Congressional:

Discussions and Votes on ACA Enhanced Premium Subsidies Continue

On Thursday, the Senate failed to pass two health care bills: the Health Care Freedom for Patients Act of 2025 (S.3386), a health care proposal from Senate Republicans, and the Lower Health Care Costs Act (S.3385), a Democratic health care proposal. Both bills received a 51-48 vote, falling short of the 60 votes needed to pass under Senate rules. The Health Care Freedom for Patients Act of 2025 would provide individuals enrolled in the Affordable Care Act (ACA) insurance marketplaces with bronze or catastrophic coverage plans with government funding of $1,000 to $1,500 annually through a Health Savings Account (HSA). The Lower Health Care Costs Act would extend expiring ACA enhanced premium tax credits (EPTCs) for three years.

Senate Majority Leader John Thune (R-SD) told reporters Wednesday that he was not ruling out extending the EPTCs, if there are changes, stating, “I think if you did something with reforms and structure this program differently so it puts downward pressure on premiums instead of upward pressure, I think you could do something." 

In the House, members from both parties filed discharge petitions on Wednesday, aiming to secure enough support to bring bills extending EPTCs directly to the House floor for a vote. At least 11 Republicans signed the discharge petition for a bill introduced by Representatives Brian Fitzpatrick (R-PA) and Jared Golden (D-ME). The Bipartisan Health Insurance Affordability Act would establish minimum premiums and income caps for enrollees, while allowing them to use half of the EPTC credit amount toward a health savings account contribution. The bill also includes language to regulate pharmacy benefit managers. 

Representative Josh Gottheimer (D-NJ) filed a similar discharge petition with 35 signatures so far, nine of them Republicans, including Representative Fitzpatrick, on the bipartisan bill, the CommonGround for Affordable Health Care Act. The legislation would extend EPTCs for 2 years while creating guardrails to prevent broker fraud. It would also require the ACA marketplaces to increase efforts to notify beneficiaries of the amount of tax credits they are receiving and to regularly confirm enrollees' eligibility to eliminate “ghost beneficiaries.”

House Republican leaders Mike Johnson (R-LA), Steve Scalise (R-LA), and Tom Emmer (R-MN) are also working on health care bills they aim to bring to the House floor for a vote next week. Majority Leader Steve Scalise said Republicans discussed the ACA credits in a meeting but did not “reach consensus” on the topic. Scalise also noted that leadership aims to decide by Friday whether to hold a series of floor votes on individual health bills or to group them into a single package. "We're going to finalize that list, but we showed a list of what the three committees of jurisdiction have been working on for months today and then encouraged all the members to give their feedback.”

Senate HSGAC Committee Holds Hearing on Healthcare Solutions

On Wednesday, the Senate Homeland Security and Governmental Affairs Committee Permanent Subcommittee on Investigations held a hearing examining the Affordable Care Act (ACA) and the expiring enhanced Premium Tax Credits (EPTCs). During the hearing, Chair Ron Johnson (R-WI) criticized the ACA as a failure that increased premiums and deductibles, created administrative waste, and narrowed provider networks. He and other Republican members emphasized the need for market-based solutions, consumer choice, and competition to lower costs and improve quality, and proposed alternatives such as health savings accounts, association health plans, and price transparency. Democrats, led by Ranking Member Richard Blumenthal (D-CT), stressed the urgency of extending EPTCs to prevent millions from losing affordable coverage, emphasizing the need to maintain protections and affordability while pursuing broader reforms. Six witnesses testified at the hearing, speaking on different perspectives and experiences with the ACA and the EPTCs. Read Mehlman’s hearing summary here.

House Judiciary Committee Subcommittees Hold Joint Hearing on Affordable Care Act Subsidy Fraud Risks

On Wednesday, the House Judiciary Committee held a joint subcommittee hearing on the Affordable Care Act (ACA) subsidy fraud risk. During the hearing, Republicans argued that the ACA has too much fraud, waste, and abuse, citing Government Accountability Office (GAO) and Paragon Health Institute findings of fake enrollees, deceased individuals receiving subsidies, and billions in unreconciled payments. Oversight Subcommittee Chair Jeff Van Drew (R-NJ) and Full Committee Chair Jim Jordan (R-OH) both called for temporary subsidy extensions to prevent immediate coverage loss but stressed that the current system is unsustainable and requires long-term reform. Democrats focused on the risk of coverage loss and the need to extend subsidies. Oversight Subcommittee Ranking Member Jasmine Crockett (D-TX) and Representative Lou Correa (D-CA) acknowledged that fraud exists in all government programs but argued that ACA fraud should be addressed with targeted anti-fraud measures, not by ending coverage. Witnesses confirmed fraud risks but also highlighted that rising healthcare costs are the core problem, with some advocating for market reforms and others for targeted anti-fraud measures. Read Mehlman’s hearing summary here.

