Congressional:

Government Shutdown Enters Sixth Week

The government shutdown, which began on October 1, is on its 38th day, making it the longest shutdown in history. At the heart of the shutdown is a disagreement between Congressional Republicans and President Trump, who have pushed for a clean continuing resolution (CR) to fund the government on a short-term basis, and Democratic leaders who have insisted that any funding deal include an extension of Affordable Care Act (ACA) enhanced advanced premium tax credits (APTCs), which are set to expire this year. 

Senators from both parties have reported that informal, bipartisan talks have increased over the last week. On Wednesday, Senate Minority Leader Chuck Schumer (D-NY) and House Minority Leader Hakeem Jeffries (D-NY) requested a second meeting with President Trump on the shutdown, with Senate Majority Leader John Thune (R-SD) and House Speaker Mike Johnson (R-LA) participating. The White House has yet to respond to the letter. President Trump has also urged Republicans to eliminate the Senate filibuster to reopen the government after saying the shutdown played a “big role” in Democrats’ political victories in the elections on Tuesday. “If you read the pollsters, the shutdown was a big factor, negative for the Republicans,” Trump said during a breakfast with Senate Republicans at the White House. However, Senate Republican leaders reiterated that they would not support removing the filibuster.

Democrats have also privately floated an arrangement for the Senate to vote separately to extend the APTCs at a simple-majority threshold rather than the 60-vote threshold. Senate Majority Leader Thune, however, rejected the idea, saying there was “no way” that would happen, stating that any possible extension of soon-to-expire APTCs must meet the 60-vote hurdle.

Adding to the shutdown pressure are reductions in Supplemental Nutrition Assistance Program (SNAP) benefits due to funding constraints, and the announcement of widespread flight cancellations or the closure of some airspace if air traffic controllers miss their second paychecks next week.

Representatives Bacon, Suozzi, Hurd, Gottheimer Release Bipartisan Principles to Temporarily Extend and Reform Affordable Care Act Enhanced Premium Tax Credits

On Monday, Representatives Don Bacon (R-NE), Tom Suozzi (D-NY), Jeff Hurd (R-CO), and Josh Gottheimer (D-NJ) released a statement of principles for lowering health care costs and temporarily extending and reforming the Affordable Care Act (ACA) enhanced premium tax credits (APTCs). The principles focus on a temporary two-year extension of APTCs, an income cap phased out between $200,000 and $400,000, and additional guardrails to prevent improper payments of APTCs. Read the press release here.

Senate Homeland Security and Governmental Affairs Holds Hearing on Assessing Obamacare

On Thursday, the Senate Homeland Security and Governmental Affairs Committee’s Permanent Subcommittee on Investigations held a hearing on the Affordable Care Act (ACA). Witnesses at the hearing included Joel White, President of the Council for Affordable Health Coverage; Tarren Bragdon, President and CEO of the Foundation for Government Accountability; Brian Blase, President of Paragon Health Institute; and Shana Verstegen, a Small Business Employee and ACA Marketplace Enrollee. During the hearing, Chair Ron Johnson (R-WI) criticized the ACA, stating that it has, over time, led to higher costs for Americans and more uninsured people. Johnson stated, "We can repair the damage done by Obamacare and transition to his health care system that actually works.” Ranking Member Richard Blumenthal (D-CT) emphasized how not extending the enhanced advanced premium tax credits (APTCs) would increase people's premiums. Blumenthal stated that "Health care costs in this country are way too high, no matter what kind of coverage you have... There are many things we can do to fix those problems, but forcing Americans who rely on the ACA to pay more, especially in this economy, will not help." Read the witness testimonies here.

Senate Special Aging Committee Holds Hearing on Families Living with Aging-Related Diseases

On Wednesday, the Senate Committee on Aging held a hearing on the reauthorization of the lapsed Older Americans Act, as well as nutrition services and federal aging programs. During the hearing, witnesses called for reauthorizing the Older Americans Act, as it has a vital role in serving people with age-related diseases. Chairman Rick Scott (R-FL) stated that support for the reauthorization was strong on the committee, saying that “it's not a big government approach” and "It's neighbors helping neighbors." Ranking Member Kirsten Gillibrand (D-NY) stated that "It is vital to pass a reauthorization this fall to modernize the statute, reflective of the evolving needs of older adults." Senators from both sides stated their support for a bill (S.2120) led by Senator Bill Cassidy (R-LA) that would reauthorize the legislation through 2030. Read the witness testimonies here. 

