Insights^

In April 2026, Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. appeared before the House Ways and Means Committee, the House Appropriations Labor-HHS Subcommittee, the House Education and Workforce Committee, and the House Energy and Commerce Health Subcommittee to discuss the Fiscal Year 2027 (FY 27) presidential budget request for HHS. Sec. Kennedy used these hearings to share how the budget proposal is designed to align with the administration’s plans to reorganize the department to reduce duplication and focus on addressing the chronic health crisis. He also used the hearings to highlight what he saw as the administration’s wins in areas related to improving nutrition and reducing health care costs. Notably, he did not highlight his actions related to vaccine policy in any hearing. However, Democratic members in each hearing expressed concerns about this topic. The four hearings featured member questions on rural health care, nutrition, prescription drugs, the management of various HHS agencies, and efforts to eliminate fraud, waste, and abuse within the department.

OPENING STATEMENTS

• House Ways and Means Committee Chairman Jason Smith (R-MO-8)
• House Ways and Means Committee Ranking Member Richard Neal (D-MA-1)
• House Appropriations Labor-HHS Subcommittee Chairman Robert Aderholt (R-AL-4)
• House Appropriations Full Committee and Labor-HHS Subcommittee Ranking Member Rosa DeLauro (D-CT-3)
• House Education and Workforce Committee Chairman Tim Walberg (R-MI-5)
• House Education and Workforce Committee Ranking Member Bobby Scott (D-VA-3)
• House Energy and Commerce Full Committee Chairman Brett Guthrie (R-KY-2)
• House Energy and Commerce Health Subcommittee Vice Chair Diana Harshbarger (R-TN-1)
• House Energy and Commerce Full Committee Ranking Member Frank Pallone (D-NJ-11)
• House Energy and Commerce Health Subcommittee Ranking Member Diana DeGette (D-CO-1)

WITNESS TESTIMONY

• Robert F. Kennedy, Jr., Secretary of Health and Human Services – Testimony

MEMBER DISCUSSION

Rural Health

During the Committee hearings, Republican representatives focused on rural health care and the need for continued investments in this area. During the Ways and Means Committee hearing, Chairman Jason Smith (R-MO-8) requested Sec. Kennedy’s commitment to ensuring Rural Health Transformation Program (RHTP) funds are distributed to rural communities, improving the Rural Emergency Hospital designation approval process, and working to equalize payments between rural and urban hospitals. Sec. Kennedy reaffirmed his commitment to work on these issues. Reps. Adrian Smith (R-NE-3), Michelle Fischbach (R-MN-7), and Randy Feenstra (R-IA-4) asked what additional actions could further improve access to rural health care. Sec. Kennedy highlighted recent investments in community health centers and the RHTP, as well as previous and ongoing efforts to move toward site-neutral payments. During the Appropriations Labor-HHS Subcommittee hearing, Subcommittee Chair Aderholt (R-AL-4) asked how the Centers for Medicare and Medicaid Services (CMS) is evaluating whether the hospital wage index accurately reflects true labor costs. Sec. Kennedy explained that changing the wage index is extremely complex because the program must remain budget-neutral, so Congress needs to intervene to affect changes. During the Energy and Commerce Health Subcommittee hearing, Full Committee Chairman Guthrie (R-KY-2) asked the secretary about his experience administering RHTP and what he is most excited about. Sec. Kennedy explained that he is most excited about how RHTP dollars will help address what he described as a crisis in rural health and an epidemic of hospital closures, Reps. Troy Balderson (R-OH-12) and Mariannette Miller-Meeks (R-IA-1) asked how the funds can be used for recruitment to address staffing shortages. Sec. Kennedy shared that RHTP funds can be used to expand residency programs in rural areas, but he is unsure if they can be put towards recruitment bonuses.

