Summary of "Bulwark Takes" Episode 11: "GOP FLIPS OUT As Trump’s Healthcare Cuts GUTTED"

Podcast Information:

• Title: Bulwark Takes
• Host/Authors: The Bulwark Team, including Sam Stein and Jonathan Cohn
• Release Date: June 26, 2025
• Description: Bulwark Takes brings you bite-sized takes on the news of the day from the entire Bulwark team, including Tim Miller, Sarah Longwell, and Bill Kristol, and more.

Introduction

In Episode 11 of Bulwark Takes, host Sam Stein is joined by political analyst Jonathan Cohn to discuss the immediate fallout from a significant Senate Parliamentarian ruling that has disrupted President Trump's ambitious healthcare reform bill. Released just a few hours after the ruling, the conversation provides a deep dive into the complexities of the budget reconciliation process, the specific healthcare cuts proposed, and the GOP's strategies in response.

The Senate Parliamentarian's Ruling and Its Immediate Impact

The episode kicks off with Sam Stein setting the stage about the recent major ruling by the Senate Parliamentarian that has thrown a wrench into Trump's healthcare plan.

Sam Stein [00:00]: "We are talking a couple hours after a fairly major ruling from the Senate parliamentarian with regards to President Trump's one big beautiful bill."

Jonathan Cohn breaks down the essence of the ruling:

Jonathan Cohn [00:47]: "Somewhere between 250 and $400 billion in cuts to healthcare out of a bill that's gonna... just got ruled. Basically, there's rules for what you can and can't do in this kind of bill. And basically, the person who decides those rules just said they're in violation."

This ruling means that a significant portion of the proposed healthcare cuts—constituting 25 to 40% of the total cuts—are now off the table, forcing Republicans to reassess their strategy to bridge a $250 to $400 billion funding gap.

Understanding the Budget Reconciliation Process

Cohn delves into the intricacies of the budget reconciliation process, a legislative procedure designed to expedite the passage of budget-related bills by circumventing the filibuster with a 60-vote threshold.

Jonathan Cohn [01:00]: "To get a bill through the Senate nowadays almost everything you need 60 votes. [...] It's a fast track privileged procedure that's called reconciliation."

He explains that reconciliation was originally intended to allow Congress to make adjustments to spending and taxes to maintain budgetary balance but is now being utilized for broader legislative changes, albeit under strict rules enforced by the Senate Parliamentarian.

The Role of the Senate Parliamentarian

Sam Stein introduces the critical role of the Senate Parliamentarian in ensuring that reconciliation bills comply with established rules.

Sam Stein [02:44]: "Now who's the person who makes the ruling?"

Jonathan Cohn [03:26]: "They're called the bird rules... you go through a bird bath and then it comes out the other side."

Named after Senator Robert Byrd, who established these stringent guidelines to prevent unrelated policy changes within reconciliation bills, the Parliamentarian’s ruling has now deemed substantial parts of Trump's healthcare cuts as non-germane, meaning they are outside the scope of the budgetary provisions and thus impermissible.

GOP's Immediate Reactions and Options

The GOP is now faced with three primary options to address the $250 to $400 billion shortfall caused by the Parliamentarian's ruling:

1. Rewrite the Bill to Make It Germane:

   • Adjust the language and provisions to fit within the budgetary constraints.

2. Seek Alternative Funding through Additional Medicaid Reforms:

   • Implement further cuts or changes to Medicaid to offset the deficit.

3. Attempt to Overrule the Parliamentarian:

   • Challenge or dismiss the Parliamentarian’s ruling, though this option faces historical resistance and low likelihood of success.

Sam Stein [04:12]: "The reaction on the Senate side has been a bit mixed... Or we'll have to work with this."

Cohn expresses skepticism about the GOP's willingness to overrule the Parliamentarian, citing historical precedents and the current political climate.

Jonathan Cohn [08:21]: "I am less convinced than you are that they're not going to overrule the parliamentarian... they are willing to do that."

The Provider Tax and Its Implications

A significant portion of the discussion centers around the "provider tax," a mechanism states use to generate additional federal Medicaid funds by taxing healthcare providers.

Jonathan Cohn [05:31]: "There's this complicated formula... they could charge a tax to their sort of health care providers in their state."

The Parliamentarian's ruling has targeted these provider taxes, deeming them non-germane, which means states can no longer utilize this method to bolster their Medicaid funding without violating reconciliation rules.

Sam Stein [06:59]: "Unless you figure out a way to like replenish the Medicaid rolls from the feds to the states, there's just going to be less money from the feds going to the states for Medicaid, which means fewer people on Medicaid."

Both hosts agree that this ruling effectively translates to significant reductions in Medicaid funding, leading to potential loss of coverage for millions of Americans.

Jonathan Cohn [10:22]: "People are going to lose insurance."

Alternative Strategies for the GOP

With the provider tax route closed, the GOP must explore other avenues to cover the budget shortfall:

1. Direct Cuts to Medicaid Federal Funding:

   • Reduce the federal government's contribution, forcing states to dial back Medicaid expansions.

2. Reforming Medicare Advantage:

   • Target the private insurance component of Medicare, potentially removing up to a trillion dollars in federal spending.

3. Scaling Back Medicaid Expansion Under the ACA:

   • Allow states to abandon Medicaid expansions, thereby reducing federal expenditures.

Jonathan Cohn [12:17]: "There is time. You could do the entire... you could get the full trillion dollars out of there if you really wanted to."

However, these options come with their own set of challenges and political pushback, especially reforms that directly reduce coverage and benefits for vulnerable populations.

Comparing to the Affordable Care Act (ACA) Passage

The hosts draw a stark contrast between the current GOP efforts and the meticulous, bipartisan process that led to the passage of the ACA.

Jonathan Cohn [16:54]: "That's the way it was deliberated extensively, not just in private, but in public."

They lament the rushed nature of the current legislative process, highlighting the lack of comprehensive debate, analysis, and transparency that characterized the ACA's development over months of committee hearings and public discourse.

Timeline and Prospects for Passage

Sam Stein expresses astonishment at the GOP's push to vote on the bill imminently despite its current state.

Sam Stein [14:03]: "We don't have a bill. How can they vote tomorrow on this?"

Jonathan Cohn acknowledges the chaotic approach but remains cautiously optimistic about the GOP's determination to pass the bill, primarily driven by the inclusion of tax cuts.

Jonathan Cohn [18:46]: "I think they'll pass it... What's in the bill, I think is still very much... tax cuts."

The duo discusses the slim likelihood of a fully polished bill reaching Trump's desk by the July 4th deadline, but they foresee eventual passage given the GOP's prioritization of tax legislation.

Conclusion

The episode concludes with a reflection on the high-stakes, fast-paced nature of the current legislative battle over healthcare, contrasting it with the deliberate and exhaustive process of past significant reforms like the ACA. Both hosts emphasize the potential widespread impact on millions of Americans' healthcare coverage and express concern over the GOP's strategies in navigating the budget reconciliation constraints.

Sam Stein [19:18]: "…We have about 15 to 18 minutes of wonkiness... Probably, we'll count on what it'll do."

This detailed summary encapsulates the key discussions, insights, and conclusions from the episode, providing a comprehensive overview for listeners who haven't tuned in.