. Senate Majority Leader John Thune can only lose three GOP senators. Adding to the challenge is Senate Republicans’ self-imposed deadline to pass the bill by July 4. If the Senate passes the bill, it will return to the House for a vote.

Rep. Jason Smith, who chairs the House Ways and Means Committee, displayed a degree of optimism in a statement Monday night.

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He said despite the work that remains to be done, “we will thread that needle to respect the needs of both bodies in the days ahead.”

Let’s take a look at some of the changes between the House and Senate versions and where some of the potential clashes could surface.

SALT still on the table

A major point of contention during the House negotiations was state and local tax deductions, referred to as SALT. The 2017 tax cuts capped SALT deductions at $10,000. Blue-state Republicans negotiated a plan to lift the cap to $40,000 for married couples with incomes up to $500,000.

There are no Republicans in the Senate who represent high-tax, primarily Democratic states like California and New York, and various GOP senators vowed the House’s SALT efforts would be reined in by the upper chamber.

The Senate’s language maintains the current $10,000 cap — but senators have said it’s a placeholder figure as negotiations continue. Assigning it a value in the text enables the CBO to begin scoring the Senate bill.

But placeholder or not — this will remain a sticking point for the SALT caucus in the House.

New York Rep. Mike Lawler posted on social media that he will “not accept a penny less” than the negotiated $40,000 cap.

“If the Senate reduces the SALT number, I will vote NO and the bill will fail in the House,” he wrote .

Lawler added he’s working with the leadership in both chambers and the White House and is “confident the deal as previously negotiated will be in the final bill.”

Debt limit

The Senate version would boost the debt limit by $5 trillion, up from the House’s $4 trillion figure. Kentucky GOP Sen. Rand Paul has already said he opposes this.

Congress has to act by late summer to adjust the debt limit, or risk defaulting on the nation’s debt.

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Taxes

The Senate text permanently extends the 2017 tax cuts, a major priority for President Trump.

Trump also campaigned on no taxes on tips or overtime.

The House-passed bill listed no stated cap on tips or overtime deductions for those earning less than $160,000 a year.

Meanwhile, the Senate text includes deductions of up to $25,000 for tips on income through 2028, phased out for incomes over $150,000 for an individual and $300,000 for a married couple.

It includes up to a $12,500 deduction on overtime pay for individuals or $25,000 for joint filers through 2028, to be phased out when an individual’s gross income exceeds $150,000 or a couple’s joint income exceeds $300,000.

It also includes a $10,000 deduction for a qualified passenger vehicle loan, to phase out when the taxpayer’s adjusted gross income exceeds $100,000 or $200,00 for a couple.

The Senate version makes various business tax breaks permanent, increases a tax deduction for seniors to $6,000 and lowers the child tax credit. Under the House version, the child tax credit is listed as $2,500 per child; the Senate version is $2,200 per child. Neither version would benefit low earning families with no tax liability.

The Senate version also creates school choice tax credits and establishes savings accounts for newborns.

Green energy rollbacks

Like the House version, the Senate language significantly rolls back the clean energy credits signed into law by former President Joe Biden. However, it does so with more flexibility.

The Senate proposal includes language friendly to the geothermal, nuclear and hydropower industries. It would phase out incentives for wind and solar in the Inflation Reduction Act at a slower pace than the House version, enabling more projects to access the credits before they finish their work.

The House bill includes a provision requiring projects start construction within 60 days of the bill’s enactment to qualify for the credits, something that concerned a group of Senate Republicans . The Senate language gives projects more time to start construction.

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The Senate proposal has provisions more friendly for companies on transferability, a concern among businesses who eyed the more restrictive House version. This will allow project sponsors to transfer their credits to a third party.

Texas GOP Rep. Chip Roy has said he won’t vote for these Inflation Reduction Act centered provisions.

Medicaid

The Senate bill would match some elements of the House version by implementing work requirements for the popular joint federal-state health care program for Americans with disabilities, the elderly and low-income people.

