Featured Blogs

The Philadelphia Eagles and the Kansas City Chiefs stamped their tickets to the Super Bowl in the NFC and AFC championship games. Not to be outdone, Washington D.C. continues to produce a lot of political gamesmanship. We have updates on the state of those political games, so let’s get into it. Welcome to the Week Ahead!
The Administration
Acting Health and Human Services (HHS) Secretary Dr. Dorothy Fink, issued an internal memo on January 21 directing staff to refrain from issuing communications until at least February 1 unless a presidential appointee has reviewed and approved it. There are exceptions for “mission critical” communications, but there are still concerns about the impact the pause could have on public health. As interested parties await the break in silence, they also hold their breaths as they look towards the nomination hearings of HHS leaders from RFK Jr. on down.
However, a communications freeze does not mean the department is waiting to move on policy. Case in point: the Food and Drug Administration (FDA) officially withdrew the menthol ban that had been lingering at the Office of Management and Budget (OMB) since October 2023. President Trump has also taken several executive actions that directly or indirectly impact health care policy. These include:
- Scrapping plans for a Centers for Medicare and Medicaid Innovation (CMMI) model that would have limited out-of-pocket costs for generic drugs as part of a broader Executive Order rescinding several Biden era policies.
- Allowing Immigration and Customs Enforcement (ICE) and Customs and Border Protection (CBP) officers to enter hospitals to detain migrants..
- Beginning the process of withdrawing from the World Health Organization (WHO).
The Senate
RFK Jr. will have the chance to make his case before the Senate Finance Committee on January 29 and the Senate Committee on Health, Education, Labor, and Pensions on January 30. Only the Senate Finance Committee will have a vote on the nomination, but both hearings matter as they will give key senators on both sides of the aisle opportunities to have their say.
RFK Jr. faces challenges from both the left and right. In the January 20 edition of the Week Ahead, we told you about an anti-RFK advertising campaign from the progressive group 314 Action. On January 22, the conservative group Advancing American Freedom announced its own advertising campaign to prevent RFK’s confirmation. Ultimately, it will be up to Senators to decide if the arguments from these strange bedfellows hold any weight.
Also this week: The Senate Committee on Veterans Affairs (VA) will be holding a hearing on the VA’s Community Care Program on January 28. This follows a House VA Committee hearing on the same topic on January 22.
The House
The House is in recess, but members are meeting with Trump in Florida. We will be watching for any news from this meeting in the White House’s southern wing.
Eyes will also be on Florida as primary elections are held for the seats left open by former Reps. Matt Gaetz (R-FL-1) and Michael Waltz (R-FL-6). These are especially important as Republicans in the House have a razor thin majority.
There You Have It
Super Bowl Sunday is coming up! Who are you rooting for? Let us know! Make it a great week!

Reforming Prior Authorization in Health Plans: A Bipartisan Issue for the 119th Congress?
As the 119th Congress begins its legislative work, one of the issues gaining increasing attention within health care reform is prior authorization. But will this issue unite lawmakers across party lines, or will it become another partisan battleground?
Prior Authorization: A Growing Problem
Prior authorization is intended to ensure that medical services or treatments are medically necessary and cost-effective, helping to control health care expenses. However, over time, critics argue that prior authorization has become a cumbersome and bureaucratic obstacle that delays patient care. According to a 2024 survey by the American Medical Association (AMA), 94% of physicians report that prior authorization causes delays in patient care, with some of these delays resulting in worsened health outcomes (AMA, 2024). Moreover, health care providers are spending more time on administrative tasks related to prior authorization requests, detracting from their ability to focus on direct patient care.
The burden of prior authorization is not confined to any one area of health care. Prior authorization affects public and private insurance systems and extends beyond medical services, including medications, imaging procedures, and durable medical equipment. While prior authorization is used to manage costs and prevent overuse of health care services, the process can be time-consuming and opaque, contributing to frustration for patients, providers, and insurers alike.
A Bipartisan Issue?
Prior authorization reform has historically garnered support from both parties, particularly as the system’s burdens have become more apparent. On the one hand, Democrats have focused on reducing administrative inefficiencies and improving access to timely care. At the same time, Republicans have typically championed efforts to cut through regulatory red tape and strengthen health care cost management.
For instance, in the previous Congress, a bipartisan bill, The Improving Seniors’ Timely Access to Care Act, aimed to reduce the burden of prior authorization for Medicare Advantage beneficiaries by introducing requirements for transparency, quicker decision-making, and a more standardized process. The legislation received broad backing from both Democrats and Republicans (with over half of members in both bodies cosponsoring the bill), alongside support from leading medical and patient advocacy groups, including the AMA and the American Heart Association.
As Congress moves into the 119th session, the push for reforms to the prior authorization process remains strong. However, expanding these reforms across broader health care sectors, particularly private insurance, will require navigating complex political dynamics. While there is a shared interest in reducing administrative burdens, insurers and Republicans who prioritize cost control may resist significant changes to the system.
