Byrd Rule Violations Continue to Mount on the Republicans’ “One Big, Beautiful Bill”

WASHINGTON, D.C. – Today, the Senate Parliamentarian again advised that several provisions in the Republicans’ “One Big, Beautiful Bill,” would be subject to a 60-vote threshold if they remain in the bill. The below provisions are in the Finance Committee’s jurisdiction.

“Democrats are continuing to make the case against every provision in this Big, Beautiful Betrayal of a bill that violates Senate rules and hurts families and workers,” said Ranking Member Jeff Merkley. “Democrats are fighting back against Republicans’ plans to gut Medicaid, dismantle the Affordable Care Act, and kick kids, veterans, seniors, and folks with disabilities off of their health insurance – all to fund tax breaks for billionaires. Republicans are scrambling to rewrite parts of this bill to continue advancing their families lose, and billionaires win agenda, but Democrats stand ready to fully scrutinize any changes and ensure the Byrd Rule is enforced.”

Provisions Subject to a 60-Vote Byrd Rule Point of Order

Finance

Prohibiting federal financial participation under Medicaid and CHIP for individuals without verified citizenship, nationality or satisfactory immigration status. This section prohibits federal financial participation in Medicaid for adults and kids whose citizenship, nationality, or immigration status cannot be immediately verified, overriding the existing 90-day reasonable opportunity period that currently exists for states to provide coverage as they verify individuals’ immigration status under threat of withholding federal funds. (Section 71109)

Immigrant Medicaid Eligibility. This section denies federal funding to states for Medicaid coverage for certain immigrants who are not citizens. (Section 71110)

Expansion of FMAP for certain states providing payments for health care furnished to certain individuals. This section lowers the Medicaid expansion federal medical assistance percentage from 90 percent to 80 percent for states that choose to provide coverage to people who are undocumented using the state’s own funds. (Section 71111)

Spread pricing in Medicaid. This section requires Medicaid managed care contracts with pharmacy benefit managers to adopt state reimbursement methodologies for pharmacy reimbursement. Reimbursement amounts from managed care organizations would be required to be fully passed through to pharmacies. (Section 71116)

Prohibiting Federal Medicaid and Children’s Health Insurance Program (CHIP) Funding for Gender Affirming Care. This section prohibits federal Medicaid and CHIP funding for gender-affirming medical care. (Section 71117)

Provider Taxes. This provision prohibits non-expansion states from increasing the rate of current provider taxes or increasing the base of the tax to a class or items of services that the tax did not previously apply. Beginning in 2027, the hold harmless threshold in expansion states for provider classes other than nursing or intermediate care facilities would be reduced by 0.5 percent annually until the maximum hold harmless threshold reaches 3.5 percent in 2031. Ending states’ ability to tax health care providers would severely limit states’ ability to provide health care to millions of Americans who depend upon Medicaid for their care. (Section 71120)

Limiting Medicare coverage of certain individuals. This section revokes eligibility from certain immigrants who are not citizens. This section effectively removes the ability of refugees, asylum seekers, and people with temporary protected status from being able to enroll in the Medicare program, even if they have sufficient work history, pay into the Medicare program, and meet other requirements, including age and disability status. (Section 71201)

Permitting premium tax credits only for certain individuals. This section limits immigrants who are not citizens from qualifying for premium tax credits or cost-sharing reductions beginning in 2027. This would prohibit over 1 million currently eligible individuals from qualifying for premium assistance when purchasing insurance through the Affordable Care Act Marketplaces. (Section 71301)

Disallowing premium tax credit during periods of Medicaid ineligibility due to immigrant status. This section prohibits the use of premium tax credits for persons buying health insurance on the Affordable Care Act Marketplaces if their immigration status alone would deem them ineligible for Medicaid, effectively eliminating access to affordable insurance coverage for these individuals. The conforming amendments to Sections 1331 and 1402 of the Affordable Care Act on immigrant eligibility for cost-sharing reductions and basic health programs for low-income individuals not eligible for Medicaid cannot be made under the Byrd Rule. (Section 71302)

Still Under Review

Repealing a Rule Relating to Eligibility and Enrollment in Medicare Savings Programs. This section prohibits the Secretary of Department of Health and Human Services from implementing, administering, or enforcing the “Streamlining Medicaid; Medicare Savings Program Eligibility Determination and Enrollment” final rule. Repealing this rule would result in more than 1 million seniors losing Medicaid coverage that helps them afford their Medicare premiums and cost-sharing. (Section 71101)

Repealing a Rule Relating to Eligibility and Enrollment for Medicaid and CHIP. This section prohibits the Secretary of Department of Health and Human Services from implementing, administering, or enforcing the “Medicaid Program; Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes” final rule. Repealing this rule would allow states to impose annual and lifetime limits, waiting periods, and lockout periods for kids enrolled in CHIP–and result in almost 600,000 kids losing coverage. (Section 71102)

Repealing Nursing Home Staffing Regulations and Transparency Policies. This provision prohibits the Secretary of Health and Human Services Secretary from implementing, administering, or enforcing any part of the final nursing home staffing rule, which requires a registered nurse be onsite 24/7 and implements staffing standards in nursing homes. (Section 71113)

Defunding Planned Parenthood. This section prohibits Planned Parenthood from receiving federal Medicaid funds. (Section 71118)

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