Senate Considers Resolution Reversing HHS Exemption from Public Notice & Comment Requirements

On Wednesday, the Senate voted 50-49 on a procedural motion to advance a disapproval resolution (S.J.Res.82) from Senator Angus King (I-ME) to repeal the Department of Health and Human Services (HHS) decision to waive public comment periods on some proposed changes to agency programs and policies. Earlier this year, Health HHS Secretary Robert Kennedy Jr. announced the agency would stop operating under a 1971 policy, known as the “Richardson Waiver,” compelling the department to publish notices of proposed rulemaking in the Federal Register, hold public comment periods, and publish final rules for issues involving agency management, personnel, public property, loans, grants, benefits, and contracts. Senate Republicans Susan Collins (R-ME), Lisa Murkowski (R-AK), and Thom Tillis (R-NC) voted with Democrats to advance the measure. Senate Majority Leader John Thune (R-SD) agreed to hold a vote on passage by Friday, December 19. A simple majority would be needed, after which it would head to the House for further action.

House Ways and Means Committee Advances Medicare Home Infusion Bill

On Wednesday, the House Ways and Means Committee held a markup on nine bills, including one health care bill, the Joe Fiandra Access to Home Infusion Act of 2025 (H.R. 4993), which passed the committee by a 41-0 vote. The legislation would guarantee Medicare coverage of self-administered home infusion pumps and associated drugs by clarifying relevant definitions. The bill now heads to the House floor for consideration.

Senate HELP Committee Holds Hearing on the Organ Procurement and Transplantation Network

On Thursday, the Senate Health, Education, Labor and Pensions Committee held a hearing on the organ procurement and transplantation network. Witnesses included Dr. John Magee, President of the Organ Procurement and Transplantation Network; Dr. Seth Karp, Vanderbilt University Medical Center System Surgeon-in-Chief; and Anthony Wright, Executive Director of Families USA. Read the witness testimonies here.

Senator Wyden, Senate Democrats Call on Pharmaceutical Companies to Disclose How Trump Drug Announcements Will Lower Costs in Medicaid

On Thursday, Senate Finance Committee Ranking Member Ron Wyden (D-OR) led seven senators in sending letters to four major pharmaceutical companies requesting details on how the companies' announcements and President Donald Trump's actions will benefit Americans with high health care costs and states facing Medicaid budget cuts. The letters, sent to Pfizer, AstraZeneca, Novo Nordisk, and Eli Lilly, ask for specific pricing information on which drugs will be affected by the announcements, the most-favored-nation price for those drugs, and what state Medicaid programs will pay. Read the press release and letters here. 

Notable Bills Introduced:

Representatives Auchincloss, Comer, and Harshbarger Introduce the Bipartisan Pharmacists Fight Back Act

On Thursday, Representatives Jake Auchincloss (D-MA), Diana Harshbarger (R-TN), and House Committee on Oversight and Government Reform Chairman James Comer (R-KY) introduced the Pharmacists Fight Back Act. The legislation would implement a transparent pharmacy reimbursement model based on market-based pricing, benchmarked to the National Average Drug Acquisition Cost (NADAC). Read the press release here and the bill here.

Senator Cruz Introduces Bill to Increase Affordable Health Coverage Options for Americans

On Thursday, Senators Ted Cruz (R-TX) and Ted Budd (R-NC) introduced the Competition and Openness in Markets to Promote Efficiency, Transparency, and Enhanced Affordability (COMPETE) Act. The bill would amend the Public Health Service Act to extend the maximum duration of short-term, limited-duration insurance (STLDI) and include a renewal guarantee provision that allows consumers to purchase STLDI plans for an extended period of time. Read the press release here and the bill here.

Senator Blackburn Introduces Legislation to Empower Families to Choose Health Care Coverage

On Thursday, Senator Marsha Blackburn (R-TN) introduced the Health Coverage Across State Lines Act, which would allow health insurers to offer individual health insurance plans across state lines. This legislation would lower costs, expand options, and increase competition in the insurance marketplace. Read the press release here and the bill here.

Bipartisan Coalition of 38 House Members Introduces CommonGround Bill to Address ACA Premiums

On Wednesday, Representatives Jen Kiggans (R-VA) and Josh Gottheimer (D-NJ), along with a bipartisan coalition of 38 total House Members, introduced the CommonGround for Affordable Health Care Act, based on the health care framework they released last week. The bill would extend the enhanced Premium Tax Credits (EPTCs) for a year with new guardrails to prevent “ghost beneficiaries,” an extension of open enrollment, and PBM reform. The bill would also require a vote in the Senate and House by July 1, 2026, on a second year of continued health insurance premium savings, including more significant reforms. Read the press release here and the bill here.