Potential Pitfalls of Reform
Despite the broad support for prior authorization reform, Congress will face several key challenges to pass meaningful legislation.
- Resistance from Insurance Companies: Many insurance companies view prior authorization as a necessary tool to manage costs and ensure the appropriate use of health care services. While insurers may acknowledge the administrative burdens on providers, they often argue that eliminating or loosening prior authorization would result in unnecessary treatments, driving up health care expenditures. This perspective could lead to significant pushback from the insurance industry, which may be able to influence lawmakers concerned about costs.
- Balancing Cost Control with Patient Care: One of the primary concerns of prior authorization reform is maintaining a balance between reducing administrative barriers and ensuring that only medically necessary treatments are covered. If the prior authorization process is reduced too much, there may be concerns about increased utilization of unnecessary services, which could ultimately increase the cost of health care across the board.
- Fragmentation Across Insurance Plans: With multiple insurance plans, both public and private, there is a lack of uniformity in the prior authorization process. Different insurers often have varying rules and guidelines, leading to confusion for both patients and health care providers. Creating a standard process across different plans could face significant resistance from the insurance industry, which may prefer to maintain its own policies and decision-making frameworks.
Where will the Administration Stand on the issue?
During his previous presidency, President Trump made efforts to reduce the burden of regulatory requirements in health care, including addressing prior authorization. In 2020, his administration signed an executive order aimed at improving transparency in health care pricing and addressing the burdens of prior authorization within both public and private health care systems. The executive order pushed for greater transparency from insurers regarding prior authorization rules and encouraged the development of electronic systems to streamline the process.
Although President Trump has not specifically spoken about prior authorization reform since leaving office, his overall approach to health care reform—focused on reducing government regulation and enhancing competition within the health care market—suggests he may support efforts to reduce administrative burdens. However, his stance on health care policy generally favors market-driven solutions, meaning that any reform efforts might need to strike a balance between improving patient care and preserving cost-control mechanisms within the insurance industry.
So, will Congress and the administration act on reforming prior authorization this year? While bipartisan support for reform exists, the complexities involved in balancing patient care, cost control, and insurance company interests could complicate the passage of significant legislation. As the legislative process moves forward, watching how Congress navigates these challenges will be important. However, we have seen over the past month that most citizens are angry about health insurance profit levels and perceived lack of access to care – so Congress will need to act on this issue one way or another before the end of 2025.

The Trump Administration is poised to reshape American health care policy with two high-profile and polarizing figures: Robert F. Kennedy Jr., nominated to head the Department of Health and Human Services (HHS), and Mehmet Oz, the celebrity doctor tapped to lead the Centers for Medicare and Medicaid Services (CMS). Their starkly different approaches to health care—prevention versus medicine—set the stage for potential clashes on key issues. One such issue, Medicare coverage of Ozempic, highlights the philosophical divide between these two leaders and serves as a litmus test for the future of U.S. health care.
Medicare and Medicaid for GLP1-s
Ozempic, a GLP-1 receptor agonist originally developed to treat Type 2 diabetes, has rapidly gained attention for its weight-loss benefits. For many, the drug represents a breakthrough in managing obesity, a major driver of chronic diseases in the U.S.
The Biden administration proposed to expand Medicare coverage of GLP-1s beyond its use to treat type 2 diabetes or cardiovascular disease. If the Trump administration finalizes the rule, CMS estimates 7 percent more Americans would have access to the drug. But Medicaid coverage remains limited, with only 13 state Medicaid programs paying for GLP-1s for obesity treatment,
GLP-1s headline the government’s list of medicines that will be subject to price negotiations over the next year as part of the Inflation Reduction Act. In addition to traditional Medicare, these drugs, including Ozempic, will also be subject to price negotiations,
The Ozempic Debate: A Microcosm of Medicine vs. Prevention
Dr. Mehmet Oz has championed the potential of Ozempic and other GLP-1s, calling the drug ‘massively beneficial’ for improving cardiovascular health and overall quality of life. He sees expanding access to drugs like Ozempic through Medicare and Medicaid as a critical step in addressing obesity and its associated costs.
In stark contrast, RFK views Ozempic with deep skepticism. He has labeled it a ‘scam’ and insists that the true solution to obesity lies in lifestyle changes, such as eating healthier and exercising more. In interviews, he has criticized the pharmaceutical industry for profiting off what he considers preventable health issues, stating that Americans have been ‘misled’ into seeking quick fixes rather than addressing the root causes of their health problems.
RFK ’s Prevention-First Agenda
As head of HHS, RFK brings a prevention-focused vision to health care policy. He has long advocated for systemic reforms, including stricter regulations on processed foods, food additives, and environmental toxins. He aims to address obesity by overhauling the U.S. food system, rather than relying on pharmaceutical interventions. His skepticism extends beyond the GLP-1s to the broader role of the pharmaceutical industry, which he accuses of prioritizing profit over public health.
