Insights^

We remember learning in school that an apple a day keeps the doctor away, but we don’t remember learning in civics class that health care would be so political!  The politics of health and health care are dominating DC this week – and honestly we love it!  Let’s get into it – welcome to the Week Ahead! 

The Administration  

While we expected vaccine policy to dominate HHS Secretary Robert F. Kennedy Jr.’s appearance before the Senate Finance Committee on September 4, we weren’t necessarily expecting the announcement coming of the State of Florida on working to end vaccine requirements for children in school.  Vax politics seem to just be getting started with red and blue states moving forward with their own mandates. 

One thing that brings red and blue states together is rural health.  States are eagerly awaiting the funding notice of the Rural Health Transformation Fund – the $50 billion initiative aimed at spurring innovation and strengthening rural health care.  Congress gifted this opportunity to the administration in the Big, Beautiful Bill, but they seem to be downplaying its potential political benefit in red and purple states with large rural areas.  So far. 

The Senate 

With government funding running out on September 30, the Senate is focused on negotiating a continuing resolution (CR) to fund the government for a short period of time, and Republicans will need Democratic support to avoid a shutdown.  Conversations are revolving around a short-term extension into November or December. 

Senate Majority Leader Chuck Schumer (D-NY) faces a critical test. After facing backlash from within his own party in the last round of negotiations to fund the government, he may be willing to risk a shutdown to gain leverage. The Trump administration’s pocket rescission package has already heightened tensions, increasing the likelihood of a standoff. Schumer’s price for supporting the CR could be securing an extension of the advanced premium tax credits (APTCs, more on that later) or including language to restrict consideration of another rescissions package. 

Congress could theoretically include language in a CR to block consideration of a future rescission package, but doing so would be procedurally difficult and politically risky. Such a move would require adding a “rider” to the CR, which is often controversial because appropriations bills are meant to fund the government, not legislate policy. Riders also face hurdles under House and Senate rules, potential challenges under the Impoundment Control Act of 1974, and even constitutional disputes over separation of powers.  

Don’t forget – we haven’t – that all those health care extenders also expire on September 30.  A likely scenario is that the policies get extended for the same amount of time as the CR.  Been there, done that before. 

Senate Health Hearings  

• September 9: Senate Homeland Security & Government Affairs Permanent Subcommittee on Investigations Hearing on “How the Corruption of Science has Impacted Public Perception and Policies Regarding Vaccines”

The House  

A bipartisan bill to extend the APTCs was introduced in the House September 4, but its prospects for movement are unclear. The proposal is rumored to score upwards of $26 billion, a cost that could complicate efforts to secure broader support, especially at a time when lawmakers are divided over spending priorities and deficit concerns loom large.  

While stakeholders—including insurers, consumer groups, and state officials—and many House members are urging action in September, it is unclear at best if an APTC extension will move forward this month. To stand a chance, any legislative effort may need to be narrowly crafted to draw bipartisan backing and fit within the broader fiscal environment. 

Delaying past September is problematic as health plans are legally required to finalize and publish their 2026 premium rates in October, and those rates depend heavily on whether APTCs are extended. Without clarity from Congress, insurers face a moving target, making it difficult to set prices and communicate accurate information to consumers.  

If lawmakers fail to act in September, the issue could become entangled in larger, high-stakes negotiations over appropriations and how to keep the government funded into 2026. While there is bipartisan support for extending APTCs, the combination of cost, timing, and political dynamics makes the path forward highly uncertain—and stakeholders are growing more nervous by the day.  That group includes vulnerable Republican House members thinking about their 2026 re-election bids. 

House Health Hearings 

• September 9: House Appropriations Subcommittee on Labor, HHS, Education and Related Agencies Full Markup  

There You Have It 

When it comes to the politics of health care, check out KFF’s Public Opinion tracking site.  Currently trending is their research on who may or may not get the COVID-19 this fall and whether parents – including self-identified MAGA parents – agree with Florida’s move on vaccines for school entrance.  Make it a great week! 

As Congress enters the final stretch of fiscal year 2025, a wide range of health care programs are set to expire on September 30, 2025, unless Congress takes action. These “health care extenders” cover everything from primary care and rural hospitals to Medicare telehealth services and workforce programs. Many of them have been renewed on a short-term basis for years—often tucked into year-end spending bills. But as the deadline looms, uncertainty grows for providers, patients, and public health programs. 

Here’s a breakdown of what’s expiring. 

Primary Care and Workforce Programs 

Several major programs aimed at improving access to care in underserved areas are set to expire: 

Community Health Centers (CHCs): CHCs provide essential primary care to nearly 30 million patients annually. Their core funding—known as the 330 Grant—is set to lapse without an extension of the Community Health Center Fund. 

National Health Service Corps (NHSC): The NHSC supports primary care clinicians who work in shortage areas through scholarships and loan repayment. It relies heavily on the same fund that supports CHCs. 

Teaching Health Centers Graduate Medical Education: Teaching Health Centers train medical residents in community-based settings. Without renewed funding, many could lose the ability to continue their residency programs. 

Public Health Programs 

Critical public health initiatives are also facing the end of federal funding: 

Special Diabetes Programs: The Type 1 Diabetes program funds NIH research and the program for Indians supports tribal and Indian Health Service services. 

