Senate Parliamentarian Elizabeth MacDonough ruled that a provision in the One Big Beautiful Bill blocking illegal immigrants from receiving Medicaid benefits had to be removed.
Senate Republicans are moving the legislation through the upper chamber using the budget reconciliation process, which means it only requires a majority vote to pass.
Normally, bills are subject to a filibuster, which can only be ended with the vote of 60 members.
But the Congressional Budget Act of 1974 allows legislation to bypass this requirement if its principal focus is permanent spending and revenue programs.
The Senate Parliamentarian makes the call whether provisions in a bill are primarily policy or budget-related.
The Wall Street Journal reported last week, “MacDonough blocked the GOP’s efforts to limit Medicaid and Medicare coverage for unauthorized migrants, ban the use of federal healthcare funding for transgender care and limit state ‘provider taxes,’ which boost federal Medicaid funding.”
Her ruling on Medicaid prompted Republican Sen. John Cornyn of Texas to offer an amendment to the One Big Beautiful Bill on Monday to waive the Budget Act regarding Medicaid benefits to illegal aliens.
It failed to meet the 60-vote threshold for a waiver, with the final vote being 56 to 44.
🚨NEW: The Senate just failed a vote (56-44) on President Trump’s OBBB to remove Medicaid benefits from illegal aliens.
If it weren’t for the Senate Parliamentarian’s interference, this vote would’ve succeeded with just 51 votes. pic.twitter.com/7eztg2RicE
— Townhall.com (@townhallcom) June 30, 2025
Should illegal aliens receive Medicaid benefits?
Turning Point USA CEO Charlie Kirk responded to her ruling, posting on the social media platform X, “Elizabeth McDonough stopped the Senate bill from blocking illegals from getting Medicaid.”
“[An] unelected Senate staffer is thwarting the will of 75 million people who voted to make sure foreign alien invaders aren’t getting taxpayer benefits. This is a red line. The Senate needs to CHANGE THE RULES, fire her, or find a solution,” he added.
🚨🚨
Elizabeth McDonough stopped the Senate bill from blocking illegals from getting Medicaid
A unelected Senate staffer is thwarting the will of 75 million people who voted to make sure foreign alien invaders aren’t getting taxpayer benefits
This is a red line.
The Senate…
— Charlie Kirk (@charliekirk11) June 30, 2025
MacDonough did allow a Medicaid work requirement to remain in the OBBB.
“It is perfectly reasonable for taxpayers who are paying into the Medicaid program to insist that everyone in the program who can contribute do so, by working,” Michael Cannon, director of health policy studies at the Cato Institute, told Fox Business.
The Journal reported that now-deceased Senate Majority Leader Harry Reid appointed MacDonough to be the parliamentarian in 2012.
Senate Majority Leader John Thune, a Republican from South Dakota, kept her in the position when he assumed the top role in January.
During former President Joe Biden’s administration, MacDonough blocked Democrats from enacting a $15 per hour minimum wage and creating a path to citizenship for eight million people using the budget reconciliation process.
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