Nutrition

There was bipartisan support for the nutrition initiatives that Sec. Kennedy has been championing across the hearings, although Democratic members questioned cutting funds for programs they argued are vital to supporting Americans’ nutrition. During the Ways and Means Committee hearing, Health Subcommittee Chair Vern Buchanan (R-FL-16), as well as Reps. Lloyd Smucker (R-PA-11) and Brian Fitzpatrick (R-PA-1) asked what future actions HHS plans to take to improve nutrition. Sec. Kennedy responded that he was interested in reviewing the list of substances generally recognized as safe (GRAS) and in driving cultural changes in diet and exercise. Rep. Gwen Moore (D-WI-4) expressed her disappointment with the proposed budget cuts to Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP), arguing that these cuts hamper efforts to improve nutrition. Sec. Kennedy acknowledged her disappointment, sharing that he was not happy with the funding changes, but with the large federal debt, cuts had to happen. During the Education and Workforce Committee hearing, Rep. Alma Adams (D-NC-12) questioned the budget cuts to programs that she argued promote nutrition, such as the Farm-to-School Program and school lunch grants. Sec. Kennedy shared that President Trump did not discuss the proposed cuts with him, but that he preserved Head Start and is focused on expanding access to whole foods. Rep. Kevin Kiley (I-CA-6) asked Sec. Kennedy to expand on the link between our food supply and chronic health issues. In response, the secretary reiterated his view that the lack of regulation of GRAS substances is a major problem. Rep. Glenn Thompson (R-PA-15) then asked about efforts to improve access to nutritional foods in schools. Sec. Kennedy explained that schools have abandoned their kitchens, that we need to help them rebuild to make good food, and that they need to continue encouraging the provision of whole milk during meals.

Vaccines

Many Democrats during all hearings expressed concerns about Sec. Kennedy’s views on vaccines and recent changes to vaccine recommendations. During the Ways and Means Committee hearing, Rep. Judy Chu (D-CA-28) questioned the removal of the universal Hepatitis B vaccination recommendation. Sec. Kennedy defended the change in recommendation, saying that infants are not generally at risk, vaccination is still recommended when the mother is positive for Hepatitis B, and that insurance companies can still cover the vaccination. Rep. Madeliene Dean (D-PA-4) asked how many members of the Advisory Committee on Immunization Practices (ACIP) he replaced. The secretary responded that he fired all 17 members because he didn’t like the work they were doing. During the Appropriations Labor-HHS Subcommittee hearing, Rep. Lois Frankel (D-FL-22) shared her concern about the lack of funding released to GAVI, the Vaccine Alliance that produces vaccines for underdeveloped countries, which was appropriated in both FY 25 and FY 26. Sec. Kennedy did not have a response. Reps. Mike Thompson (D-CA-4) and Linda Sanchez (D-CA-38) on Ways and Means, and Rep. Dean (D-PA-4) on the Appropriations Labor-HHS Subcommittee, focused on the rise in measles cases and the decline in measles vaccination rates. When asked by Reps. Sanchez (D-CA-38) and Dean (D-PA-4), if the vaccine was safe and effective, especially compared with contracting the disease, Sec. Kennedy agreed that it was. During the Education and Workforce Committee hearing, Rep. Suzanne Bonamici (D-OR-1) and Rep. Haley Stevens (D-MI-11) asked why Sec. Kennedy does not approve of the measles vaccine. The secretary stated that he has never been anti-vaccine, but that the combined measles vaccine for those under two was dangerous. He also cited a new cancer vaccine that HHS approved to show his support for vaccines. House Education and Workforce Committee Chair Tim Walberg (R-MI-5) provided the secretary with an opportunity to defend his actions by asking Sec. Kennedy to address allegations that he was responsible for the measles outbreak. Sec. Kennedy responded that the accusation is not science-based because the outbreak began before he took office. Sec. Kennedy also shared that if the 2 children who died in Texas had been given proper treatment when they went to the hospital, they could have been saved. During the Energy and Commerce Health Subcommittee hearing, Reps. Kim Schrier (D-WA-8) and Marc Veasey (D-TX-33) pressed the secretary on his rhetoric surrounding vaccines and the impact of said rhetoric. Sec. Kennedy reiterated that he has never been anti-vaccination and never removed measles from the list of recommendations. Rep. Schrier (D-WA-8) specifically focused on what she called the “RFK Jr. Spillover Effect,” which she “RFK Jr. Spillover Effect,” which she characterized as leading to overall distrust of doctors and negatively Vitamin K injections for newborns. Sec. Kennedy again emphasized that anybody could get vaccines covered by insurance and noted that he has never said anything about Vitamin K.

