Congressional:

Affordable Care Act Premium Tax Credit Extension Discussion Continues

As the clock ticks toward an expected vote in the United States Senate next month, key members of the House and Senate are touting proposals to extend, modify, or replace the Affordable Care Act’s (ACA) enhanced Premium Tax Credits (PTCs), set to expire at the end of the year.

Democrats, who were promised a December vote in the Senate by Majority Leader John Thune (R-SD), have continued to advocate for extending the enhanced PTCs, at least for a one, two, or three-year period.

In the Senate, Senator Bill Cassidy (R-LA) is working on a proposal for a federally funded account for certain Affordable Care Act (ACA) plans with high deductibles. Senate Minority Leader Chuck Schumer (D-NY), however, told reporters Wednesday that the Democrats only want an extension of the enhanced PTCs and that “Cassidy’s proposal, as I understand it, replaces them.” “It’s privatizing health insurance, and it looks like it’s really problematic,” Schumer said. Other Republican senators, including Senator Lisa Murkowski (R-AK), said earlier this week that there is not enough time to make “major changes.” The Government Accountability Office (GAO) also recently published a report on health savings accounts (HSAs), finding that among individuals in plans with high deductibles, HSAs and similar medical expense accounts were more common among those with higher incomes, those in excellent or very good health, and those with employer-sponsored plans.

In the House, Majority Leader Steve Scalise (R-LA) said on Tuesday that he’s working with the three House committees with health policy jurisdiction “on legislation that would actually lower costs for families and give families options, so they’re not trapped in the unaffordable care act policies.” Some of the ideas floated so far by Republicans include providing additional funding for HSAs or flexible spending arrangments (FSAs), increasing access to association health plans, increasing transparency around pharmacy benefit managers (PBMs), and promoting increased use of telehealth. Scalise said he expects to bring bills to a vote by the end of the year and dismissed the Senate's planned mid-December vote to extend the ACA subsidies, which Senate Majority Leader John Thune (R-SD) promised Democrats. "The Senate's going in a different direction," Scalise said. "We're not here to bail out insurance companies. We're here to give families lower premiums and better options." Representative Brian Fitzpatrick (R-PA), the top Republican on the centrist House Problem Solvers Caucus, said it was inevitable the House would vote on enhanced PTC legislation and “will get it to the floor” by the end of the year. Representative Tom Suozzi (D-NY), who leads the centrist Problem Solvers Caucus with Fitzpatrick, said lawmakers might need to start a discharge petition, which would let rank-and-file lawmakers bypass leadership and force a floor vote on a subsidy extension with 218 signatures.

Meanwhile, President Donald Trump said in a Truth Social post that he would not support legislation to extend the enhanced ACA subsidies. Trump has pushed for members to consider policies that would send money to individuals to subsidize health care costs rather than by lowering premiums paid to insurance companies participating in the marketplace. Trump said in the post "THE ONLY HEALTHCARE I WILL SUPPORT OR APPROVE IS SENDING THE MONEY DIRECTLY BACK TO THE PEOPLE, WITH NOTHING GOING TO THE BIG, FAT, RICH INSURANCE COMPANIES."

Senate Finance Committee Holds Hearing on Rising Health Care Cost Solutions

On Wednesday, the Senate Finance Committee held a hearing on rising health care costs, with much of the focus on the enhanced  Premium Tax Credits (PTCs), which are set to expire at the end of the year. During the hearing, Chair Mike Crapo (R-ID) said that a bipartisan solution to PTCs was still possible. Crapo also discussed several other policy options, including telehealth flexibility, clinical payment reform, and that he and Ranking Member Ron Wyden (D-OR) would soon reintroduce PBM oversight legislation. Other Republicans discussed the deficiencies of the Affordable Care Act (ACA), including rising premium rates and alleged insurer fraud. Senator Bill Cassidy (R-LA) encouraged members to support his plan, aligned with President Trump’s suggestion, to replace the enhanced PTCs with direct funding to enrollees’ health savings accounts (HSAs). Ranking Member Wyden and other Democrats disagreed, stating that the HSA plan would incentivize patients’ enrollment in health care plans that do not provide adequate coverage, and emphasized their support for the extension of the enhanced PTCs. Read Mehlman’s hearing summary here.

