The Senate side of the U.S. Capitol building – Photo: Scrumshus, via Wikimedia
The U.S. Senate parliamentarian blocked several provisions in President Donald Trump’s proposed tax and budget bill, including a transgender health care ban that would have prohibited federal funds from covering gender-affirming care.
The provision seeks to block transgender people of all ages — including adults — from accessing transition-related care by banning Medicaid, ACA marketplace plans, and the Children’s Health Insurance Program from covering the cost.
But Senate Parliamentarian Elizabeth MacDonough, who is tasked offering nonpartisan advice to federal lawmakers on Senate rules, declared that the proposed transgender health care ban violates the Byrd Rule, which requires reconciliation bills — those cobbled together to resolve differences between House and Senate versions — to only contain provisions that impact the budget or spending, and not any “extraneous” matters.
The Byrd Rule allows the Senate to pass budget-related bills with a simple majority vote, bypassing the 60-vote threshold needed to overcome a filibuster. Legislation that doesn’t directly address federal spending remains subject to the filibuster.
MacDonough also ruled that a Senate proposal to cap states’ use of health care provider taxes — fees levied on hospitals and nursing homes to help fund a state’s share of Medicaid — violates the Byrd Rule, according to the Associated Press.
States use provider tax revenue to fund Medicaid base rates, supplemental payments, and expanded benefits under the Affordable Care Act, including coverage for more low-income individuals. According to PBS, because the federal government matches state Medicaid spending at rates between 50% and 80% with no upper limit, higher provider taxes lead to higher state spending — and more federal matching funds.
Republicans had hoped that capping health care provider taxes would sharply reduce federal Medicaid spending and free up hundreds of billions in savings — money they plan to use to make President Trump’s first-term corporate tax cuts permanent.
Other provisions MacDonough blocked for violating the Byrd Rule include cutting off health care access for undocumented immigrants and limiting the power of federal courts to block potentially unconstitutional policies. She also rejected a repeal of EPA auto emissions rules and a proposal to ease access to gun silencers.
Additional rejected measures include a school voucher program that would subsidize religious schools at taxpayer expense and a provision allowing developers to bypass judicial environmental reviews by paying a fee.
Some Republicans expressed outrage at MacDonough.
Sen. Tommy Tuberville (R-Ala.) tweeted that she should be fired, while Rep. Greg Steube (R-Fla.) accused her of partisan bias, questioning why an “unelected swamp bureaucrat, who was appointed by Harry Reid over a decade ago” gets to decide what’s germane to a budget bill.
But MacDonough has also dealt setbacks to Democrats. In 2021, she ruled that a minimum wage increase couldn’t be included in a COVID-19 relief bill — prompting liberal Democrats to urge Senate leaders, including then-Vice President Kamala Harris, to overrule her with a 51-vote majority.
Later that year, MacDonough ruled that a Democratic-backed provision allowing millions of immigrants to remain temporarily in the U.S. was not germane to a climate bill.
While the parliamentarian’s ruling is non-binding and Republicans could overrule MacDonough, party leaders are reluctant to take that step. Some fear it would set a dangerous precedent, enabling Democrats to push through legislation over the parliamentarian’s objections if they regain control of Congress.
Senate Majority Leader John Thune (R-S.D.) told reporters his leadership team has “contingency plans” to ensure Trump’s “big, beautiful bill” passes. But with some Medicaid cuts rejected, Republicans must now find other cost-saving measures to offset the price of making Trump’s corporate tax cuts permanent — or identify ways to bring the cuts into compliance with the Byrd Rule.
Senate Democrats estimate that the provisions rejected by MacDonough amount to about $250 billion in spending cuts, leaving Republicans scrambling to find alternatives, according to The Hill. Meanwhile, Trump is pressuring lawmakers to pass the bill by July 4 — even urging them to remain in Washington until it reaches his desk for signature.
Sen. Ron Johnson (R-Wis.), a member of the Senate Finance Committee, called MacDonough’s ruling “a big ol’ grenade” that could jeopardize the bill’s chances. He urged colleagues to seek alternative spending cuts, leaving entitlements like Medicaid untouched — at least for now — and focusing instead on other federally mandated spending.
Senate Finance Committee Chair Mike Crapo (R-Idaho) told The Hill his staff would try to “work it out” to keep the bill on track.
“This is regular process,” Crapo said of the parliamentarian’s ruling. “Now we know what the guidance was, we will react to it.”
LGBTQ groups welcomed the parliamentarian’s ruling but remain wary of Republican lawmakers, whom they see as determined to push through a ban or tighter restrictions on gender-affirming care — even for adults.
“The fact remains that this bill belongs in the trash,” said David Stacy, vice president for government affairs at the Human Rights Campaign. “It continues to include devastating cuts to health care programs — including Medicaid — that would disproportionately harm the LGBTQ+ community, all so the already rich can receive huge tax cuts.”
More than 100 prominent celebrities have signed on to a letter urging President Donald Trump's administration to hold off on implementing budget cuts that would eliminate specialized services for LGBTQ youth who contact the National Suicide and Crisis Lifeline.
Since its launch in 2022, callers to contact the national suicide prevention lifeline by dialing 988 have been given the option of speaking with counselors trained to work with specific populations, from Spanish-language speakers to LGBTQ youth.
The 988 service for LGBTQ youth has received nearly 1.3 million calls, texts, and chat messages since launching three years ago, according to the Substance Abuse and Mental Health Services Administration. In February alone, the program received a daily average of 2,100 crisis contacts, reports The Hill.
Jonathan Joss, who voiced the character of John Redcorn in the animated comedy series King of the Hill, was shot and killed by a neighbor with whom he had allegedly clashed.
In addition to his role on King of the Hill, Joss was also known for a recurring part as Chief Hen Hotate in Parks and Recreation, as well as appearances in Tulsa King, Ray Donovan, True Grit, and The Magnificent Seven.
According to TMZ, the 59-year-old was shot on his property in San Antonio, Texas, allegedly by his neighbor, Sigfredo Alvarez Ceja, who was arrested and remains in police custody.
A Montana court has struck down that state's law banning gender-affirming care for transgender minors, finding that restricting their access to care -- and punishing the doctors who attempt to provide that care -- is unconstitutional.
Montana Fourth Judicial District Judge Jason Marks found that the 2023 law, pushed through by Montana Republicans, violates transgender minors' right to privacy, equal protection, and free speech, as guaranteed by the Montana Constitution.
A lower court had previously issued an order blocking the law from taking effect in 2023, which the Montana Supreme Court upheld last December.
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