Courtney Leader has been closely following the contentious tax and spending debate in Washington – not that she cares much for politics, but because she believes the proposed Medicaid cuts are a matter of life or death for her daughter.

The reconciliation process lets Republicans push the bill through the Senate—where they have a 53-47 majority—on a simple majority vote. But the process comes with strings attached, and those limits are known as the Byrd Rule, for the late Sen. Robert Byrd (D., W.Va.).

The Senate parliamentarian has advised that a key Medicaid provider tax overhaul that is central to President Donald Trump's big tax cut and spending bill does not adhere to procedural rules, delivering a crucial blow to Republicans rushing to finish the massive package this week.