Republicans are dealt a setback on their big bill as Senate referee disqualifies key provisions

Some conservatives called for the parliamentarian to be fired or overruled after she determined a series of policies in the legislation didn't comply with Senate budget rules.

WASHINGTON — Republicans suffered a blow Thursday after the Senate referee ruled that a series of health care cuts and savings in their sweeping domestic policy bill are ineligible for the party-line path they're using to get around the chamber's 60-vote threshold.

Senate parliamentarian Elizabeth MacDonough, who adjudicates procedural disputes between the two parties, has disqualified several provisions, including Medicaid rules prohibiting funds without verification of immigration status, reimbursement changes to contracts with pharmacy benefit managers (PBMs), provider tax restrictions aimed at saving federal dollars, and new limitations surrounding eligibility for Affordable Care Act funding.

The disqualified provisions total from $200 billion to $300 billion in savings over a decade, said Matthew Fiedler, an expert in health care policy and economics at the Brookings Institution.

That's a problem for Republicans, who are aiming to pass the One Big Beautiful Bill for President Donald Trump's agenda through the Senate in the coming days. The House-passed version of the legislation was already projected to add $2.4 trillion to the national debt over the next 10 years, and additional red ink could make Republicans even more nervous about voting for the final product.

“Everything is challenging, but they’re all speed bumps,” Senate Majority Leader John Thune, R-S.D., told reporters Thursday. “And we have contingency plans — plan B, and plan C, we’ll continue to litigate it.”