Move to Bar Medicaid Funding of Trans Surgeries Nixed by Senate Parliamentarian, Drawing GOP Wrath

The One Big Beautiful Bill Act—the main legislative vehicle for fulfilling President Donald Trump’s campaign promises—would not prevent taxpayer funds from going to transgender surgeries, unless Senate Republicans take action.

Democrats on the Senate Committee on the Budget announced Thursday that Senate Parliamentarian Elizabeth MacDonough—essentially, the chamber’s rules referee—had tossed out a provision that “prohibits federal Medicaid and CHIP funding for gender-affirming medical care.”

MacDonough did so under the Byrd Rule, a Senate rule meant to block provisions in 10-year budget packages that are more policy-oriented than budgetary. The rule is named for then-Sen. Robert Byrd, D-W.Va., who was the rule’s main sponsor when it was adopted in 1985.

That has outraged Rep. Dan Crenshaw, R-Texas, who has accused MacDonough of inconsistency and called for her dismissal.

“She allowed a $50 million grant program for environmental justice, whatever that means … but denied my prohibition on Medicaid funds for transgender surgeries, because it didn’t have a direct enough budget impact. Of course that’s not true, it had a $2.5 billion budget impact.”

But like all rules in the Senate, the Byrd Rule is not self-enforcing. MacDonough’s ruling is essentially an advisory that the Senate ought to reach a 60-vote threshold in order to waive her recommendation against the provision.

That’s exceedingly unlikely given the Senate’s sharply partisan divide, so Republicans are now broadly calling to push back on MacDonough’s rulings.

“It’s time to fight,” Rep. Ralph Norman, R-S.C., who is closely watching the Senate’s deliberations, told The Daily Signal on Thursday, adding:

If we have to sit up here through July 4 and have to sit up here in all of August on our break, we need to do it. This bill is that important.

MacDonough has drawn the wrath of prominent Senate Republicans, such as Sen. Tommy Tuberville, R-Ala.

“Her job is not to push a woke agenda,” Tuberville wrote Thursday after she nixed a provision that was meant to prevent illegal immigrants from receiving Medicaid benefits.

“THE SENATE PARLIAMENTARIAN SHOULD BE FIRED ASAP,” he added, in all-uppercase letters for emphasis.

Firing the parliamentarian is a rather extreme measure, but it would not be unprecedented. 

Then-Senate Majority Leader Trent Lott, R-Miss., did so with then-Parliamentarian Robert Dove in 2001 over his frequent overruling of Senate budgetary proposals.

There is also the option of amending the provision and resubmitting it to MacDonough in the hope that she would approve it. 

An important fact is that the Senate parliamentarian is not enforcing law, but rather the generally agreed-upon rules of the chamber.

Vice President JD Vance could technically overrule her as presiding officer of the Senate, although that would break with precedent. 

Some Democrats urged just such an action during President Joe Biden’s administration, when MacDonough struck down items on their progressive wish list.

In 2021, Rep. Ro Khanna, D-Calif., urged then-Vice President Kamala Harris to overrule MacDonough striking a $15 minimum wage provision from the American Rescue Act, a budget reconciliation package during the Biden administration.

“I’m sorry—an unelected parliamentarian does not get to deprive 32 million Americans the raise they deserve,” Khanna said at the time. “This is an advisory, not a ruling. VP Harris needs to disregard and rule a $15 minimum wage in order.” Harris ultimately did not do so.

Rep. Ilhan Omar, D-Minn., called for MacDonough’s firing at the time.

“Abolish the filibuster. Replace the parliamentarian,” she said on social media. “What’s a Democratic majority if we can’t pass our priority bills? This is unacceptable.”

Rep. Chip Roy, R-Texas, however, says that the parliamentarians’ rulings are no excuse for backsliding on conservative priorities.

“Look, maybe the parliamentarian isn’t doing exactly what she should do, but stop hiding there,” Roy said Thursday. “Go make the right arguments and go do what you need to do to get the bill delivered.”