Fraud, Waste, and Abuse

Addressing fraud, waste, and abuse was a major topic in all hearings. During the Ways and Means hearing, Full Committee Ranking Member Richard Neal (D-MA-1) and Health Subcommittee Ranking Member Lloyd Doggett (D-TX-37) questioned the Trump administration’s pardoning and reinstatement of those who were charged with Medicare and Medicaid fraud to be brokers. Sec. Kennedy did not have an answer to these questions. Reps. Beth Van Duyne (R-TX-24) and Rudy Yakym (R-IN-2) asked what steps HHS has taken to reduce fraud, waste, and abuse. Sec. Kennedy pointed to investigations into durable medical equipment, hospice, and home health, as well as ensuring proper Medicaid enrollment. During the Appropriations Labor-HHS Subcommittee hearing, Rep. Andy Harris (R-MD-1) asked broadly what the secretary is doing to crack down on fraud, waste, and abuse. Sec. Kennedy said that HHS is ending the pay-and-chase system and auditing state Medicaid claims. During the Education and Workforce Committee hearing, Rep. Burgess Owens (R-UT-4) raised concerns about fraud, waste, and abuse and asked what specific deficiencies were being addressed. Sec. Kennedy stated that there is fraud in both red and blue states, but he argued that Florida cooperated in their investigation while Minnesota did not. During the Energy and Commerce Health Subcommittee hearing, Chair Guthrie (R-KY-2) asked if the secretary was surprised by the amount of fraud, waste, and abuse he has found. Sec. Kennedy explained that the Biden administration opened the door with the pay-and-chase model and by only evaluating reimbursement validations once a year. Rep. Miller-Meeks (R-IA-1) requested Sec. Kennedy’s support for her legislation aimed at investigating programs with significant increases in billing over a 6-month period to prevent fraud, which the secretary described as a great idea but something that he would need to look into further.

Affordability

During the hearings, there was bipartisan interest in health care affordability. At the Ways and Means hearing, Rep. Steven Horsford (D-NV-4) was specifically interested in knowing what steps HHS was taking to lower premiums and increase insurance coverage. Sec. Kennedy emphasized HHS’s actions to negotiate lower drug prices. Reps. Jodey Arrington (R-TX-19) and Max Miller (R-OH-7) asked what steps Congress and HHS can take to support affordability in the future. Sec. Kennedy shared that he would like to address perverse incentives that lead to higher costs, address concerns about certain pharmacy benefit manager (PBM) practices, increase direct primary care, and promote individual choice in health. Rep. Miller (R-OH-7) requested a framework for the future. During the Energy and Commerce Health Subcommittee hearing, Reps. Cliff Bentz (R-OR-2) and Nick Langworthy (R-NY-23) asked what steps HHS is taking to drive down prices. Sec. Kennedy shared that they have dozens of initiatives, including the most favored nation deals, cost-sharing, and “cleaning up the coverage pool.”

Members from both parties also raised questions about efforts to lower prescription drug prices. Education and Workforce Committee Ranking Member Scott (D-VA-3) asked if the secretary could commit to releasing the information on the deals from the most-favored-nation deals, to which he responded that most of the information is public, and he said that all that hasn’t been shared is proprietary. Rep. Rick Allen (R-GA-12) and Rep. James Comer (R-KY-1) turned the focus to PBMs and vertical integration. Sec. Kennedy explained that they are driving up costs everywhere and steering patients towards more expensive medications to receive higher compensation. The secretary also stated that vertical integration is a major safety issue and has led to people without medical degrees making decisions about which medications patients have access to. During the Energy and Commerce Health Subcommittee hearing, Rep. Buddy Carter (R-GA-1) raised concerns about the 340B program and its shift away from its intended goals. Sec. Kennedy shared his concerns and stated that any change to the program would need to be statutory, but he would be happy to work with Congress on any solutions.

Sec. Kennedy also faced questions from Democrats regarding Medicaid and Medicare. At the Ways and Means hearing, Rep. Joe Courtney (D-CT-2) and Rep. Greg Casar (D-TX-5) raised concerns about cuts to Medicaid and Medicare in H.R.1 and argued that these cuts have resulted in a high number of Americans losing their health insurance. Sec. Kennedy emphasized his belief that both Medicare and Medicaid are critical programs that need to be saved and stated that the cuts to Medicaid are solely the result of ending coverage for illegal immigrants. During the Energy and Commerce Health subcommittee, Sec. Kennedy was repeatedly questioned about Medicaid cuts, which he adamantly denied occurred, based on a recent Congressional Budget Office (CBO) report. Rep. Alexandria Ocasio-Cortez (D-NY-14) specifically focused on Medicare Advantage (MA) reimbursement rates and the increase in reimbursement for MA plans that the administration provided for 2027. Sec. Kennedy agreed that insurance companies are fleecing Americans, but said HHS was facing huge blowback from the insurance industry, which was threatening to abandon patients, so the department did what they thought was best.

