Insights^

“Eyeing the exits” according to Google AI means “people are looking to leave a situation, often due to dissatisfaction or high stress, like lawmakers sensing a negative trend or escaping political turmoil.  That couldn’t be more true this week in DC!  We can smell jet fuel from the tarmac – let’s see what Congress can get done before heading home for the rest of the year.  Welcome to the Week Ahead! 

The Administration  

The administration is looking ahead to 2026, preparing to send Rural Health Transformation Program funding to the states and providing guidance on implementing Medicaid work requirements. 

On RHTP implementation, HHS officials have told us they are on track to meet the December 31 deadline to announce awardee decisions.  The real work begins in 2026, when states try to workout how to navigate their own legislative and procurement processes.  We expect the Centers for Medicare and Medicaid Services (CMS) to keep in constant contact with the States, ensuring they meet the MAHA goals. 

On the Medicaid work requirement guidance, stakeholders have a lot of questions, as you might expect. For example, the guidance says that “CMS (Centers for Medicare and Medicaid Services) continues to evaluate which existing state section 1115 demonstration populations meet the definition of an ‘applicable individual.’” Since nearly all states have at least one active Section 1115 Waiver, this is an important question! 

Caprice Knapp, Principal Deputy at the Center for Medicaid and CHIP Services, said during the Medicaid and CHIP Payment and Access Commission (MACPAC) December meeting that CMS expects to publish additional guidance in June 2026.  Ms. Knapp declined to say whether stakeholders might expect additional guidance before June, but she did say that CMS will hold monthly informational calls and all state calls on implementation. 

Be on the lookout for the 4th extension of the temporary Drug Enforcement Administration rule allowing controlled substances to be prescribed via telehealth.  The proposed rule has left OMB and should be published imminently.  

The Senate  

Following the Senate’s failure to pass either the GOP health care reform bill or the Democratic enhanced advance premium tax credit (APTC) extension bill, Senate leadership is turning its attention to consideration of the annual National Defense Authorization Act (NDAA). The Senate is showing few, if any, signs that it is considering additional legislation to extend the enhanced APTCs or to make other major health care reforms before the end of the year. 

The issue of the expiring APTCs is far from dead. With almost half (47%) of U.S. adults expressing concerns about their ability to afford necessary health care in 2026, we expect Senators on both sides of the aisle to continue working to show they are responding to what their constituents care about. Additionally, Senate Democratic leadership will likely be looking to see if any additional Republican Senators will join the four who crossed over party lines on December 11 to support enhanced APTC extension legislation.  

Yes, indeed, the repeat showdown on APTCs will come quickly in the new year.  January 30 is the next likely flash point when Congress must act on government funding and expiring health care extenders.   

The House 

House Republican leadership is working to put a health care reform bill on the floor this week (wait, what? I thought we were only working on APTCs?). On December 12, House Republican leadership unveiled the Lower Health Care Premiums for All Americans Act, which includes:  

• A “stop-loss” provision to allow small businesses that fund their own health insurance to purchase policies to protect against unexpectedly high insurance claims 

• Codification of association health plans  

• Funding to pay for “cost-sharing reductions” in Obamacare 

• A provision designed to bring increased transparency to the role pharmacy benefit managers (PBMs) play in the cost of prescriptions. 

Notably, the bill does not include an extension of the enhanced APTCs.  

House Republican moderates had been promised a vote on an amendment that would extend the enhanced APTCs. However, that deal has collapsed because of disagreements over the amendment’s text. Reps. Brian Fitzpatrick (R-PA), Jen Kiggans (R-VA), Mike Lawler (R-NY), and David Valadao (R-CA) are reportedly planning on offering an amendment like Fitzpatrick’s bipartisan legislation at the Rules Committee hearing on December 16. This amendment to extend enhanced APTCs for 2 years with certain reforms to address fraud concerns would require Democratic support, which may be hard to get if Democrats want to keep pushing for a clean extension. Statements from Democratic leaders, such as House Ways and Means Ranking Member Richard Neal (D-MA) suggest they are sticking to their guns. And even if the amendment passes, GOP representatives who oppose the enhanced APTCs could still kill the underlying bill. 

If the amendment fails, it’s an open question what GOP House moderates will do. Do they still go along with the broader health care bill? Do they support the Democratic discharge petition, which needs another 4 votes to force a vote on a three-year extension of the enhanced APTCs? In all likelihood, it doesn’t matter since the discharge petition would likely require a 7 legislative day waiting period before getting a vote (time the House does not have). 

Mirroring pending proposed rules at OMB, the House Rules Committee will also be considering this week H.R.498, to prohibit federal Medicaid funding for gender transition procedures for minors, and H.R.3492, to prohibit gender affirming care on minors.  

Other Health Care Hearings This Week 

• December 15: House VA Tech Modernization Subcommittee hearing on EHR Modernization 

• December 17: U.S. Congress Joint Economic Committee hearing on improving health care outcomes and reducing costs  

There You Have It 

With that, we will be back online with the Week Ahead when Congress comes back in 2026.  Have you enjoyed our weekly updates?  Let us know!  We at Chamber Hill Strategies wish you and yours a very happy and healthy New Year!