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House Energy & Commerce Committee Markup of Budget Reconciliation

Date: May 16, 2025

Starting on May 13, 2025, the House Energy & Commerce Committee held a markup of the Committee’s budget reconciliation committee print, which will be added to work of other committees to produce a larger budget reconciliation bill for consideration by the full House at a later date. While health policy has received much of the attention, the instructions to the Committee under the budget resolution are not confined only to health policy, and the Committee print included 4 subtitles covering energy, environment, communications, and health. Following debate on the separate titles and the consideration of amendments, the Committee approved the subtitles in party line votes, sending the committee print to the House Committee on the Budget to be incorporated with legislation from other House committees into a larger legislative package.

OPENING STATEMENTS

Before moving to the formal debate of the legislation before the Committee, several members offered opening statements. Chairman Brett Guthrie (R-KY) and Ranking Member Frank Pallone (D-NJ) began the May 13 markup with opening statements. Health Subcommittee Ranking Member Diana DeGette (D-CO) and numerous members of the Committee also made opening statements, with members on both sides of the aisle sharing personal stories of Medicaid enrollees. Committee Democrats highlighted individuals in their home states concerned about losing Medicaid coverage should the budget reconciliation legislation move forward and be signed into law. Republican statements focused on stressing that Medicaid is unsustainable as a program and that the legislation will help preserve Medicaid by addressing waste, fraud, and abuse in the program, implementing a work requirement for able-bodied Medicaid enrollees, ending Medicaid coverage for immigrants without legal status, and forbidding Medicaid coverage of transgender surgeries for minors. Democratic statements focused on estimates from Congressional Budget Office (CBO) communications that more 13 million individuals could potentially lose coverage and connected the reductions in Medicaid to Republican efforts to extend tax cuts for wealthier Americans. Not surprisingly, Republicans and Democrats disagreed about the veracity of the numbers of individuals who could lose coverage. Regarding the work requirement, Chairman Guthrie outlined specific exceptions to the work requirement to address many concerns that have been raised, while Democrats raised the objection that the work requirement would cause eligible individuals to lose coverage.

HEALTH SUBTITLE AND AMENDMENTS

For consideration of the health subtitle, Chairman Guthrie offered an amendment of the nature of a substitute to serve as the base text for consideration. During their comments, Committee Democrats continued to highlight the stories of Medicaid enrollees and the more than 13 million estimated to lose coverage in CBO communications. Following comments from multiple members regarding the health subtitle, the Committee moved to consideration of amendments.

During the debate, the Committee considered 20 separate amendments on a range of provisions and issues.

Each amendment offered was defeated on a party-line vote. Among the amendments of note and interest include the following:

Health Subcommittee Ranking Member Rep. Diana DeGette (D-CO) offered the first amendment, which would prevent the provisions of the health subtitle from taking effect until the Secretary of Health & Human Services certifies that the legislation would not reduce benefits under state plans.
Rep. Marc Veasey (D-TX) offered an amendment to strike the provisions setting limits on new provider taxes. Often criticized as a gimmick or loophole for states to access additional federal dollars, arguments for the amendment centered on the value to states in utilizing provider taxes to generate funding for their Medicaid programs and provide additional funds back to states.
Rep. Kathy Castor (D-FL) offered an amendment to remove the legislation’s limits on state directed payments, which would allow existing state directed payment systems in place to continue but would cap the level of future state directed payments at Medicare levels.
Rep. Raul Ruiz, MD (D-CA) offered an amendment requiring states to submit a report assessing the effects of the bill on rates of uncompensated care and on emergency department wait times.
Rep. Scott Peters (D-CA) offered an amendment to strike the work and community engagement requirement for the Medicaid expansion population. Supporters of the amendment cited concerns about the administrative burden that would be imposed under the requirement, and supporters also cited past experiences in Arkansas and Georgia to demonstrate that the requirement could lead to eligible individuals losing coverage. Chairman Guthrie responded noting that the provisions were created with exceptions and provisions to help address and prevent situations like those that occurred under Arkansas and Georgia’s work requirements.
Rep. Robin Kelly (D-IL) introduced an amendment requiring state audits of individuals who lost coverage under the legislation’s community engagement or work requirement but would otherwise have qualified for coverage under the requirement’s exceptions.
Rep. Greg Landsman (D-OH) offered an amendment to strike the provision allowing states to assess cost-sharing of up to $35 per service on Medicaid expansion adults with incomes over 100 percent of the federal poverty level (FPL). Supporters of the amendment argued that this will lead to large numbers of enrollees forgoing care, further driving up costs of uncompensated care. Chairman Guthrie and other Republican committee members pointed out requiring enrollee “skin the game” is important and required in other health plans and that states have flexibility to impose much lower cost-sharing much lower than $35.
Rep. Nanette Diaz Barragan (D-CA) offered an amendment to strike the provision limiting retroactive coverage under Medicaid and CHIP to one month prior to an individual’s application date, which would be a reduction from current law which allows for 3 months of retroactive coverage. Committee Democrats argued that this will reduce healthcare coverage for children and families that earn too much to qualify for Medicaid but not enough to afford coverage under the health insurance exchange under the Affordable Care Act (ACA).
Rep. Debbie Dingell (D-MI) offered an amendment stating a sense of Congress supporting most favored nation pricing for prescription drugs. Supporters noted President Trump’s recent executive order to lower U.S. drug costs by linking prices to those paid in other developed countries. Chairman Guthrie expressed agreement with the President on the need to address American drug pricing but pointed out that Americans also benefit from pharmaceutical innovation.
Rep. Alexandria Ocasio-Cortez (D-NY) introduced an amendment which would include the provisions to address risk adjustment in Medicare Advantage along with modifying the update to Medicare physician payments to be consistent with the Medicare economic index (MEI) ,which is an annual measure of the inflationary rise in medical practice costs. Health Subcommittee Chair Buddy Carter (R-GA) offered supportive comments regarding the amendment but stated the reconciliation legislation was not the appropriate avenue for these provisions.
Rep. Ocasio-Cortez (D-NY) offered an amendment that would effectively undo the legislation’s provisions rescinding the nursing home staffing rule that was finalized under the Biden administration.
Rep. Dingell (D-MI) offered an amendment prohibiting states from imposing new limitations or payment reductions for home and community-based services (HCBS).