Senator Marshall Introduces the Marshall Plan

On Tuesday, Senator Roger Marshall, M.D. (R-KS), introduced “The Marshall Plan,” or the Lowering Healthcare Costs for Americans Act. The legislation would extend enhanced premium tax credits for 2026 and, beginning in 2027, redirect funding to a Hyde-protected healthcare affordability account, similar to an HSA, with a 700% income cap and a five-year phase-down. The bill would also require ID verification and minimum monthly premium payments for Affordable Care Act plans, appropriate cost-sharing reductions, and fund state-run invisible reinsurance pools. Read the press release here and the bill here.

Senator Husted Introduces Bill to Make Health Care More Affordable, Prevent Fraud, and Provide Premium Stability

On Tuesday, Senator Jon Husted (R-OH) introduced the Accountability for Better Care (ABC) Act. The bill would extend the ACA Enhanced Premium Tax Credits (EPTCs) by two years, require a minimum monthly payment of $5 for all ACA enrollees, maintain household premium contributions for incomes between 100% and 400% of the Federal Poverty Level (FPL), and extend eligibility to individuals between 400% and 600% FPL, with gradually increasing household premium contributions up to 600% FPL threshold. Read the press release here and the bill here.

Representative Fitzpatrick Leads Bipartisan Action to Prevent ACA Premium Spikes and Protect Affordable Healthcare

On Tuesday, Representatives Brian Fitzpatrick (R-PA), Jared Golden (D-ME), Tom Suozzi (D-NY), Don Bacon (R-NE), Rob Bresnahan (R-PA), Marie Gluesenkamp Perez (D-WA), Donald G. Davis (D-NC), and Nicole Malliotakis (R-NY) introduced the Bipartisan Health Insurance Affordability Act. The legislation would extend enhanced premium tax credits through 2027, require consent and prompt notification before any plan modifications take effect, require full rebate pass-through with pharmacy benefit managers (PBMs), and expand access to Health Savings Accounts (HSAs). Read the press release here and the bill here.

Representatives Pfluger, Bean, Colleagues Introduce Health Freedom Accounts Bill

On Tuesday, Representatives August Pfluger (R-TX) and Rep. Aaron Bean (R-FL) introduced the House companion to Senator Rick Scott's (R-FL) More Affordable Care Act (MACA). The legislation would redirect federal subsidies currently being sent to insurance companies into new, HSA-style accounts, establish a "Health Freedom Waiver Program" allowing states to opt into a system where health plans can be sold across state lines, and expand the small business tax credit to encourage employer-sponsored coverage. Read the press release here and the bill here.

Senators Moreno, Collins Unveil Two-Year ACA Subsidy Reform Agenda

On Monday, Senators Bernie Moreno (R-OH) and Senate Appropriations Committee Chairwoman Susan Collins (R-ME) introduced the Consumer Affordability and Responsibility Enhancement (CARE) Act to cap income eligibility and eliminate zero-premium plans. The legislation would provide a 2-year extension of Affordable Care Act premium tax credits, end premium tax credits once household income reaches $200,000, and require a $ 25-per-month premium. Read the press release here.

Senator Grassley Introduces Bill Requiring Improved Fraud Risk Assessments

On Tuesday, Senator Chuck Grassley (R-IA), a senior member and former chairman of the Senate Finance Committee, introduced the Fraud Risk Assessment of Obamacare Subsidies Accountability Act. The legislation would require the Centers for Medicare & Medicaid Services (CMS) to improve its fraud risk assessment of the Affordable Care Act Marketplace plans and issue annual updates to Congress and the Department of Health and Human Services Inspector General. Read the press release here and the bill here.

Senators Cornyn, Smith, Colleagues Introduce Ensuring Excellence in Mental Health Act

On Tuesday, Senators John Cornyn (R-TX), Tina Smith (D-MN), Thom Tillis (R-NC), and Catherine Cortez Masto (D-NV) introduced the Ensuring Excellence in Mental Health Act, which would improve access to Certified Community Behavioral Health Clinics (CCBHCs) by establishing a formal funding structure and allowing for coverage of the services they provide under Medicare. Read the press release here and the bill here.