Agency Management

Hearings also featured bipartisan interest in the management of HHS agencies. During the Ways and Means Committee hearing, Reps. Darin LaHood (R-IL-16) and Blake Moore (R-UT-1) expressed interest in updates about the Food and Drug Administration (FDA). Rep. LaHood (R-IL-16) raised the possibility of mismanagement at the FDA. Sec. Kennedy responded that the FDA has set records for the number of approvals of new drugs, generics, and medical devices, and has improved efficiency through the use of artificial intelligence. Rep. Moore (R-UT-1) asked about coordination between the FDA and CMS to provide temporary coverage of breakthrough medical devices. Sec. Kennedy shared that an announcement would be coming soon. During the Energy and Commerce Health Subcommittee hearing, Reps. Kat Cammack (R-FL-3) and Erin Houchin (R-IN-9) asked what specifically the FDA and HHS were doing to accelerate domestic manufacturing in hopes of maintaining U.S. leadership in pharmaceutical production. Sec. Kennedy described a pre-check program that will fast-track proposals to expand domestic plants and stated that 90% of the FDA is now using AI, which he stated has condensed the time taken to review applications for drugs.

Funding Reductions to Agencies

During all hearings, members of both parties also raised questions about funding reductions for certain agencies. At the Ways and Means hearing, Reps. Brendan Boyle (D-PA-2) and Brad Schneider (D-IL-10) expressed concerns about the proposed funding changes to the National Institutes of Health (NIH), with Rep. Schneider (D-IL-10) saying that it would likely lead to fewer drugs coming to market in the next 5 years. Rep. Boyle (D-PA-2) was specifically concerned about the impact on pediatric cancer research funding. Sec. Kennedy shared that the only Institute within the NIH to see an increase in funding was the National Cancer Institute and emphasized that duplicative programs were reallocated. When asked during the Appropriations Labor-HHS Subcommittee hearing by Rep. Bice (R-OK-5) about the primary areas that would see reductions under the budget, Sec. Kennedy stated that they must make cuts to the NIH to recalibrate funding toward chronic health rather than spending all the agency’s time on genetic testing. During the Education and Workforce Committee hearing, Rep. Donald Norcross (D-NJ-1), Rep. Adelita Grijalva (D-AZ-7), and Rep. Mark DeSaulnier (D-CA-10) voiced concerns with the cuts to research programs within the NIH, the Centers for Disease Control and Prevention (CDC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). Sec. Kennedy cited the Great American Recovery Initiative and the increase in funding for the National Cancer Institute as examples of not cutting funding but rather shifting focus. Rep. Grijalva (D-AZ-7) asked which areas he believes deserve less medical research. The secretary stated that diversity, equity, and inclusion (DEI) has never cured any diseases or created new drugs. Rep. Summer Lee (D-PA-12) questioned cuts to research surrounding black maternal mortality rates. Sec. Kennedy explained that maternal mortality impacts everyone, and the perinatal pilot project he has implemented in various hospitals has reduced mortalities by 42% across the board.

Hearings also featured Democratic concerns about staffing changes at agencies. During the Ways and Means Committee hearing, Rep. Don Beyer (D-VA-8) questioned the changes in funding and staffing at the Agency for Healthcare Research and Quality (AHRQ) and SAMHSA, requesting briefings on the agencies. Sec. Kennedy shared that AHRQ has appropriate staffing levels and that the SAMHSA grant termination letters were a mistake. He also agreed to meet about the agencies in the future. During the Appropriations Labor-HHS Subcommittee hearing, Rep. Steny Hoyer (D-MD-5) asked about the changes made to the HHS workforce. Sec. Kennedy explained that there are currently 72,000 employees and that they plan to hire another 12,000 employees who will focus on chronic health. He explained that those who lost their jobs were not bad actors and were doing their jobs, but they had to be fired to change the culture.

