President Trump’s Big, Beautiful Bill hit a major roadblock late Monday as the Senate rejected a key provision that would have removed illegal immigrants from Medicaid, a move Trump allies saw as a linchpin in reducing taxpayer costs and enforcing immigration law.

The measure, which fell in a 56-44 vote, would have eliminated millions of illegal aliens from the Medicaid rolls, aligning with Trump’s broader push to tighten federal benefits and discourage illegal immigration. The provision’s defeat came just days after Senate Parliamentarian Elizabeth MacDonough ruled that numerous immigration enforcement measures in the bill would require 60 votes rather than a simple majority, effectively dooming their inclusion in the reconciliation package.

Among the rejected measures were proposals to impose mandatory fees on asylum seekers, diversity visa applicants, and those requesting continuances in immigration court. Additionally, the parliamentarian blocked language that would have expanded the expedited removal of criminal noncitizens and required sponsors of unaccompanied minors to post a $5,000 bond.

The Medicaid provision became a flashpoint in the broader immigration debate, with Republicans arguing that taxpayer-funded healthcare should not be extended to those in the country illegally. Sen. Jim Banks (R-IN) condemned the vote as “shameful,” blasting Democrats for “voting to let criminal illegals on Medicaid” at the expense of American taxpayers.

The defeat highlights the growing challenges for Trump’s legislative agenda as he seeks to fulfill campaign promises to cut government spending on illegal immigration while navigating Senate rules that limit what can be passed with a simple majority. The parliamentarian’s rulings have forced GOP leaders to reconsider strategy on multiple immigration enforcement components, leaving only a few options for Republicans eager to deliver on Trump’s push to secure the border and reduce incentives for illegal crossings.

Trump’s allies argue that cutting illegal immigrants off Medicaid would save billions in federal spending while reinforcing the principle that taxpayer-funded benefits should be reserved for American citizens and legal residents. Critics, however, claim the measure would strip essential healthcare from vulnerable individuals and complicate state-level healthcare systems.

The Senate’s vote comes as the broader Big, Beautiful Bill nears final negotiations, with Trump’s team aiming to secure sweeping tax cuts, border security funding, and significant policy victories before Congress recesses for the summer. However, the parliamentarian’s rulings on immigration provisions, combined with the failed Medicaid measure, signal that Trump’s push to enforce stricter immigration controls through budget reconciliation may be more difficult than initially planned.

With this setback, Trump will now need to decide whether to pursue these immigration restrictions through standalone legislation or use executive action if Congress fails to deliver before the 2026 midterms ramp into full swing. As negotiations continue, the future of Trump’s signature bill — and the fate of immigration enforcement within it — hangs in the balance.