House Ways and Means Committee Holds Hearing on Modernizing Chronic Disease Care

On Wednesday, the House Ways and Means Committee held a hearing to evaluate strategies to increase access to care, improve care coordination and quality, and lower the cost of healthcare for Americans. Witnesses for the hearing included Michael Hoben, chief medical officer of population health services for Novant Health; Ashish Parikh, chief population health officer at Summit Health; Allison Reichert, a pharmacist at Bode Drug; and Brian Connell, vice president of federal affairs for Blood Cancer United. The witnesses shared testimonies detailing the benefits of telemedicine, interdisciplinary care teams, electronic health record optimization, and providers operating at the top of their licensure to patient care. Read the witness testimonies here.

Senate Special Aging Committee Holds Hearing on Restoring Trust in Our Medicines

On Wednesday, the Senate Special Committee on Aging held a hearing on pharmaceutical manufacturing in the U.S. Witnesses at the hearing included Patrick Cashman, president of USAntibiotics; Allan Coukell, chief government affairs and public policy officer at Civica Rx; Eric Edwards, CEO of PHLOW-USA; and Tom Neely, board chair at Oxford Pharmaceuticals. Read Mehlman’s hearing summary here.

Senate Finance Committee Advances Thomas Bell Nomination for HHS Inspector General

On Wednesday, the Senate Finance Committee voted 14-13 along party lines to advance the nomination of Thomas Bell to serve as Inspector General for the Health and Human Services Department. Bell is currently general counsel for the House Committee on Administration and previously served as chief of staff of the Office of Civil Rights during the First Trump administration. He also served as senior counsel at the Justice Department. The nomination now heads to the full Senate for a confirmation vote. 

Notable Bills Introduced:

Senator Scott Introduces Bill to Fix ACA and Drive Down Health Care Costs

On Thursday, Senator Rick Scott (R-FL) introduced the More Affordable Care Act. The legislation would establish Trump Health Freedom Accounts, HSA-style accounts, allow shopping across state lines with the creation of a state waiver program within the Affordable Care Act, and codify President Trump’s Executive Order to increase transparency in health care. Read the press release here and the bill here.

House Democratic Health Leaders Introduce Bill to Lower Prescription Drug Prices

On Thursday, Energy and Commerce Committee Ranking Member Frank Pallone, Jr. (D-NJ), Ways and Means Committee Ranking Member Richard E. Neal (D-MA), and Education and Workforce Committee Ranking Member Robert C. "Bobby" Scott (D-VA) introduced the Lowering Drug Costs for American Families Act. The legislation would allow Medicare to negotiate more drug prices each year from 20 to 50. The legislation would also extend the annual $2,000 out-of-pocket cap on prescription drugs and the $35 per month cap on out-of-pocket costs for prescription drugs and insulin to people with private health insurance. Read the press release here and the bill here.

Representative Miller Introduces Kidney Care Access Protection Act

On Thursday, Representatives Carol Miller (R-WV) and Terri Sewell (D-AL) introduced the Kidney Care Access Protection Act (KCAPA). The bill would strengthen Medicare’s kidney care benefits by ensuring sustainable reimbursement for dialysis providers, expanding access to patient education resources, and supporting a long-term payment pathway for new therapies and emerging technologies. Read the press release here and the bill here.

Representatives Buchanan, Tonko Introduce Bipartisan, Bicameral Legislation to Expand Alzheimer's Screening and Prevention

On Wednesday, Representatives Vern Buchanan (R-FL) and Paul Tonko (D-NY) introduced the Alzheimer’s Screening and Prevention (ASAP) Act. The legislation would authorize the Secretary of Health and Human Services to provide Medicare coverage for FDA-approved or cleared blood-based biomarker tests for the early detection of Alzheimer’s and other dementias. Senators Susan Collins (R-ME) and Catherine Cortez Masto (D-NV) introduced companion legislation in the Senate. Read the press release here and the bill here.

Representative Fitzpatrick Introduces Bipartisan Legislation to Address Underfunding of Pediatric Cancer Research

On Wednesday, Representatives Brian Fitzpatrick (R-PA), Mike Kelly (R-PA), Dwight Evans (D-PA), Elise Stefanik (R-NY), Josh Gottheimer (D-NJ), and Susie Lee (D-NV) introduced the Fairness to Kids with Cancer Act of 2025. The legislation would require that federal pediatric cancer research funding match the percentage of Americans under age 18. Read the press release here and the bill here.

Senators Coons, Budd Introduce Bicameral, Bipartisan Legislation to Strengthen U.S. Biopharmaceutical Manufacturing

On Tuesday, Senators Chris Coons (D-DE) and Ted Budd (R-NC) introduced the Biomanufacturing Excellence Act, which would promote U.S. leadership in biotechnology and strengthen domestic biopharmaceutical manufacturing. The legislation would establish a public-private center dedicated to advancing biopharmaceutical manufacturing. Companion legislation is being led in the House by Representatives Chrissy Houlahan (D-PA), Jim Baird (R-IN), David Rouzer (R-NC), and Deborah Ross (D-NC). Read the press release here and the bill here.

