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The recent announcement that Washington, D.C. will host the 2027 NFL Draft has certainly excited local football fans. Republicans in Congress are hoping to score with two key committees taking up reconciliation. Meanwhile, Secretary Kennedy Jr takes the field for hearings on the FY 26 Department of Health and Human Services (HHS) budget request. So, with that, let’s get into it. Welcome to the Week Ahead!
The Administration
President Trump is looking at his playbook to address prescription drug affordability and availability. The President unveiled a proposal from his first administration, known as the “Most Favored Nation” policy, which would tie federal payments for prescription drugs to the lower costs paid in other countries. He has also forecasted tariffs targeting the pharmaceutical industry to address concerns about overreliance on foreign countries.
These plays are not without risks. Expect the pharmaceutical industry to mount a strong defense against the “Most Favored Nation” policy, which stalled toward the end of the first Trump term. Additionally, the President could call an audible if the markets show little appetite for more tariffs.
President Trump is also gauging the reception of his new pick for Surgeon General, Dr. Casey Means. There is already resistance to this pick based on Dr. Means’ views on subjects such as the cause of autism. However, the real issue may be the resistance from Laura Loomer, who was a prominent voice in calling for President Trump to reconsider his first pick for the position.
The Senate
The Senate Committees have not been in a hurry to schedule markups of the budget resolution, as we previously reported, and rumor has it the Senate may skip the committee process altogether. The Senate could go straight to the floor, taking up the House-passed bill and voting on it or amending it then and there.
Also on our radar, Secretary Kennedy Jr is scheduled to appear before the Senate Health, Education, Labor, and Pensions Committee on May 14 for a hearing on the proposed FY 26 HHS budget request. Expect Republican and Democratic Senators to raise concerns about the proposed restructuring of HHS and its potential impact on various agencies and programs.
Other Senate Health Care Hearings
- May 13: Senate Judiciary Committee hearing on PBMs
- May 14: Senate Indian Affairs Committee hearing on oversight of Indian Health programs
The House
The House Energy and Commerce Committee and the House Ways and Means Committee are each scheduled to hold their respective markups of reconciliation-related legislation starting May 13.
Both E&C and W&M have released their respective texts. The legislation appears to be a deal struck between conservatives and moderates in the Republican Party on Medicaid.
Health care provisions in the E&C legislation include:
- Bumping up eligibility requirement determinations for the expansion population to every 6 months.
- Setting a ceiling of $1M in the home equity limit when making determinations regarding long-term care eligibility.
- Requiring verified citizenship or appropriate immigration status for Medicaid and the Children’s Health Insurance Program (CHIP).
- Reducing the Federal Medical Assistance Percentage (FMAP) by 10% for states providing coverage to illegal immigrants.
- Sunsetting the 5% temporary enhanced FMAP under the American Rescue Plan Act to states that opt to expand Medicaid. This provision would apply prospectively, not affecting states currently receiving an enhanced federal match under this authority.
- Freezing states’ provider taxes in effect and prohibiting states from establishing new provider taxes.
- Limiting state-directed payments for services from exceeding the total published Medicare payment rate.
- Setting a requirement for able-bodied adults without dependents to work at least 80 hours per month, through community service, work program, educational program, or any combination of these options.
- Requiring states to impose cost sharing on Medicaid expansion adults with incomes over 100 percent of the federal poverty level (FPL).
- Expanding Exclusion for Orphan Drugs from the Drug Price Negotiation Program.
- Delaying the Medicaid Disproportionate Share Hospital (DSH) reductions, currently $8 billion in reductions per year that are set to take effect for fiscal years 2026 through 2028, to instead take effect for fiscal years 2029 through 2031. This section also extends funding for Tennessee’s DSH program, which is set to expire at the end of this fiscal year, through fiscal year 2028.
- Requiring pharmacy benefit managers (PBMs) in Medicare Part D to share information relating to business practices with Medicare Part D plan sponsors, including information relating to formulary and coverage decisions that benefit affiliated pharmacies.
And a “doc fix”: Notably, the mark includes language tying the Medicare physician fee schedule update in 2026 to a portion of the Medicare Economic Index.
