The Senate’s massive Republican-backed domestic policy bill — hailed by its authors as a “Big, Beautiful Bill” — just ran into a wall of procedural fire. In a series of rulings issued Sunday, the Senate parliamentarian struck down multiple provisions as violations of the chamber’s strict reconciliation rules, throwing the future of the bill into uncertainty.

Among the casualties: last-minute Medicaid payment boosts for Alaska and Hawaii, which GOP leaders hoped would win over swing vote Senator Lisa Murkowski (R-Alaska). The provisions were ruled out of bounds under the Byrd Rule — the guideline that governs what types of legislation can pass through budget reconciliation with a simple majority.

Also nixed were attempts to block several Biden-era healthcare regulations. These included protections designed to make it easier for older adults and disabled Americans to enroll in Medicaid — as well as a rule requiring improved staffing at nursing facilities, which GOP leaders wanted scrapped.

Senate Republicans had loaded the bill with controversial items. One provision, still under review, would ban Planned Parenthood from receiving federal Medicaid funds. Another, which survived, would block Medicare coverage for immigrants — including refugees and asylum seekers. Additional measures that were greenlit would bar undocumented and temporary immigrants from receiving ACA health subsidies or tax credits.

But perhaps the most strategic blow came in the form of rejected language around “orphan drugs.” Republicans wanted to expand exemptions for drug pricing negotiations to include more rare disease treatments — a gift to the pharmaceutical lobby. That proposal was ruled noncompliant with reconciliation rules.

Democrats were quick to pounce. Sen. Jeff Merkley (D-Ore.), ranking member of the Senate Budget Committee, called the bill “a Big, Beautiful Betrayal” and vowed to continue challenging its provisions.

“This bill is a Trojan horse of cruelty,” Merkley said. “We’re removing every brick that hurts families, workers, and the most vulnerable.”

Meanwhile, Senate Republicans celebrated small victories: a provision delaying planned cuts to provider taxes used by states to fund Medicaid was approved. It pushes the drawdown of the provider tax cap to 2028 — a key ask from red-state governors.

The bill’s fate remains unclear. While Murkowski voted to advance the bill over the weekend — after some backroom negotiations — the loss of Alaska-specific Medicaid boosts could reignite her objections.

All eyes are now on the remaining rulings — including the still-pending ban on Planned Parenthood funding — as Republicans scramble to hold their fragile coalition together.

Whether the “Big, Beautiful Bill” makes it through the gauntlet of Senate rules and public backlash remains to be seen. But as one Democratic aide put it bluntly: “If this is what they’re calling beautiful, I’d hate to see their ugly.”