The Senate’s provision would require “nonpregnant, nondisabled, childless adults, aged 19-64, to complete a minimum of 80 hours” of work, community service or other qualifying activities in order to qualify for Medicaid.

There would be several exemptions, including for veterans with a “disability rated as total,” individuals who are medically frail, young people in foster care through the age of 26, among other groups.

The proposal also increases the frequency of eligibility verifications and boosts requirements for eligibility documentation.

“The Republican Senate Finance cuts to Medicaid are deeper and more devastating than even the Republican House’s disaster of a bill,” Senate Minority Leader Chuck Schumer said in a statement.

Some Republican senators are also raising concerns about a provision that would incrementally lower provider tax in states that expanded Medicaid under the Affordable Care Act to 3.5% by 2031, down from the current 6%. The cap would be phased in by lowering it 0.5 % annually starting in 2027.

Critics of the provider tax say it’s a loophole that drives expenditures — supporters say it’s a critical form of funding for hospitals, particularly rural hospitals.

“I’m an optimist — that we’re all going to be able to come together and we’ll get, you know, some fiscal sanity and we’ll also make sure that states like mine that didn’t expand Medicaid are not treated unfairly,” said Florida Sen. Rick Scott.

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Missouri Sen. Josh Hawley, who remains on the fence on the bill, said he was taken aback by the changes to provider tax.

He argued it would hurt rural hospitals in his state.

“It just baffles me. I’d invite them to come explain that to the people of Missouri,” he said after a Senate Republican meeting over the plan’s latest changes.

NPR’s Claudia Grisales contributed to this report.

After 120 days, the 2025 Nevada legislative session ended with a flurry of last-minute confusion and partisan tension, adjourning sine die after midnight on June 3.

Using a series of parliamentary motions, Sen. Ira Hansen (R-Sparks) ran out the clock in the session’s final 15 minutes to protest an eleventh-hour introduction of two resolutions related to the state’s Legislative Commission, which approves regulations proposed by state agencies. One measure would have reduced Republicans’ clout on the panel.

As the session slipped away from Senate Democrats, there was confusion as to whether lawmakers could still take action on the resolutions after the constitutionally mandated midnight deadline because there was an open vote on the floor.

Legislative Counsel Bureau staff provided a verbal legal opinion suggesting limited business could continue, but Republican Lt. Gov. Stavros Anthony, who presides over the Senate, rejected it without seeing the guidance in writing.

Hansen’s time-consuming filibuster may have killed the Republican governor’s crime bill, which did not get a Senate vote to sign off on changes the Assembly made.

Following the adjournment, however, Senate Minority Leader Robin Titus (R-Wellington) told reporters outside the chamber that the protest had nothing to do with any other bills.

While lawmakers passed all five constitutionally required budget bills, four of Gov. Joe Lombardo’s five priority proposals failed — but some of his proposals, including $38 million over the next two years for charter school teacher raises and the establishment of the Nevada Health Authority, were folded into other measures. A controversial film tax credit expansion backed by major Hollywood studios also stalled.

A spokesperson for Lombardo declined to weigh in on the Legislature’s adjournment or whether he plans to call a special session to revisit his legislation.

With the session concluded, the governor turns his attention to the bills awaiting action on his desk. He has 10 days to sign or veto them before they become law by default.

Photojournalist David Calvert documented the chaotic final day for The Nevada Independent.