Hearings also featured discussions about high-profile vacancies at roles within agencies. For example, during the Ways and Means Committee hearing on April 16th, Rep. Jimmy Panetta (D-CA-19) expressed concerns about vacancies in multiple roles at the Centers for Disease Control and Prevention (CDC) and at the US Surgeon General’s office. This hearing took place before Dr. Erica Schwartz was nominated to be the CDC Director. At the Energy and Commerce Health Subcommittee hearing, Rep. Raul Ruiz (D-CA-25) asked the secretary for his opinion on Dr. Schwartz and why the previous CDC Director, Dr. Monarez, was fired. Sec. Kennedy shared that he was consulted on the nomination and helped vet Dr. Schwartz. He also stated that Dr. Monarez was fired because she said he could not trust her, not because of her differing views on vaccines. During the Appropriations Labor-HHS Subcommittee hearing, Vice Chair Julia Letlow (R-LA-5) gave Sec. Kennedy space to promote Surgeon General nominee Casey Means. The secretary emphasized her importance in upholding the work of MAHA and educating people on metabolic health. He described Means as an effective evangelist for MAHA.

Women’s Health

Both Republicans and Democrats spent time questioning and clarifying various issues related to women’s health. During the Ways and Means Committee hearing, Rep. Nicole Malliotakis (R-NY-11) questioned how HHS plans to advance women’s health. Sec. Kennedy pointed to the RHTP to address issues related to maternal mortality. Rep. Malliotakis (R-NY-11) shared that she would like attention for safety net facilities, especially for those in urban areas that will not benefit from RHTP. During the Appropriations Labor-HHS Subcommittee hearing, Subcommittee Chair Robert Aderholt (R-AL-4) asked how the FDA could appropriately address the risk of chemical abortion drugs, specifically Mifepristone, without the reporting in place on the serious adverse events. Sec. Kennedy stated he couldn’t speak on Mifepristone because of the ongoing litigation in Louisiana. Full Committee and Labor-HHS Subcommittee Ranking Member Rosa DeLauro (D-CT-3) then questioned if Sec. Kennedy plans to reinstate the maternal health experts who were let go, to which he responded that it would be up to the new CDC leadership. Vice Chair Letlow praised the secretary for his work on women’s health and asked about the actions being taken after the national conference. Sec. Kennedy detailed the initiatives in the proposed budget, specifically to address maternal health and disparities among minorities. Rep. Andrew Clyde (R-GA-9) and Rep. Blake Moore (R-UT-1) asked about the use of Title X funding going towards abortion and research using fetal tissue. Sec. Kennedy explained that new rules and regulations are coming soon to address this, and it is illegal to use fetal tissue in NIH-funded research. During the Energy and Commerce Health Subcommittee hearing, Subcommittee Ranking Member Diana DeGette (D-CO-1) and Reps. Robin Kelly (D-IL-2) and Nanette Barragan (D-CA-44) questioned cuts to maternal mortality programs. Sec. Kennedy stated his support for access to birth control but defended the cuts saying there were 27 maternal mortality programs and he is consolidating them.

Other Topics

During the Ways and Means Committee hearing:

• Rep. Carol Miller (R-WV-1) expressed concern about how the bundled payment rate for chronic kidney disease could decrease innovation incentives. Sec. Kennedy expressed that he would be happy to work with her on increasing innovation.
• Rep. David Schweikert (R-AZ-1) requested to work with Sec. Kennedy on ways to improve MA, as the Medicare Payment Advisory Commission (MedPAC) has issued reports about the misalignment of incentives and costs.

During the Appropriations Labor-HHS Subcommittee:

• Reps. Jake Ellzey (R-TX-6) and John Moolenaar (R-MI-4) raised concerns about health care cybersecurity, particularly risks tied to the strategic national stockpile and emerging technologies, with secretary Kennedy responding that HHS is coordinating with the Administration for Strategic Preparedness and Response (ASPR) and CMS, reducing reliance on Chinese products, and emphasizing stronger protections as investments in AI and telehealth expand.
• Rep. Bice (R-OK-5) and Rep. Moolenaar (R-MI-4) asked what HHS is doing to reverse the trend of China conducting more Phase 1 trials than the U.S. Sec. Kennedy explained that they are working to accelerate approvals and shorten time to patients, as well as planning to invest $325 million into reshoring pharmaceuticals that puts drugs researched in the U.S. first in line for approvals. He also stated that there is money coming in from Trump’s tariffs, which are also helping the pharmaceutical companies build more plants in the U.S.