Personal Responsibility Education Program: This program funds evidence-based initiatives to reduce teen pregnancy and promote adolescent health. 

Medicare Extenders 

Several Medicare provisions with significant implications for rural providers and seniors will expire: 

Medicare-Dependent Hospital (MDH) Program: Provides additional funding to rural hospitals where a high percentage of patients are on Medicare 

Low-Volume Hospital Payment Adjustment: Supports rural hospitals with limited inpatient volume to help them remain financially viable 

Work Geographic Practice Cost Index (GPCI) Floor: Ensures that Medicare payments to rural physicians aren’t reduced unfairly based on geographic payment formulas 

Telehealth Flexibilities: These pandemic-era provisions include waivers for geographic restrictions, audio-only telehealth, and expanded provider eligibility  

Hospital at Home Waiver:  CMS authority to allow acute-level care to be delivered at home under Medicare 

Ground Ambulance Add-On Payments: Payment increases for rural and super-rural ambulance services 

Medicare Quality Measurement Support: CMS funding for developing and endorsing Medicare quality metrics 

Medicare Outreach and Enrollment Support: Assistance programs that help low-income seniors navigate Medicare  

Medicaid and Behavioral Health 

Medicaid Disproportionate Share Hospital (DSH) Payment Cuts: Delayed cuts to safety-net hospitals are scheduled to take effect. Without another delay, hospitals serving large numbers of low-income or uninsured patients would lose significant funding. 

Certified Community Behavioral Health Clinics (CCBHCs): The original demonstration authority for CCBHCs in 2016 states will expire. While the program is now an optional Medicaid benefit, not all states have opted in. 

Other Key Programs 

Conrad 30 Waiver Program: Allows international medical graduates on J-1 visas to stay in the U.S. in exchange for practicing in underserved areas 

Children’s Hospital Graduate Medical Education (CHGME): Supports pediatric residency programs 

What Happens Next? 

With dozens of health care programs scheduled to expire on September 30, 2025, Congress faces a significant number of time-sensitive decisions. Here are their options: 

• Make some or all of these programs permanent 

• Extend some or all of these programs for a year or more 

• Align the extension of some or all of these programs with a continuing resolution to fund the entire federal government past September 30, 2025 

If past is prologue, Congress will delay making permanent decisions on these programs and opt for some sort of extension.  While health care providers need certainty to continue or revise programs, unfortunately Congress – regardless of which party is in control – has disappointed the health care sector before.  But if faced with no extension or elimination of funding and authority, health care providers will be forced to support short-term patches.   

Is anyone even working in D.C. in August? 

If you’ve ever tried to schedule a meeting in Washington during August, you’d be forgiven for thinking the entire federal government evaporates into thin air. Lawmakers vanish. Hearing rooms go dark. Suits are replaced by polos. Surely nothing important is happening, right? 

Wrong. 

While Congress heads home for its traditional District Work Period—hosting town halls and visiting local businesses—federal agencies are deep in the weeds drafting, publishing, and collecting comments on major regulatory proposals. In fact, some of the most consequential Medicare rules of the year drop precisely when Capitol Hill is empty. 

Congressional District Work Period: A Historical Snapshot 

The August break dates back to the mid-20th century, when longer sessions, heavier legislative workloads, and a sweltering, pre-air-conditioned Washington led lawmakers to seek respite during the hottest part of the year. But it wasn’t until the 1970s—amid government reforms and rising constituent demands—that Congress institutionalized this district-focused period in the 1970 Legislative Reorganization Act. 

What Congress Is Doing 

During August, Members of Congress actively: 

• Hold town halls and community events 

• Visit schools, businesses, and local organizations 

• Engage with civic and media stakeholders 

• Address constituent concerns and casework 

This time back home isn’t a vacation—it’s a political imperative. (Especially in an election year.) 

What Agencies Are Doing 

Back in Washington, regulatory agencies like CMS, HHS, and FDA are hard at work. The August calendar often includes: 

• Release of Medicare payment rules for the next calendar year 

• Opening of public comment periods for providers, associations, and advocates 

• Data and policy development for final rules due in the fall 

• Stakeholder meetings, technical briefings, and internal regulatory review 

Currently Open Medicare Rules 

Here’s what’s live now on Regulations.gov and requires action in the very near-term: 

• CY 2026 ESRD Prospective Payment System (CMS20250240) – Comments due August 29 

• Provider Enrollment Changes (CMS20250242) – Comments due August 29 

• CY 2026 Home Health Prospective Payment System – (CMS202512347) – Comments due September 5 

• CY 2026 Medicare Physician Fee Schedule & QPP (CMS1832P) – Comments due September 12 

• CY 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Proposed Rule – (CMS202513360) – Comments due September 15 

 These comment windows are crucial—and they don’t wait for Congress to return. 

 Why August Matters 

For health care advocates, it’s one of the busiest months of the year.  Here’s what we are doing: 

• Meeting with lawmakers in-district to shape fall legislative priorities 

• Hosting site visits 

• Catching up Congressional staff who have a bit more time to talk 

• Analyzing proposed rules and draft formal comments 

August does mean a break but it doesn’t mean sitting back.