President Donald Trump on Thursday celebrated what he described as a “big, beautiful bill” during a White House event with GOP lawmakers and handpicked American workers, even as Senate Republicans grappled with a major procedural setback that threatens key portions of the legislation. The Senate parliamentarian, the chamber’s official rules adviser, advised that several critical components of the sweeping tax and spending package—including a Medicaid provider tax overhaul and provisions restricting immigrant access to health programs—violate Senate procedural rules and cannot be included in the reconciliation process.
The parliamentarian’s ruling undermines Republican efforts to finalize the legislation ahead of Trump’s July 4 deadline, dealing a blow to their strategy of combining $3.8 trillion in extended tax cuts with deep reductions in federal safety net programs. GOP leaders had been counting on savings from Medicaid and food stamp cuts to offset the massive cost of the tax breaks, which would otherwise expire in December.
Guidance from the parliamentarian is rarely challenged and could force Republicans to remove or substantially revise key parts of the package. Majority Leader John Thune acknowledged the setback but maintained that the GOP was pressing forward, saying, “We have contingency plans.” Meanwhile, votes expected as early as Friday now appear increasingly unlikely as Republican leaders scramble to rewrite provisions in compliance with Senate rules.
Democrats, united in opposition to the bill, seized on the ruling as further proof that the legislation is flawed. Senator Ron Wyden, the top Democrat on the Senate Finance Committee, said the Republican proposal would have stripped $250 billion from Medicaid, hurting “kids, seniors, Americans with disabilities, and working families.” The nonpartisan Congressional Budget Office previously estimated that more than 10.9 million people would lose health coverage under the House-passed version of the bill.
Despite the turmoil, Trump appeared unfazed during his appearance at the White House, where he was joined by Speaker Mike Johnson, Republican lawmakers, and workers including truck drivers, tipped employees, ranchers, and firefighters. Trump dismissed GOP critics and urged holdouts to stop “grandstanding,” saying the bill contains “hundreds of things” including tax relief, spending cuts, and funding to support his proposed mass deportation agenda. “It’s so good,” Trump said.
The House passed the bill earlier this month, but the Senate version introduced steeper Medicaid cuts. One of the most controversial proposals involved reducing the Medicaid provider tax—a mechanism used by most states to secure additional federal funding. The Senate plan would cut or freeze this tax, a move critics say would devastate rural hospitals that depend on these funds. Some Republican senators, including Josh Hawley and Susan Collins, have pushed back, citing concerns for hospitals in their states. Hawley said he spoke with Trump on Wednesday night, and the president supported reverting to the House’s more moderate version of the tax change.
Hospital associations have warned that cutting the provider tax could result in closures, particularly in rural areas. Although Republicans floated the idea of creating a $15 billion rural hospital fund to mitigate the impact, some senators argued the amount was insufficient, while others wanted a significantly larger cushion—up to $100 billion.
The parliamentarian also ruled against a series of other Republican priorities. These included efforts to cut food stamp funding, block states from enrolling immigrants in Medicaid, and dismantle the Consumer Financial Protection Bureau. A provision aimed at eliminating student loan forgiveness programs was also rejected. Any attempt to keep these provisions in the bill would trigger procedural challenges requiring 60 votes to overcome—an insurmountable threshold in a closely divided Senate.
Senator Lindsey Graham, chairman of the Budget Committee, rejected calls from some Republicans to fire the parliamentarian. “We’re working with the office to find a pathway forward,” he said. Others, like Senator Kevin Cramer, stressed the importance of maintaining the Senate’s institutional integrity even if they disagreed with the rulings.
The setback has left Senate Republicans with limited options and mounting time pressure. If the bill is not amended to comply with reconciliation rules, or if consensus on the revisions cannot be reached, the entire package risks collapse. Trump and GOP leaders are determined to avoid that outcome, aiming to claim a major legislative win ahead of the upcoming election season. But as the parliamentarian’s rulings continue to pile up, the path forward is growing narrower.
