Can the US Senate Parliamentarian really veto Medicaid reforms?
Senate Parliamentarian Elizabeth MacDonough decided on Thursday to reject key Medicaid provisions in the GOP’s “Big Beautiful Bill” (BBB) in a move that could end up costing taxpayers hundreds of billions over the next decade. This sent some legislators back to the drawing board, while others called for her to be fired, contending that her refereeing had crossed the line into legislating.
The parliamentarian is the senate’s advisor on rules and procedures. Ms. MacDonough has held the position since 2012 when she was picked by democrats, but has since served under both parties. Nonconforming bill provisions deemed unfit for a simple majority can be removed under the “Byrd Rule” named for the late Sen. Robert Byrd (D-WV). This sifting of bills through a process sometimes referred to as the “Byrd Bath” has hit snags for both parties in the past, but perhaps never as consequential one as the Medicaid rulings on June 26th.
MacDonough rejected major portions of the BBB because they would:
- Restrict Medicaid and Children’s Health Insurance Program (CHIP) from covering illegal immigrants.
- Drop Federal Medical Assistance Percentage (FMAP) from 90 to 80 in states that use Medicaid funds for illegal immigrants (expansion states, including MN).
- Bar subsidies under the Affordable Care Act from flowing to qualified plans that pay for abortions.
- Cap state “sick taxes” used to draw down additional federal funds.
Minnesota is a Medicaid expansion state that covers both children and adult illegal aliens under MNCare (adults will no longer be eligible after Jan 1). Governor Walz and Republican leaders in Minnesota opted to revive the “sick tax” after it was eliminated by Gov Dayton. In 2023, Walz eliminated nearly every abortion restriction bill signed into law, and signed abortion sanctuary language into state law.
Senator Majority Leader John Thune (R-SD) has indicated that he will not seek to overrule Ms. MacDonough, but his real problem might not be with her. Thune’s 53-47 majority lacks the 60 votes needed for cloture (to cut off debate and move to a floor vote on most bills) which gives the parliamentarian the ability to decide if a bill provision can move ahead on a simple majority vote, or if it needs the additional nine votes of a super-majority.
Thune clearly has caucus members who would like MacDonough fired, but others who may be happy to avoid taking a tough vote on Medicaid reform. Senator Tommy Tuberville (R-AL) called for removal after posting on X, “The WOKE Senate Parliamentarian, who was appointed by Harry Reid and advised Al Gore, just STRUCK DOWN a provision BANNING illegals from stealing Medicaid from American citizens” while others like Sen Susan Collins (R-ME) says, “She may rule the way you like one day, the way you don’t the next.”
Minnesota, New York and a few other “blue” states stand to benefit financially if the ruling of the parliamentarian stands. However, leaders in Minnesota have made the state more dependent on the federal government every year, while codifying socially divisive bills that put those federal dollars at risk. The true price of Legislative sessions like 2023, when generational decisions were made because the stars of one party all aligned, will be paid one way or another in the next few years.