Insights^

It’s a high-stakes week in Washington as Senate Republicans work furiously to finalize their budget reconciliation bill and as Republicans’ self-imposed July 4 deadline gets ever closer. Meanwhile, the Trump administration continues to work on drug pricing reform. Let’s get into it. Welcome to the Week Ahead! 

The Administration  

The Trump administration is looking at advancing its “Most Favored Nation” (MFN) policy as a demonstration through the Center for Medicare and Medicaid Innovation (CMMI). The proposal would tie the price of blockbuster drugs in the U.S. to the lowest prices paid in OECD countries, adjusted for rebates.  

The possibility of this new model comes as manufacturers were dealt an ultimatum: cut prices voluntarily by June 12 or face regulatory roulette. The price benchmark? The lowest among countries with a GDP per capita of at least 60% of the U.S.—a move that could shake up the entire pricing deck. Discussions among pharmaceutical executives and administration officials are taking place behind closed doors. However, the policy is still being shuffled, and no one is yet sure who will emerge with the winning hand

But that’s not the only game in town. The Trump administration is also seeking to turn the tables on foreign players who they feel are freeloading off U.S. innovation. Specifically, they’re eyeing trade tools such as those found under  Section 301 of the Trade Act of 1974.  Additionally, a report is expected soon on an investigation into the effects of pharmaceutical imports on national security (aka a “Section 232 report”). Both of these actions could result in the administration dealing out tariffs or other retaliatory actions against countries with strict price controls.  

The Senate  

Over in the Senate, the stakes couldn’t be higher as lawmakers head into what’s shaping up to be a critical week for meeting the self-imposed July 4 deadline for passage of a budget reconciliation bill. Senate Finance Committee Chair Mike Crapo (R-ID) is set to present on the committee’s provisions, including the tax and health care provisions, on June 16 at a GOP conference meeting. Meanwhile, the Senate Parliamentarian is playing the role of dealer, making sure every provision of the legislative text comports with the complex Byrd Rule. The July 4th recess is looming over the whole game, and lawmakers are racing the clock to wrap negotiations before the fireworks fly.  

One of the biggest issues in the negotiations is over State and Local Income Tax (SALT) deductions. Negotiators are caught between a rock and a hard place: a $30,000 cap can’t clear the House, but a $40,000 cap can’t make it through the Senate. On one side of the table, you have blue state Republicans, like Rep. Mike Lawler (R-NY), threatening to vote no if the Senate does not preserve enough of a deduction. On the other side of the Capitol, Republican Senators, who don’t represent many constituents impacted by high state and local income taxes, but have voiced concerns over the house passed cap.  Will the Senate jam the House, or can they come to an agreement during a truncated conference committee process?  

For health care, many Republicans like Senators Josh Hawley (R-MO), Susan Collins (R-ME), Lisa Murkowski (R-AK), and Jim Justice (R-WV) are concerned about the Medicaid provisions, such as limits on provider taxes, work requirements, and new copays.  On the other side, Sens. Rand Paul (R-KY), Rick Scott (R-FL), and Mike Lee (R-UT) are wanting to up the ante on spending cuts. Senate Republican leadership can’t lose more than three members if they want to pass the bill.  

Some Republican members, such as Rep. Young Kim (R-CA), have a stake in both the SALT and Medicaid games. It’s possible that Senate Republican leadership tries to make reductions to SALT easier to swallow by pushing back work requirements or grandfathering existing provider tax rates. However, that will no doubt anger conservatives in both chambers. Balancing both interests has turned this into a real high-wire act, with leadership trying to keep the coalition together without losing key votes. Much like a table full of pros waiting for someone to blink, everyone’s watching for tells, backroom deals, and surprise plays that could shift the momentum before time runs out. 

The House 

The House may be in recess, but the players aren’t far from the table. House members are watching the Senate’s every move, trying to influence things, and getting ready to receive the Senate’s revised bill. Even Speaker Johnson is waiting to see how the Senate plays its hand and is constantly reminding the Senate that the House passed its version by a single vote. 

Meanwhile, the government funding for FY 26 remains in the air. The House Appropriations Committee has advanced legislation to fund the Department of Defense and the Department of Veterans Affairs. However, a June 11 Appropriations markup of the Ag-FDA funding bill ended after 11 hours when committee Chair Cole (R-OK) realized they wouldn’t be able to finish ahead of the scheduled markup of the defense bill due to numerous amendments that were filed.  The House also passed a rescissions package before leaving town with cuts to global HIV/AIDS prevention funding.  However, that’s for already approved funding and is considered a dead hand by many in the Senate, including some Republicans.  

There you Have It  

New NBA and Stanley Cup champions could both be crowned this week—who’s your pick to take it all? Make it a great week! 

In what seems like a premiere of the Real Housewives of Pennsylvania Avenue, Elon Musk and President Trump are splitting faster than members of Congress heading to recess. As Musk and Trump throw shade at each other, the Senate’s ‘Big Beautiful Bill’ might need a big, beautiful rescue plan. Let’s get into it. Welcome to the Week Ahead!  

The Administration  

The deadline is this week for the Centers for Medicare and Medicaid Services (CMS) request for information on regulatory burden, and the administration is looking for respondents to dish on how to best reduce the red tape. Health care groups have no shortage of ideas, but like a VIP party, we probably won’t see the guest list except for those who decide to share that they were there. And remember, this is just an RFI, not a new rule or regulation. The administration can decide to take suggestions or leave them as it suits them.  