During the Education and Workforce Committee hearing:

• Chair Walberg (R-MI-5) and Rep. Mark Harris (R-NC-8) asked about moving certain programs, such as the Foreign Medical Accreditation, from the Department of Education to HHS. Sec. Kennedy explained that those programs align better with HHS priorities, and they are talking with other agencies to see what can be shifted. He also shared that he believes medical school accreditation should fall under HHS’s purview because of its focus on health education.
• Reps. Glenn Grothman (R-WI-6) and Harris (R-NC-8) shared their disapproval of sex change operations and the promotion of them by mental health professionals. Sec. Kennedy explained that it is a multi-billion-dollar industry that is very corrupt, and the administration has ended all federal funding for puberty blockers and gender surgeries. He also confirmed that they are seeing hospitals rolling back on transgender surgeries and treatments since Trump’s Executive Order to suspend Medicare and Medicaid reimbursements if they perform the procedures.

During the Energy and Commerce Health Subcommittee hearing:

• Rep. Gus Bilirakis (R-FL-12) asked if Sec. Kennedy saw any opportunity to engage further on potential links between environmental toxins and neurodegenerative diseases. The secretary shared that he believes it’s regulatory malpractice that we don’t know the full extent of impacts, and he committed to working on getting answers.
• Rep. John Joyce (R-PA-13) asked what HHS is doing to ensure standards under the Stark Law are enforced. Sec. Kennedy explained that they are reforming the site neutrality rule so rural hospitals don’t get paid less to disincentivize families from moving their relatives.
• Rep. Balderson (R-OH-12) asked for HHS’s view on wearable technology, specifically in early detection. Sec. Kennedy stated that he believes they are critical and can revolutionize chronic disease prevention. He specifically mentioned glucose models and their dramatic impact.
• Rep. Debbie Dingell (D-MI-6) asked if Sec. Kennedy planned on addressing the staffing crisis following the CMS decision to repeal the 2024 nursing home staffing requirements. The secretary explained that the requirements were closing rural facilities that couldn’t withstand the staffing numbers, so repealing it helped.

On April 21, the House Ways and Means Committee held a hearing to examine fraud in Medicare. There was strong bipartisan support for ending and preventing fraud in Medicare. Democratic members raised strong objections to actions taken by the Trump administration related to the prosecution of Medicare fraud. Republican members, in contrast, praised the administration’s efforts to combat Medicare fraud, highlighting harm to beneficiaries.

OPENING STATEMENTS

• Chairman Jason Smith (R-MO-8)
• Ranking Member Richard Neal (D-MA-1)

WITNESS TESTIMONY

• Dr. Lynn Ianni, Ph.D., Medicare beneficiary and Medicare fraud victim – Testimony
• Ms. Shelia Clark, President and CEO, California Hospice and Palliative Care Association – Testimony
• Mr. David Klebonis, Chief Operating Officer, Palm Beach ACO – Testimony
• Mr. Christopher Deery, Director of Corporate and Financial Investigations, Independent Blue Cross – Testimony
• Ms. Kristi Martin, Principal, Highway 136 Consulting – Testimony

MEMBER DISCUSSION

Fraud Prevention

There was bipartisan support for preventing fraud in Medicare. Health Subcommittee Chair Vern Buchanan (R-FL-16), and Reps. Danny Davis (D-IL-7), Ron Estes (R-KS-4), Carol Miller (R-WV-1), and Nicole Malliotakis (R-NY-11) asked for input on how to best prevent fraud in Medicare. Mr. Klebonis shared that patient satisfaction surveys and site visits are critical for ensuring proper validation of providers. Ms. Clark repeatedly emphasized the need for better validation during program entry, education for beneficiaries, and looking at data from the beneficiary level to better understand if various claims data make sense. Rep. Davis requested more information on what education could be helpful to beneficiaries. Ms. Martin shared that campaigns on protecting their beneficiaries’ information have been successful. Ms. Clark shared that information about how to identify and report fraud to the senior Medicare Patrol has been important with beneficiaries she has worked with.

Rep. Greg Steube (R-FL-17) suggested that requiring a Certificate of Need can be effective in preventing new fraudulent hospice openings, a view Ms. Clark agreed with. Health Subcommittee Ranking Member Lloyd Doggett (D-TX-37) suggested that the Centers for Medicare and Medicaid Services (CMS) should deactivate the national provider identifier number for those known to be committing fraud. All witnesses supported this suggestion.

