ACA enhanced premium tax credits expiring 

On December 11, the Senate rejected two competing bills that would have extended ACA enhanced premium subsidies (EPTCs), which are set to expire on December 31, 2025. The failed votes increase the likelihood that the EPTCs will not be extended, impacting the more than 20 million Americans who rely on the subsidies to afford coverage. The expiration of the EPTCs is projected to raise health insurance premiums by 26% on average, and out-of-pocket costs are expected to more than double. Low-income enrollees and those who live in states that have not expanded Medicaid are expected to see the most significant premium increases. 

While there is a bipartisan group of Senators continuing to negotiate, a health package to include an extension of the EPTCs will not be released until after Congress returns in January. 

Copay accumulators

The House version of the Help Ensure Lower Patient (HELP) Copays Act (H.R. 6423/ S. 864) has been introduced by Representatives Thomas Kean, Jr. (R-NJ) and Nanette Barragán (D-CA). PAN has long supported the legislation to ban copay accumulator programs by: 

• Updating the ACA’s definition of cost-sharing to require that all out-of-pocket payments made by or on behalf of a patient count toward the patient’s deductible and out-of-pocket limit. This would prohibit copay accumulator programs in marketplace insurance plans.  

• Clarifying that the ACA’s annual out-of-pocket limit applies to all prescription drugs covered in a health plan, as all covered drugs would be defined as essential and therefore the plan must count any cost sharing toward patients’ annual limits. This would end the Essential Health Benefits loophole that allows plans to deem certain categories of drugs as non-essential. 

Telehealth

The Medicare telehealth flexibilities granted during the pandemic expire on January 30, 2025, as part of the Continuing Resolution (CR) to keep the government funded. In lieu of permanency, advocates are urging Congress to pass a two-year extension to provide stability and to delink the flexibilities from the annual appropriations process.  

The flexibilities for the teleprescribing of controlled substances, instituted during the public health emergency by the Drug Enforcement Agency (DEA), will expire on December 31, 2025. The DEA has yet to issue a new proposed rule to establish a special registration process, per the Ryan Haight Act of 2008, or finalize policies for when the practitioner and the patient have not had a prior in-person medical evaluation. A fourth extension of the flexibilities is currently under review by OMB. The timeline for the extension is unknown but will likely be through the end of 2026. 

Adult dental services

The 2026 Physician Fee Schedule final rule formally integrated oral health into the Medicare Quality Payment Program. Physicians and other eligible clinicians will now be recognized for incorporating oral health screening, counseling, and referrals into their primary care practice. 

Medicare Prescription Payment Plan

Congress continues to be interested in the implementation of the Medicare Prescription Payment Plan (MPPP). The Increasing Medication Access for Seniors Act (H.R. 6401) was introduced by Representatives Jennifer Kiggans (R-VA) and Raja Krishnamoorthi (D-IL) and requires CMS to report on the program’s implementation and outreach efforts. PAN joined 53 other organizations in supporting the legislation. 

In addition, the House Fiscal Year 2026 Labor, Health and Human Services Subcommittee report includes language that directs CMS to report to Congress on uptake of the MPPP, the methods by which CMS is educating beneficiaries about the program, identifying barriers to participation, and outreach efforts with stakeholders such as provider associations and societies, patient and consumer advocacy groups, pharmacy benefit managers, pharmacies, and health insurance providers. CMS is also instructed to continue to explore mechanisms to facilitate point-of-sale enrollment to ensure easy access to the program. PAN joined other patient groups in sending a letter thanking the subcommittee leadership for inclusion of the report language.