Representatives Yakym, Carson Introduce Bill to Protect Patients from Unsafe Compounded Drugs

On Tuesday, Representatives Rudy Yakym (R-IN) and André Carson (D-IN) introduced the Safeguarding Americans from Fraudulent and Experimental (SAFE) Drugs Act of 2025. The legislation would restrict mass compounding of unapproved drugs, improve transparency into interstate distribution, and strengthen oversight of large-scale facilities through more routine FDA inspections. Read the press release here and the bill here.

Senators Marshall & Blunt Rochester Introduce Legislation to Help Lower Prescription Drug Costs Through PBM Transparency

Late last week, on Thursday, Senator Roger Marshall, M.D. (R-Kansas) and Senator Lisa Blunt Rochester (D-Delaware), introduced the PBM Disclosure Act, bipartisan legislation that would require Pharmacy Benefit Managers (PBMs) and other third-party administrators to disclose all forms of direct and indirect compensation they receive while managing prescription drug benefits for employer-sponsored health plans. Read the press release here and the bill here.

Welch and Scott Introduce Bipartisan Bill to Create New Multigenerational Home Caregiver Tax Credit 

Late last week, on Friday, Senator Peter Welch (D-VT), a member of the Senate Finance Committee, and Senator Rick Scott (R-FL) introduced the Multigenerational Home Caregiver Credit Act. The legislation would create a $2,000 tax credit for adults caring for an older family member within the same residence. Read the press release here and the bill here. 

Executive Branch:

CMS Announces MAHA ELEVATE to Bring Lifestyle Medicine to Original Medicare

On Thursday, the Centers for Medicare & Medicaid Services (CMS) announced the Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence (MAHA ELEVATE) Model. The model will provide approximately $100 million to fund 3-year cooperative agreements for up to 30 proposals that promote health and prevention for Original Medicare beneficiaries. The proposals will utilize evidence-based, whole-person care approaches, including functional or lifestyle medicine interventions, currently not covered by Original Medicare. CMS will release a Notice of Funding Opportunity (NOFO) in early 2026 for the first cohort, and the voluntary model will launch on September 1, 2026. Read more on the model here.

CMS Posts Informational Bulletin on Implementing Medicaid Work Requirement

On Monday, the Centers for Medicare & Medicaid Services (CMS) posted an informational bulletin on Section 71119 of the One Big Beautiful Bill Act, Public Law 119-21: Requirements for States to Establish Medicaid Community Engagement Requirements for Certain Individuals. The document informs state Medicaid agencies that individuals subject to the work requirement will have their eligibility reviewed every six months, during which Medicaid recipients will have the opportunity to submit evidence of compliance. The agency recommends that states obtain this information from reliable sources, such as payroll data and data sources from higher education, job training, or community service institutions. The guidance also includes examples of the types of individuals excluded from the requirements. These include parental guardians or family caregivers, disabled veterans, those who are medically frail or disabled, pregnant women, and inmates. Temporary exemptions will also be granted to adults facing “short-term hardship events,” such as natural disasters or extended hospital care. Read the informational bulletin here and the press release here.

Treasury, IRS Provide Guidance on New Tax Benefits for Health Savings Account Participants Under the One Big Beautiful Bill

On Tuesday, the Department of the Treasury and the Internal Revenue Service issued a notice providing guidance on new tax benefits for Health Savings Account (HSA) participants under the One Big Beautiful Bill (OBBB). The OBBB expands access to HSAs by permanently allowing telehealth and remote care services before meeting the high-deductible health plan (HDHP) deductible starting in 2025 and by treating bronze and catastrophic plans as HSA-compatible beginning in 2026. It also permits individuals enrolled in certain direct primary care (DPC) arrangements to contribute to HSAs and use HSA funds tax-free to pay DPC fees starting in 2026. Read the notice here.

President Trump Directs HHS to Evaluate Vaccine Schedules

Late last week, on Friday, President Trump signed a memorandum directing the Secretary of Health and Human Services and the Acting Director of the Centers for Disease Control and Prevention “to begin the process to align US core childhood vaccine recommendations with best practices from peer, developed countries.” The memorandum stated that “In January 2025the United States recommended vaccinating all children for 18 diseases, including COVID-19, making our country a high outlier in the number of vaccinations recommended for all children.” Read the memorandum here and the fact sheet here.

CMS Releases 2026 Marketplace Enrollment Snapshot Report

Late last week, on Friday, the Centers for Medicare & Medicaid Services (CMS) reported that nearly 950,000 consumers who do not currently have health care coverage through plans in the individual market Marketplace have signed up for coverage in 2026, since the start of the Marketplace Open Enrollment Period (OEP) on November 1, 2025. In total, over 4.8 million existing consumers have already returned to the Marketplace to select a plan for 2026. Read the 2026 Marketplace enrollment snapshot report here.