In a dramatic turn of events on Capitol Hill, the Senate Parliamentarian has ruled that several critical provisions of the Republican-led domestic policy budget bill violate reconciliation rules, threatening the bill’s path forward just as party leaders were scrambling to secure the final votes needed for passage.
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The rulings were made public Sunday in a memo from the Democratic members of the Senate Budget Committee, shaking the foundation of the carefully brokered legislative deal — including a last-minute, backroom deal struck with Senator Lisa Murkowski (R-Alaska) to shield her state from deep Medicaid and food assistance cuts.
According to the Parliamentarian, two provisions added late last week — aimed at boosting Medicaid payments to Alaska and Hawaii — run afoul of the Senate’s “Byrd rule,” which restricts what can be passed via the fast-track reconciliation process. That process allows certain budget-related bills to bypass the filibuster and pass with a simple majority, but bars the inclusion of policies deemed incidental to budget changes or those with "merely incidental" fiscal impacts.
Murkowski’s Deal in Jeopardy
Senator Murkowski, seen as a key swing vote, had expressed strong opposition to the bill’s original cuts to Medicaid and the Supplemental Nutrition Assistance Program (SNAP). After tense negotiations behind closed doors, she agreed to advance the bill late Saturday in exchange for carveouts that would lessen the impact on Alaska.
But the Parliamentarian’s Sunday decision undercuts those promises, casting serious doubt over Murkowski’s continued support. Without her vote, GOP leadership faces a razor-thin margin and renewed uncertainty over whether the legislation can move forward.
Drug Pricing Provision Also Rejected
Another high-stakes provision rejected by the Parliamentarian was a Republican attempt to expand an exemption for so-called “orphan drugs” — medicines that treat rare diseases — from Medicare price negotiations. While the House-passed version of the bill included language to broaden the exemption to drugs that treat multiple rare conditions, the Senate Parliamentarian determined that such a provision exceeds the limits of reconciliation.
The orphan drug language was notably absent from the initial Senate Finance Committee draft earlier this month, signaling intra-party disagreement over its inclusion. Sunday’s ruling reinforces concerns that Senate Republicans may need to go back to the drawing board if they hope to salvage their sweeping policy package under reconciliation rules.
Next Steps Uncertain
The Parliamentarian's rulings come at a critical time, as Republican leaders try to whip enough votes to pass the bill without any Democratic support. The decision forces lawmakers to confront a familiar dilemma: scale back the legislation or pursue a longer, more arduous process to pass their priorities outside reconciliation.
For now, key elements of the domestic policy agenda — including Medicaid and SNAP reform, as well as Medicare drug pricing changes — hang in the balance.
With the future of the GOP’s signature domestic legislation uncertain, all eyes now turn to the Senate floor — and to a small group of Republicans whose votes may decide whether the bill lives or dies.
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