Representatives Moore, Schneider Introduce Bipartisan Legislation to Increase Access to Health Care

On Tuesday, Representatives Blake Moore (R-UT) and Brad Schneider (D-IL) introduced the Health Accelerating Consumer's Care by Expediting Self-Scheduling (ACCESS) Act. The legislation would establish a new safe harbor within the Anti-Kickback Statute to reduce provider barriers to online health care systems while maintaining regulatory guardrails to prevent fraud. Read the press release here and the bill here.

Representatives Letlow, Schrier Introduce Bipartisan Maternal Support Bill

On Tuesday, Representatives Julia Letlow (R-LA) and Congresswoman Kim Schrier (D-WA) introduced legislation to increase support for new mothers and infants by distributing newborn supply kits. The Newborns Essentials Support Toolkit (NEST) Act would authorize an existing pilot program within the Department of Health and Human Services (HHS) to provide items such as diapers, wipes, breastfeeding supplies, and postpartum mental health resources in areas of need. Read the press release here and the bill here. 

Executive Branch:

HHS Backs AI Innovation for Caregivers

On Tuesday, the Department of Health and Human Services (HHS), through HHS’ Administration for Community Living (ACL), announced a new $2 million Caregiver Artificial Intelligence Prize Competition to support caregivers. The AI Prize Competition will fund and recognize innovators developing tools that support caregivers in providing safe, person-centered care at home and or support employers by improving efficiency, scheduling, and training in the caregiving workforce. Read the press release here.

Calley Means Formally Joins HHS as Senior Advisor

Earlier this week, it was announced that Calley Means, a close ally of Health Secretary Robert F. Kennedy Jr., is formally joining the Department of Health and Human Services (HHS) as a senior adviser supporting food and nutrition policy after serving as a special government employee earlier this year. Means, a vocal proponent of the Make America Healthy Again movement, will work directly with Kennedy.

CMS Releases 2026 End-Stage Renal Disease (ESRD) Prospective Payment System Final Rule

On Thursday, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to update payment rates and policies under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to Medicare beneficiaries on or after Jan. 1, 2026. The final rule plans to allocate $6 billion to approximately 7,600 end-stage renal disease facilities in 2026. CMS estimates that, in aggregate, Medicare payments under the rule will increase by roughly $180 million in 2026 compared with 2025. Medicare payments to hospital-based dialysis centers will increase by 1.5% in 2026, while standalone clinics will see an estimated 2.2% increase. The rule is also estimated to lead to a 2.2% increase, or approximately $40 million, in coinsurance payments to beneficiaries. Read the press release and final rule here.

CMS Issues Guidance on State Medicaid Provider Taxes

Late last week, on Friday, the Centers for Medicare & Medicaid Services (CMS) issued preliminary guidance for states regarding the implementation of new federal requirements on health care-related (provider) taxes in Medicaid. In line with the changes made under the One Big Beautiful Bill Act, CMS will generally prohibit new or increased health care-related taxes and end financing practices that previously allowed certain states to draw down federal matching funds. “CMS is restoring the federal-state partnership by ensuring that Medicaid dollars are spent responsibly, transparently, and in service of the beneficiaries who depend on this program for their health and dignity,” CMS Administrator Mehmet Oz said in a statement Friday. “While closing a loophole that some states were taking advantage of to shift billions in costs onto federal taxpayers, we have crafted policy that gives states time to transition as the new tax limits are implemented.” Read the press release and guidance here.

Medicare Announces 2026 Premium and Deductible Increases

Late last week, on Friday, the Centers for Medicare & Medicaid Services (CMS) released the 2026 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2026 Medicare Part D income-related monthly adjustment amounts. The Medicare Part A inpatient hospital deductible will be $1,736 in 2026, an increase of $60 from $1,676 in 2025. Daily coinsurance rates for extended hospital stays will also increase, with beneficiaries paying $434 per day for days 61-90 of hospitalization and $217 daily for skilled nursing facility care on days 21-100. The standard Medicare Part B premium will increase to $202.90 per month in 2026, up $17.90 from the current $185 monthly rate. The annual Part B deductible will also rise to $283, up from this year's $257. The new rates take effect January 1, 2026. Read the press release here.