News Briefs: Key Health Care Changes in Budget Bill Don’t Survive ‘Byrd Bath’

Jun 27
Jun 27, 2025

The Senate parliamentarian has flagged several health care-related provisions in Republicans’ “One Big Beautiful Bill Act” as violating the Byrd Rule. That rule, named after the late Sen. Robert Byrd (D-W. Va.), stipulates that provisions included in a budget reconciliation bill must directly affect federal revenues and spending. Measures that don’t meet those criteria — when reviewed via a process called the “Byrd bath” — can remain in the bill but would be subject to a 60-vote threshold to pass, and Republicans have just a 53-47 majority in the Senate. The provisions flagged by the parliamentarian include those that would change immigrants' eligibility for Medicaid, ban spread pricing in Medicaid managed care contracts with PBMs, and limit states’ ability to use provider taxes to help fund a state's share of Medicaid spending, among others. “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,” Sen. Jeff Merkley (D-Ore.), ranking member of the Senate Budget Committee, said on June 26.
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Tim Casey

Leslie Small

Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.