The Senate parliamentarian has advised that a Medicaid provider tax overhaul central to President Donald Trump’s tax cut and spending bill doesn't adhere to the chamber’s procedural rules, delivering a crucial blow as Republicans rush to finish the package this week. Republicans were counting on big cuts to Medicaid and other programs to offset trillions of dollars in Trump tax breaks, their top priority. The attention falling on Senate Parliamentarian Elizabeth MacDonough’s ruling reflects a broader change in Congress: Lawmakers are increasingly trying to wedge top policy priorities into bills that can’t be filibustered.