Rep. Steven Horsford (D-NV-4) shared that he would like to reduce fraud but that new measures cannot be put into place at the expense of patient care and asked for options on how to strike a balance. Ms. Martin agreed with the statement and highlighted that any new regulations should not delay care.

Beneficiary Harm

Other members of the Committee focused their questioning on the harms to beneficiaries who have experienced fraud. Reps. Miller, Nathaniel Moran (R-TX-1), and Michelle Fischbach (R-MN-7) requested an explanation of the impact of fraud on beneficiaries. Ms. Clark explained that it is a time-intensive process for beneficiaries to get the care they need after experiencing fraud, and that beneficiaries are often expected to pay for medical services received while fraud is being investigated. Dr. Ianni shared that she wished she had received more compassion and communication through the process of working with CMS, as the emotional toll was quite high. Rep. Estes said he believes fraud is a patient safety issue, especially when patients cannot receive the care they need.

Use of Technology

There was interest from Committee members in understanding how technology can be useful for preventing fraud. Chairman Smith (R-MO-8), Reps. Adrian Smith (R-NE-3), David Schweikert (R-AZ-1), Greg Murphy (R-NC-3), and Blake Moore (R-UT-1) all suggested use of artificial intelligence (AI) could be helpful in identifying fraudulent claims. Mr. Deery agreed, but with the caveat that a human is still needed to guide AI use and make the final decision on whether a claim is fraudulent. Mr. Deery also emphasized the importance of data visualization tools to help identify whether a new claim might be part of a pattern of fraud as well as to track where every dollar is being spent.

Administrative Actions

Many Democrats raised concerns about actions taken by President Trump to pardon individuals convicted of Medicare fraud, as well as other actions that impact the prosecution of fraud claims. Reps. Doggett, Mike Thompson (D-CA-4), and Don Beyer (D-VA-8) questioned the firing of HHS Inspector Generals and attorneys at the Department of Justice. Rep. Beyer explained that many fraud cases have been closed without a full investigation due to inadequate staffing across multiple departments.

Other Topics

• Rep. Beyer highlighted how a federal all payer claims database could create a more robust picture of health care data, which would be beneficial in identifying fraud.
• Rep. Brian Fitzpatrick (R-PA-1) raised concerns about fraud in addiction treatment centers, specifically in Pennsylvania. Mr. Deery responded that a significant dent in fraudulent activities has been made, and commercial insurers are now the primary targets.
• Multiple Democratic members expressed support for H.R. 7966, the Hospice CARE Act of 2026, which implements new hospice program integrity measures.

On April 9 and 10, the Medicare Payment Advisory Commission (MedPAC) met for their April meeting, the last meeting in the 2026 Cycle. Commissioners discussed several topics including, how to improve payment incentives, the impact of Medicare Advantage (MA) on hospitals’ and post-acute care (PAC) providers’ finances, and institutional special needs plans (I-SNPs). Commissioners all expressed concerns with the current system and voiced numerous solutions.

IMPROVING PAYMENT INCENTIVES IN MEDICARE

MedPAC staff began this session discussing the drivers of Medicare’s spending growth, payment incentives within fee-for-service (FFS), alternative payment models (APMs) and MA, as well as recommendations to improve Medicare’s incentives. These recommendations can be viewed on slides 29-38 in the Improving Payment Incentives” slideshow found here. MedPAC staff shared that its presentation, along with the Commissioners’ discussion, will be included in the MedPAC June 2026 report to Congress.

Overall, Commissioners agreed on the shortcomings of FFS, APMs, and MA, saying that they each have their strengths and weaknesses when it comes to payment incentives. Commissioners expressed that FFS is foundational, in that it serves as a guardrail to ensure MA provides a variety of services, yet it leads to high inflation. Commissioners shared that APMs are an incentive layered on top of FFS and have tools to avoid unnecessary plan expenses but do not have sufficient funding to support the infrastructure needed. In terms of MA, a few Commissioners said that it is effective at controlling costs, but the incentive is currently centered around coding care rather than quality of care. Commissioners concluded that each of these services play a core role and are vital but agreed that there needs to be stronger tools to provide better incentives to providers.