Therapy dog Penny inside the Legislature on the final day of the 83rd session in Carson City on June 2, 2025. (David Calvert/The Nevada Independent)

From left, lobbyists Billy and Nick Vassiliadis and Vince Saavedra outside the Legislature on the final day of the 83rd session in Carson City on June 2, 2025. (David Calvert/The Nevada Independent)

Legislation on the desk of Assembly Chief Clerk Bonnie Borda Hoffecker inside the Legislature on the final day of the 83rd session in Carson City on June 2, 2025. (David Calvert/The Nevada Independent)

Assms. Rich DeLong (R-Reno), right, Tanya Flanagan (D-Las Vegas), left, and Selena La Rue Hatch (D-Reno), back, inside the Legislature on the final day of the 83rd session in Carson City on June 2, 2025. (David Calvert/The Nevada Independent)

Lobbyist and former state Sen. Mo Denis inside the Legislature on the final day of the 83rd session in Carson City on June 2, 2025. (David Calvert/The Nevada Independent)

Gov. Joe Lombardo leaves Senate Majority Leader Nicole Cannizzaro’s (D-Las Vegas) office inside the Legislature on the final day of the 83rd session in Carson City on June 2, 2025. (David Calvert/The Nevada Independent)

Assembly Minority Leader Greg Hafen (R-Pahrump), left, speaks to Majority Leader Sandra Jauregui (D-Las Vegas) inside the Legislature on the final day of the 83rd session in Carson City on June 2, 2025. (David Calvert/The Nevada Independent)

The Senate Finance Committee meets behind the bar inside the Senate chamber inside the Legislature on the final day of the 83rd session in Carson City on June 2, 2025. (David Calvert/The Nevada Independent)

Brandon Birtcher, center, CEO of Birtcher Development, inside the Legislature on the final day of the 83rd session in Carson City on June 2, 2025. (David Calvert/The Nevada Independent)

Gov. Joe Lombardo’s Legislative Director Madeline Burak, left, and Policy Director Isabel Graf are reflected in the glass inside the Assembly chamber while watching a vote from the gallery on the final day of the 83rd session in Carson City on June 2, 2025. (David Calvert/The Nevada Independent)

A poster board with the 120-day legislative calendar in a trash can inside the Legislature on the final day of the 83rd session in Carson City on June 2, 2025. (David Calvert/The Nevada Independent)

Attorney General Aaron Ford watches the final hour of the 83rd legislative session from the gallery in the Assembly chamber in Carson City on June 2, 2025. (David Calvert/The Nevada Independent)

Assembly Speaker Steve Yeager, center left, (D-Las Vegas) and Majority Leader Sandra Jauregui (D-Las Vegas), center right, inside the Legislature on the final day of the 83rd session in Carson City on June 2, 2025. (David Calvert/The Nevada Independent)

Sen. Ira Hansen (R-Sparks) uses a series of parliamentary motions in the final minutes of the session to protest the last-minute introductions of two resolutions related to the state’s Legislative Commission, which approves proposed regulations brought forth by state agencies, on the final day of the 83rd Legislature in Carson City on June 2, 2025. (David Calvert/The Nevada Independent)

Senate Majority Leader Nicole Cannizzaro (D-Las Vegas) watches the final minutes of the 83rd session in Carson City on June 2, 2025. (David Calvert/The Nevada Independent)

From left, Sen. Melanie Scheible (R-Las Vegas), Senate Majority Leader Nicole Cannizzaro (D-Las Vegas) and Minority Leader Robin Titus (R-Wellington) speak with Asher Killian, the Nevada Legislative Counsel Bureau chief deputy legislative counsel, after midnight on June 3, 2025, following a parliamentary protest from Sen. Ira Hansen (R-Sparks) that ran out the clock on the final minutes of the 83rd session in Carson City. (David Calvert/The Nevada Independent)

Lt. Gov. Stavros Anthony presides over the Senate in the final minutes of the 83rd session in Carson City on June 2, 2025. (David Calvert/The Nevada Independent)

Sens. Melanie Scheible (D-Las Vegas), center, and Rochelle Nguyen (D-Las Vegas), are accompanied by a legislative police officer to the Capitol where the lawmakers deliver their sine die message to Gov. Joe Lombardo after midnight on the final day of the 83rd session in Carson City on June 3, 2025. (David Calvert/The Nevada Independent)