As expected, Democrats are panning the legislation as cuts to benefits and enrollment. Immense pressure from President Trump will make voting against the markup in either committee difficult for any Republican. So, we expect party line votes on the bills – at least until the floor.
While most of the attention at Ways and Means is on taxes, there is a provision which limits Medicare coverage for non-citizens. There were intense discussions about including the Trump administration’s ACA marketplace integrity rule, but that was not included in the mark, for now.
Expect the markups to take multiple days; don’t expect to see all CBO scores yet as provisions keep shifting and it takes CBO more time than you think to score these policies.
Health Care Hearings in the House
- May 14: House Appropriations Labor, HHS Subcommittee hearing on the FY 26 HHS budget request
- May 14: House Judiciary Antitrust Subcommittee hearing on the medical residency antitrust exemption
There You Have It
The week of May 11 is National Hospital Week. We celebrate and extend our gratitude to health systems and hospital staff for their unwavering dedication to patient care and access. Make it a great week!
The markups of the House Energy and Commerce, Ways and Means, and Agriculture Committees have been delayed, but there’s still plenty to talk about with the President’s proposed “skinny budget” for fiscal year 2026. So, let’s get into it. Welcome to the Week Ahead!
The Administration
President Trump released his “skinny budget” for FY26 on May 2, outlining the White House’s discretionary budget requests. Continuing the theme of reducing government spending, the administration is requesting $33.3B less than was enacted last year for the Department of Health and Human Services (HHS), including cuts for the Health Resources and Services Administration, the Centers for Disease Control and Prevention, and the National Institutes of Health by eliminating and consolidating different programs.
The “Make America Healthy Again” Commission, which is tasked with implementing HHS Sec. Kennedy’s agenda to tackle chronic disease through the promotion of healthy living and improving the nation’s food quality, has a $500M request.
But as far as the federal budget process goes, “the president proposes, and Congress disposes.” Congress will take these requests and consider them during their deliberations on appropriations, a process which is just getting under way.
The administration is expected to release more details of their budget in the coming weeks. Those details have been the subject of leaks in the last few weeks. Be on the lookout for the mandatory funding tables and HHS’ budget in brief, both of which highlight what the administration hopes to accomplish via regulation and legislation.
The Senate
The budget resolution calls on several Senate committees to submit recommendations to the Senate Budget Committee by May 9. Based on our conversations with lawmakers, the committees are not hurrying to meet this nonbinding date.
While the Senate HELP Committee could include health care provisions, they are expected to mirror their House counterpart (Education and Workforce) in focusing on reducing education and spending. And while not tasked with finding savings, the Senate Finance Committee could still wade into health care, whether on health care taxes, Medicaid, or Medicare, all of which would fall under Finance’s jurisdiction.
Senate Health Care Hearings This Week
- May 6: Senate Finance Committee nomination hearing to consider James O’Neil to be Deputy HHS Secretary and Gary Andres to be an Assistant Secretary of HHS
- May 8: Senate HELP Committee nomination hearing for James O’Neil to be Deputy Secretary and Janette Nesheiwat to be Surgeon General
The House
House Speaker Mike Johnson (R-LA) continues to push aggressively for reconciliation legislation even as he has acknowledged the delayed target date of July 4 for getting a package to the President’s desk.
During the listening sessions that House leadership and Energy and Commerce Chair Guthrie (R-KY) held with Republicans last week, the caucus fissures are starting to show. A growing number of Republicans want a much lower savings target for Medicaid because of the large number of Medicaid enrollees in their district. Other Republicans are pointing out the futility of making politically vulnerable House members take a vote on Medicaid changes that the Senate is unlikely to agree with. Yet, some hardliners are pushing for even more spending reductions in Medicaid than what is on the table.
The House Energy and Commerce bill is likely to include savings related to the Medicaid expansion population (expanded work requirements, bringing down the enhanced federal matching rate) and other policies that Republicans argue are about going after waste, fraud, and abuse (dropping of the provider tax safe harbor and targeting states that provide coverage to undocumented immigrants).
It’s unlikely the bill will include changes to advanced premium tax credits, Medicare Advantage, or physician payments, with the thought being that there will be time to address those topics in health care legislation down the road.