Notable Bills Introduced:

Senator Cassidy Introduces Bill to Protect Americans’ Private Health Data

On Tuesday, Senator Bill Cassidy, M.D. (R-LA), chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee, introduced the Health Information Privacy Reform Act. The legislation would require health technologies not subject to the Health Insurance Portability and Accountability Act (HIPAA) to disclose how consumer information is collected and shared. Read the press release here and the bill here. 

Executive Branch:

President Trump Announces New Most-Favored-Nation Pricing with Novo Nordisk and Eli Lilly

On Thursday, President Trump announced agreements with pharmaceutical manufacturers Eli Lilly and Company and Novo Nordisk, the manufacturers of the widely used GLP-1 medications for obesity and diabetes. Under the agreement, the price of the drugs Ozempic and Wegovy will fall from $1,000 and $1,350 per month, respectively, to $350 when purchased through the direct-to-consumer purchasing website TrumpRx. The price of Zepbound and Orforglipron, if approved, will fall from $1,086 per month to an average of $346 when purchased through TrumpRx. Additionally, the agreement provides for reduced costs on other Eli Lilly and Novo Nordisk medicines when purchased through TrumpRx. For Medicare patients and state Medicaid programs, the prices of Ozempic, Wegovy, Mounjaro, and Zepbound will be $245, with a $50 monthly copay for Medicare patients. Eli Lilly and Novo Nordisk also announced new investments to expand U.S. manufacturing capacity. According to Eli Lilly and Novo Nordisk, the companies will receive three years of tariff relief and will not be subject to future pricing mandates. Read the White House fact sheet here.

CMS Announces New Drug Payment Model

On Thursday, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced a new demonstration aimed at lowering the prices Medicaid pays for drugs. The voluntary demonstration called the “GENErating cost Reductions fOr U.S. Medicaid (GENEROUS) Model” enables state Medicaid programs to buy drugs at the rate other developed countries pay, known as the most-favored-nation or MFN price. The program will launch in 2026. CMS has released a Request for Applications for drug manufacturers interested in participating in the model and will also seek letters of intent from state Medicaid agencies interested in participating. Manufacturers that join the demonstration will negotiate with CMS to offer set pricing for certain outpatient drugs. Read the press release here.

All 50 States Apply for Rural Health Fund

On Thursday, the Centers for Medicare & Medicaid Services (CMS) announced that all 50 states submitted applications for the $50 billion Rural Health Transformation Program. Congress created the $50 billion fund in July under the One Big Beautiful Bill Act (H.R. 1). All submitted applications will now undergo CMS review. States with approved applications will receive baseline funding, representing 50% of the total available program funds, distributed equally among approved states. Approved states will then undergo a data-driven merit review for the remaining 50% of available program funds. The review will assess each state’s proposed initiatives and alignment with program goals. CMS will announce approved awardees by December 31, 2025, with funding distributed over five years beginning in federal fiscal year 2026. Read the press release here.

CMS Releases Calendar Year 2026 Medicare Physician Fee Schedule Final Rule

Late last week on Friday, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that announces final policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2026. The final rule sets the physician conversion factor of $33.5675 for qualifying participants in advanced alternative payment models and $33.4009 for other clinicians, representing increases of 3.77% and 3.26%, respectively, from 2025 levels. CMS also finalized a 2.5% efficiency adjustment across most procedure codes, with exceptions for time-based codes, such as evaluation and management (E/M) services, care management services, behavioral health services, services on the Medicare telehealth list, and maternity codes with a global period of MMM. Notably, CMS exempted new services from the adjustment. CMS also finalized a proposal to reduce the indirect practice expense allocation for facility services to 50% of the allocation for non-facility services, and finalized the Ambulatory Specialty Model, a mandatory five-year alternative payment model targeting heart failure and low back pain treatment. Read the press release here and the fact sheet here.