The U.S. Senate on June 30 voted 56–44 to reject a key provision in President Donald Trump’s “One Big Beautiful Bill” (OBBB) that would have barred undocumented immigrants from receiving Medicaid benefits.
The move followed a ruling from Senate Parliamentarian Elizabeth MacDonough, who determined the measure violated the Byrd Rule, which restricts budget reconciliation bills to provisions with direct budgetary impacts.
Why it matters
The rejected provision was aimed at removing an estimated 1.4 million undocumented immigrants from Medicaid rolls. Supporters, including Trump allies, argued it would safeguard resources for U.S. citizens and reduce federal costs. But critics viewed the measure as a political maneuver wrapped in fiscal packaging.
Driving the news
The vote occurred during a Senate “vote-a-rama,” a marathon amendment session on the reconciliation package. Because of MacDonough’s ruling, the Medicaid restriction required 60 votes instead of a simple majority—making passage impossible for the GOP’s 53-seat majority.
What they’re saying
Vance added that ICE funding and immigration enforcement in the OBBB outweighed other fiscal concerns:
He concluded with a stark warning:
Between the lines
Senate Majority Leader John Thune (R-SD) characterized MacDonough’s ruling as a “speed bump,” stating the GOP had backup plans. However, Sen. Tommy Tuberville (R-AL) accused MacDonough of being “woke” and demanded her removal. Rep. Greg Steube (R-FL) urged Vice President Vance to overrule her, a move seen as politically risky.
Democrats’ response
Sen. Ron Wyden (D-OR) hailed the ruling, noting it eliminated over $250 billion in healthcare cuts, including protections for refugees and asylum seekers. Senators Ed Markey (D-MA) and Chris Coons (D-DE) pushed amendments to shield rural hospitals, though these fell short.
State of play
The OBBB includes an estimated $900 billion in Medicaid cuts over 10 years. Concerns from GOP Sens. Susan Collins (R-ME), Thom Tillis (R-NC), and Josh Hawley (R-MO) prompted a $25 billion fund for rural hospital relief, though some of these provisions were also rejected by MacDonough.
What’s next
Republicans are now rewriting parts of the bill to comply with the Byrd Rule and still meet Trump’s July 4 deadline. Once passed in the Senate, the revised bill must be approved again by the House—where hardline conservatives have voiced discontent over increased spending and reduced immigration provisions.
The bottom line
The Senate’s rejection of the Medicaid restriction showcases the high-stakes balance between fiscal policy, immigration reform, and parliamentary rules—and could reshape both healthcare access and border security priorities in the months ahead.
🚨NEW: The Senate just failed a vote (56-44) on President Trump’s OBBB to remove Medicaid benefits from illegal aliens.
— Townhall.com (@townhallcom) June 30, 2025
If it weren’t for the Senate Parliamentarian’s interference, this vote would’ve succeeded with just 51 votes. pic.twitter.com/7eztg2RicE