It’s important to remember that everything is still very much in flux. Recently, the White House threw another wrench in the plans by suggesting that the reconciliation package should include a “Most Favored Nation” policy to tie federal payments for prescription drugs to the lower costs paid in other countries. This could divide the GOP caucus, as some may see it as price controls.
House Health Care Hearings This Week
- May 5: House VA Tech Modernization Subcommittee hearing entitled “Improving Access to External VA Care through Enhanced Scheduling Technology”
- May 6: House VA Committee markup of pending legislation, including legislation related to health care
There You Have It
Did you know that Anna Jarvis, the person who founded Mother’s Day in the US and around the world, tried unsuccessfully in the 1940s to cancel the legal holiday because she felt the day has succumbed to commercial and ideological distortion? Make it a great week!
On April 29, 2025, the House Energy and Commerce Committee held a Markup of 6 health care bills. The health care bills focused on a variety of topics including funding for opioid recovery and treatment, research for lung cancer, regulation of human cell and tissue products, and changing the law to allow caregivers to pick up their patient’s medications. All of these bills were advanced to the House floor.
OPENING STATEMENTS
- Chairman Brett Guthrie (R-KY) praised the committee’s efforts to reauthorize and enhance programs addressing substance use disorders, protect seniors’ access to prescription medications, prevent discrimination in organ transplants for individuals with disabilities, and improve safety standards for human cell and tissue products. Guthrie highlighted the SUPPORT for Patients and Communities Reauthorization Act.
- Ranking Member Frank Pallone (D-NJ) criticized Republican colleagues for what he described as partisan approaches to health legislation. He expressed concern that certain bills under consideration lacked adequate funding increases and failed to address critical issues such as public health data improvements and medical supply chain vulnerabilities. Pallone emphasized the importance of bipartisan cooperation to effectively support public health initiatives and ensure comprehensive preparedness for future health emergencies.
LEGISLATION INCLUDED IN THE MARKUP
- H.R. 2483, SUPPORT for Patients and Communities Reauthorization Act of 2025 (Reps. Guthrie and Petterson): This bill would reauthorize key parts of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, which was signed into law in 2018. This reauthorization would include public health programs focused on prevention, treatment, and recovery for patients with substance use disorder. Passed 36-13 with amendment.
- H.R. 1520, Charlotte Woodward Organ Transplant Discrimination Prevention Act (Reps. Cammack, Dingell, Issa, and Wasserman Schultz): This bill would prohibit health care providers and other entities from denying or restricting an individual’s access to organ transplants solely on the basis of the individual’s disability, except in limited circumstances. Passed 46-1.
- H.R. 2319, Women and Lung Cancer Research and Preventive Services Act of 2025 (Reps. Boyle and Fitzpatrick): This bill would require the Department of Health and Human Services (HHS) to conduct an interagency review on the status of, and identify research related to, women and underserved populations with lung cancer. The review would include assessments of current research and access to prevention services, the availability of research opportunities regarding prevention, detection, and treatment, and recommendations for national public education and screening strategies. Passed by voice vote.
- H.R. 1669, To amend the Public Health Service Act to reauthorize the Stop, Observe, Ask, and Respond to Health and Wellness Training Program (Reps. Cohen and Buddy Carter ): This bill would reauthorize the Stop, Observe, and Respond (SOAR) to Health and Wellness Training Program for five years. The SOAR to Health and Wellness Act was originally signed into law in 2018 and authorizes resources to help build capacity in local communities to identify and respond to the various needs of individuals who have experienced trafficking. Passed by voice vote.
- H.R. 1082, Shandra Eisenga Human Cell and Tissue Product Safety Act (Reps. Moolenaar and Dingell): This bill would require the Secretary of HHS to conduct a national education campaign to increase public and health care provider awareness regarding the potential risks and benefits of human cell and tissue product transplants. It would also direct the Food and Drug Administration (FDA) to take additional steps to streamline regulatory oversight of human cell and tissue products, including by publishing educational materials, best practices, and other relevant information related to FDA’s Tissue Reference Group, as well as by conducting workshops and other educational sessions for relevant stakeholders and establish a public docket for related comments. Lastly, the bill would require the Secretary of HHS to report to Congress with recommendations for modernizing the regulation of human cell and tissue products. Passed by voice vote.