Meanwhile, Office of Management and Budget (OMB) Director Russell Vought, has told the House Appropriations Committee not to expect more details about the President’s budget request and to work with what they’ve got when it comes to the President’s budget for fiscal year 2026. But it’s already June, and before you know it, summer will be over, and the September 30 deadline to pass FY 26 funding bills will be here. We are already seeing some House Republican appropriators express concerns about the timeline. As summer drags on, that number of doubters could grow.   

The Senate 

Senate GOP leadership has one goal this week: get “pens down” on the Senate’s version of the One Big Beautiful Bill Act and start the next scene. But let’s be real—they’re still far from a finished product. And now what GOP leaders had hoped would be a steady march toward passage is a lot like a group dinner gone wrong. Some Committees are releasing legislative text, but no one agrees on the guest list, the menu, or the bill. 

Republicans are looking at changes to the health section, including  the possibility of adding changes to Medicare Advantage (MA) to help reduce the overall cost of the bill. Specifically,  the Senate is looking at dialing back coding intensity adjustments that could net significant savings. Other potential changes to the menu could include: 

• Pushing back the December 31, 2026 effective date for new Medicaid work requirements, The House Energy & Commerce Committee had set the effective date for January 1, 2029 in its version of the bill.  

• Giving states more time before they are required to conduct Medicaid eligibility checks every 6 months instead of the current every 12 months for the expansion population. Currently, that provision is set to go into effect for renewals scheduled on or after December 31, 2026.  

• Extending the effective date for ending the incentives for states to expand Medicaid coverage. That date is currently set for January 1, 2026. 

In addition to these considerations, the Senate could bend to pressure to weaken the House-passed bill’s prohibition on new provider taxes and its freeze on existing provider taxes. Senators from states with provider taxes in place have complained that these provisions leave a bitter aftertaste in their mouths.  

The trick will be making sure the menu remains appealing to diners in both the House and Senate, some of whom have very different tastes. The menu could get a little less salty if Senate Republicans decide to trim the current state and local tax (SALT) deduction. The House SALT Caucus is demanding respect and threatening to walk if their concerns are not addressed in the final cut.  

Will we see a markup?  With all the Republican talk of using regular order, so far, the negotiations on tax and health care have been only within their own party.  Senate Minority Leader Chuck Shumer (D-NY) and Finance Ranking Member Ron Wyden (D-OR) sent a letter demanding a markup, which suggests Finance may not have one. Democrats are ready to host the reunion and get the drama out in the open.  

As for the rest of the Senate cast, they’re trying to act calm and collective, but the group chat is full of shade. Negotiations are happening behind closed doors, but the energy is “we’re not far apart” one minute and “we’re done here” the next. 

And don’t forget the guest stars. Several fly-ins are happening this week, including key Medicaid constituencies such as nursing homes and children’s hospitals. They’re storming the Hill like Housewives entering a new season—scripted talking points, matching outfits, and a deep fear of being left out of the final edit. 

Senate Health Hearings 

• June 4: Senate Appropriations Labor-HHS Subcommittee hearing on FY 26 NIH Budget Request 

The House 

Over in the House, things are a little quieter—but not without drama. The Energy and Commerce Health Subcommittee is having a hearing on domestic manufacturing and the health care product supply chain on June 11. The hearing is expected to provide a high-level overview of a broad range of supply chain concerns, and explore the underlying background and contributing factors that have led to current disruptions—emphasizing a deeper understanding of the “what” and the “why” behind these issues. Expected topics include drug shortages, tariffs, international reference pricing, inspections of foreign drug manufacturing sites, and more.  While we don’t expect the majority to push a proposal or fix it at the hearing, we do expect members to offer plenty of ideas.  

Meanwhile, the House is watching the Senate with the same energy as a reunion special audience—waiting to see who flips, who cries, and whether groups such as the Freedom Caucus or SALT Caucus will throw the whole thing off track.  Everyone’s whispering about it like it’s a secret affair we’re all pretending not to know about.  

Additionally, a rescissions package that bill is causing slashes funding to HIV/AIDS programs like PEPFAR is expected on the floor this week. This will cause an uproar among public health groups, as well as both Republican and Democratic representatives who have been supportive of the program.  

The reintroduction of the Improving Access to Medicare Coverage Act is likely this week. This bipartisan bill would count patients’ time spent under observation status in a hospital towards the three-day stay required for Medicare coverage of care in a skilled nursing facility. CMS had waived the requirement during the COVID-19 public health emergency (PHE), but with the PHE in the rearview mirror, supporters are hoping lessons learned from the PHE will help draw new interest and a willingness to explore including the legislation in a must-pass health care package this Congress. 

Other Health Hearings This Week  

• June 10: House Appropriations Committee MILCON-VA Subcommittee Markup of FY 26 Allocations 

• June 11: House VA Oversight Subcommittee Legislative Hearing on H.R. 3482 Veterans Community Care Scheduling Improvement Act and H.R. 3494, VA Hospital Inventory Management System Authorization Act 

• June 12: House VA Health Subcommittee Legislative Hearing on H.R. 785, The Representing Our Seniors at VA Act of 2025; H.R. 2068, The Veterans Patient Advocacy Act; H.R. 2605, The Service Dogs Assisting Veterans (SAVES) Act; H.R. 3400, The Territorial Response and Access to Veterans’ Essential Lifecare (TRAVEL) Act of 2025; H.R. 3643, The VA Data Transparency and Trust Act; H.R. 1404, The CHAMPVA Children’s Care Protection Act of 2025; and H.R. 2148, The Veteran Caregiver Reeducation, Reemployment, and Retirement Act 

There you Have it 

A reminder that Father’s Day is June 15! Chamber Hill Strategies wishes all the Dads out there a very Happy Father’s Day.