Following the consideration and dispensing of amendments, the Committee approved the health subtitle, as amended by Chairman Guthrie’s amendment in the nature of a substitute, on a party line vote.

COMPLETION OF CONSIDERATION AND NEXT STEPS

Following approval of the health subtitle, the full Energy & Commerce Committee voted 30-24 along party lines to report and transmit the legislation and its four subtitles, consistent with the instructions received under the budget resolution, to the House Committee on the Budget.

The House Budget Committee has announced plans to meet in a markup on Friday, May 16 to consider the legislative package that incorporates the E&C Committee’s work and the work of other House committees to be considered under the budget reconciliation process.

Assuming passage by the House Budget Committee, Speaker of the House Mike Johnson (RLA) and House Republican leadership continues to assert their plans to bring up the legislative package before the full House of Representatives for consideration and passage before Memorial Day.

The Senate has not announced plans for consideration, but it is speculated that the Senate will not meet in its respective committees to consider the legislative package. Rather, there is speculation that the full Senate will take up, amend, and pass the House-passed legislation in June.

Following Senate consideration and passage, the House and Senate will need to work to reconcile their respective differences in the weeks that follow in June and July.

So, you want to form a coalition?

Date: May 13, 2025

Achieving meaningful change with a coalition doesn’t happen by accident—it starts with a clear goal and a smart strategy. Whether you’re a seasoned advocate or just beginning to engage in the policymaking process, defining your end policy goal is critical. It sets the foundation for everything that follows: identifying partners, planning outreach, and ultimately measuring success. So, how do you make a coalition happen?

Do You Know Your End Policy Goal? Start Here.

When it comes to influencing policy, one of the most important first steps is knowing your end goal. What is the specific policy change you hope to achieve? Without a clear destination in mind, it’s difficult to map out an effective strategy, identify potential allies, or even measure success.

Think Strategically About Partnerships

Once your goal is clear, ask yourself: Can you achieve this on your own? Are you the primary voice in this space, or are others already leading the charge? If policymakers and staff don’t immediately associate your organization with the issue, it may be time to think of a coalition. Strategic partnerships can lend credibility, expand your reach, and strengthen your case.

Amplify Your Message

Size matters—especially when it comes to your policy voice. If your organization isn’t large enough to create the impact you need, consider who could help amplify your message. Do you need grassroots advocates? A broader range of voices for Capitol Hill outreach? Expanding your coalition can turn up the volume where it matters most.

Outreach Matters—So Does Execution

It’s one thing to brainstorm your dream team of partners—but quite another to successfully engage them. Are you able to connect with key stakeholders in a persuasive, meaningful way? Effective outreach is part message, part method, and part diplomacy.

Next Steps

Every successful coalition effort begins with a clear understanding of your goals and a realistic assessment of your capacity to achieve them. Whether you need to build a coalition, amplify your message, or strengthen your outreach strategy, being intentional at the outset can make all the difference. Look for our next blog about successfully convening a coalition.

Chamber Hill Strategies

When it comes to coalition building, Chamber Hill Strategies stands out among lobbying firms in DC. Our comprehensive approach helps clients achieve their advocacy goals. With strong relationships on Capitol Hill and a track record of shaping health policy, we turn complex challenges into real-world wins.

Let our expertise in Washington, DC guide your efforts towards successful and meaningful stakeholder engagement.

Week Ahead: Game Time

Date: May 12, 2025

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!

Week Ahead: Reconciliation Waiting Game

Date: May 5, 2025

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!