- H.R. 2484, Seniors’ Access to Critical Medications Act (Reps. Harshbarger and Wasserman Schultz): This bill would amend the physician self-referral law to permit Medicare patients to receive prescription drugs through caregivers picking up drugs on the patient’s behalf, through the mail, or by couriers delivering the drug to the patient in instances when a provider prescribes a drug to be dispensed by a pharmacy that falls under the self-referral law’s definition of an in office ancillary service. Current law prohibits such arrangements for Medicare beneficiaries. The amendments made by this bill would be implemented on January 1, 2026, and sunset on December 31, 2030. Passed 38-7.
Since its passage in 2014, the Protecting Access to Medicare Act (PAMA) has had a significant impact on the health care landscape—particularly in how clinical laboratory services are reimbursed under Medicare. While PAMA aimed to modernize the payment system by tying lab test reimbursement rates to market data, the implementation has been fraught with challenges. Now, Congress is revisiting PAMA with bipartisan calls for reform—efforts that could shape the future of diagnostic testing and access to timely care.
What PAMA Was Meant to Do
PAMA was designed to create a more accurate, market-based pricing model for clinical laboratory tests. By collecting private payer rates from a sample of laboratories, the Centers for Medicare & Medicaid Services (CMS) would set Medicare reimbursement rates that better reflect the actual market value of lab services.
However, in practice, the data collection process under PAMA has been criticized for being both incomplete and unrepresentative. Large national labs dominated the data submissions, while many smaller and hospital-based labs—where a significant portion of testing occurs—were left out. As a result, CMS reimbursement rates have plummeted for many essential lab tests, putting smaller labs at financial risk and potentially limiting patient access to critical diagnostics.
Delays in Data Reporting and Reimbursement Cuts: A Legislative Lifeline
Recognizing the problematic rollout of the data collection process, Congress has repeatedly stepped in to delay upcoming data reporting requirements and postpone associated reimbursement cuts. These legislative delays have provided temporary relief to the clinical laboratory community and bought time to pursue more permanent reforms.
Originally, PAMA required applicable laboratories to report private payer data every three years, with each reporting period leading to updated—and often lower—payment rates. However, the COVID-19 pandemic and growing bipartisan concerns over the fairness of the system led Congress to pass several delays, including:
- Coronavirus Aid, Relief, and Economic Security (CARES) Act (2020) – Delayed the reporting period and postponed cuts.
- Consolidated Appropriations Act (2022) – Further delayed cuts scheduled for 2023 and pushed back the next reporting cycle to 2024.
Most recently, additional delays passed in late 2023 have suspended further reductions and postponed the next data collection deadline, which was expected to trigger another round of cuts. Without these interventions, laboratories could have seen reimbursement slashed by up to 15% for hundreds of common diagnostic tests—at a time when the healthcare system is still recovering from pandemic-related disruptions.
These legislative pauses have prevented a downward spiral of access and affordability. However, they are stop-gap measures. According to the American Laboratory Association (ACLA), long-term stability in lab reimbursement requires structural changes to the PAMA framework, not just short-term legislative patches.
Congressional Reform Efforts
A top priority for ACLA is comprehensive change to PAMA through enactment of the Saving Access to Laboratory Services Act (SALSA) which aims to:
- Establish a more statistically valid and representative approach to data collection.
- Protect labs from steep year-over-year reimbursement cuts.
- Ensure better oversight and transparency in how rates are determined.
Bipartisan, bicameral support for SALSA highlights a shared understanding that accurate diagnostics are foundational to effective treatment and patient care. However, likely cost to the federal government associated with enactment of comprehensive reform has been a barrier to passage. Whereas, yearly short term legislative delays in data reporting and reimbursement cuts have resulted in budget savings. In fact. Congress has stepped in six times to delay the data reporting period and five times to delay further cuts.
Looking Ahead
As Congress deliberates reforms to PAMA, cost will continue to be a driving factor determining further action. Without action, clinical labs will again face reimbursement cuts of up to 15% on January 1, 2026. While enactment of comprehensive reform to PAMA will continue to be a top priority for ACLA and the clinical lab industry, given legislative history and congressional pressure to limit congressional outlays, Congress is again most likely to pass another short term patch to prevent the impending cuts.