Additionally, Commissioners emphasized the need to ensure beneficiaries know they are being enrolled in Medicare, MA, or APMs so they can best understand the benefits available to them. There was also concern regarding the rise of costs as people age and are diagnosed with additional chronic illnesses. Commissioners recommended payment mechanisms that encourage specialist-led services with more focus on patients and increased specialist engagement with APMs to combat the rising costs. A few Commissioners mentioned rising drug costs and expressed concern over the focus on price and quantity impacts, rather than innovation impacts. A few Commissioners noted that there are tools in place to manage every cost except for drug costs and recommended the utilization component as an incentive to control when drugs are used in a managed environment.

MA ENROLLMENT AND HOSPITALS’ AND POST-ACUTE CARE (PAC) PROVIDERS’ FINANCES

MedPAC staff began this session giving a brief background on MA enrollment and plan incentives, then discussed how MA enrollment affects hospital finances and PAC providers’ finances. The staff explained the elements of the study they conducted as there was no pre-existing literature that included all of the information they needed. Their research showed that there is no significant association between MA penetration and hospitals’ and PAC providers’ finances, despite complaints that providers are experiencing difficulties navigating the space. This chapter will be included in the June 2026 Report to Congress.

A number of Commissioners voiced concerns on the subjectivity of what is medically necessary, specifically in terms of referrals and denials. One Commissioner detailed that providers have different resources they use to evaluate medical necessity than health plans do, which contributes to different decisions. One Commissioner explained that an MA plan can decide a procedure is not necessary if it’s nonemergent, which leads to increased time-to-placement, which increases costs. While the overturn rate of these denials is very high, providers then lose money and time appealing the decision. Other Commissioners echoed concerns about this. One Commissioner questioned if the reason data is not reflecting the issue is due to the way providers and hospitals have adjusted to MA market penetration in order to combat the rising costs.

Commissioners also spent time discussing heterogeneity between MA plans, and between home health agencies (HHAs), skilled nursing facilities (SNFs), and inpatient rehabilitation facilities (IRFs). Commissioners explored how MA plans vary in how they approach situations depending on the geography and relationships with providers in the areas they are operating in. Commissioners noted that each facility varies in size, coverage, and care level and that these differences impact the solutions they need. For example, one commissioner detailed that smaller SNFs operate better than larger SNFs, while smaller HHAs are not as effective as larger HHAs. Commissioners continuously raised this concern and there was agreement about the need to look into the structural failures currently in place that are either positively or negatively impacting each player.

INSTITUTIONAL SPECIAL NEEDS PLANS (I-SNPS): PROVISION OF SERVICES, NETWORK-ADEQUACY REQUIREMENTS, AND STAR RATINGS

MedPAC staff began this session reviewing their work last year on I-SNPs. Staff also emphasized that this work will not be included in the June 2026 Report to Congress, but if there were commissioner interest, they would conduct additional work in the next cycle and include this as a chapter in the June 2027 Report.

A number of Commissioners voiced concerns about the interaction between Medicare and Medicaid plans within I-SNPs as it is the only model that can apply to long-stay older adults on Medicaid that are getting care in nursing homes from Medicare. One Commissioner specifically raised the issue of conflicting incentives in terms of nursing homes electing to send patients to the hospital due to higher reimbursement rates from Medicare versus I-SNPs focus on keeping care within the nursing home. Additionally, Commissioners expressed the need to better understand what nurse practitioners are doing and how they interact with the rest of the nursing home staff.

Other Commissioners also asked questions regarding the functionality of I-SNPs and the data collected on them. One Commissioner asked if there was a way to identify incident to billing in nurse practitioner visits, to which the staff explained that they are salaried employees, so it is unclear if they are cataloging every visit. Another Commissioner asked why insurer sponsored I-SNPs are getting higher star ratings over those that are provider sponsored. Staff explained that insurer sponsored I-SNPs are simply larger, so they have more enrollees and therefore get more data. Additionally, one Commissioner proposed having CMS require SNP beneficiaries, or their proxy, be educated about the choice of FFS, MA, or I-SNP coverage within the nursing home.

Today’s sessions concluded with a public comment period. Shannan Wu, the Director of Payment Policy at the American Hospital Association urged MedPAC to continue carefully examining the role MA plays in access to care and spending. Wu explained that the major high-cost drivers in Medicare can be found in MA, despite the greater administrative burdens, and believes the Commission should look towards combatting that.