RFK plans to reallocate resources within HHS, shifting the focus of agencies like the National Institutes of Health (NIH) from infectious diseases to chronic disease prevention. However, implementing such sweeping reforms will be no easy task. HHS is a massive bureaucracy, and many of his proposals—such as limiting fluoride in drinking water or promoting the value of unpasteurized or “raw” milk—also fall under the purview of other federal agencies, like EPA and CDC. Institutional inertia and budgetary constraints may further hinder his efforts.
Dr. Oz Supports New Innovations
Mehmet Oz’s tenure at CMS will likely emphasize medical innovation and treatment. A vocal supporter of GLP-1s like Ozempic and Wegovy, Oz views such drugs as essential tools for improving public health outcomes. He has advocated for making GLP-1 inhibitors widely accessible and believes Medicare and Medicaid coverage of these drugs would yield significant long-term health benefits.
Oz’s enthusiasm for medical solutions extends to telehealth and digital health technologies, which he sees as critical for increasing access to care. His leadership may prioritize policies integrating these technologies into Medicare and Medicaid programs, potentially creating new avenues for managing obesity and other chronic conditions.
The Ozempic debate is likely the first of many policy clashes between RFK Jr. and Oz. As CMS Administrator, Oz could advocate for expanding Medicare coverage of Ozempic, while RFK Jr., as head of HHS, may push back in favor of prevention-focused alternatives
The focus may shift toward public health campaigns promoting lifestyle changes, potentially delaying access to pharmaceutical interventions for those who need them. On the other hand, if Oz’s perspective dominates, Medicare and Medicaid could see expanded pharmaceutical coverage, but at significant financial cost and without addressing the underlying causes of obesity.
Conclusion
The leadership of RFK Jr. and Mehmet Oz at HHS and CMS marks a pivotal moment for American health care. The Ozempic debate encapsulates the broader philosophical divide between prevention and medicine, offering a glimpse into the challenges and opportunities that lie ahead. Whether their approaches can coexist—or whether one will prevail—remains to be seen.
The Trump administration’s approach to Ozempic may offer a glimpse into U.S. health care policy for the next four years. How will HHS and CMS address chronic diseases, allocate resources, and balance prevention with treatment? How will Medicare and Medicaid navigate the institutional and budgetary constraints while pursuing transformative change?
Moreover, the dynamic between RFK Jr. and Oz may set the tone for how the Trump Administration handles other contentious health care issues, from vaccine policies to public health emergencies. Will their contrasting visions lead to innovation and compromise, or will their differences hinder progress?

At 12 PM on January 20, 2025, Donald Trump joins Grover Cleveland as the second President to serve two non-consecutive terms in office. As he returns to office, there is already a lot on his plate, as well as the plates of the Republican majorities in the House and Senate. All we can say is bon appétit and welcome to the Week Ahead!
The Administration
The incoming Trump administration is reportedly planning a major immigration enforcement action in Chicago. Cities such as Washington, D.C., Philadelphia, L.A., and Denver could also be sites for early immigration enforcement actions.
Trump’s early actions on immigration will set the tone for his second term and could give us a hint into how he will act on matters where immigration and health care intersect. While much of the attention will be on deportations of those implicated in serious crimes, other executive actions in the coming days could provide insights as to how federal health care programs, such as Medicaid and the Affordable Care Act, might be utilized in the effort to combat illegal immigration. For example, Trump could revive his 2019 rule to include the use of Medicaid as a qualifying factor to declare someone as inadmissible to the United States as a “public charge.” In addition, the new administration could also try to tie Medicaid funding to states to cooperation with federal immigration officials.
The Senate
Although a hearing has yet to be announced, RFK Jr. has continued hitting the Hill and meeting with senators to build support for his nomination to run the Department of Health and Human Services (HHS).
Kennedy’s push comes as some outside groups continue their campaigns to urge opposition to Kennedy’s confirmation. One group, 314 Action, announced the next phase of an advertising campaign targeting GOP senators that the group thinks could be key in determining if Kennedy can get across the finish line. The senators they are targeting include Mitch McConnell (R-KY), Lisa Murkowski (R-AK), Joni Ernst (R-IA), Bill Cassidy (R-LA), Susan Collins (R-ME), Thom Tillis (R-NC), John Curtis (R-UT), John Cornyn (R-TX), and Mike Rounds (R-SD).
In addition to the nomination process, Sen. Bill Cassidy (R-LA) has scheduled the first meeting https://hearing/of the Senate Health, Education, Labor, and Pensions (HELP) in the 119th Congress on January 21. The executive session will be when the Committee adopts its rules for the 119th Congress. If you are looking for hints on what Sen. Bill Cassidy’s (R-LA) chairmanship of the Committee will look like, look no further than the press release which highlights, among other things, his work to pass pharmacy benefit manager (PBM) reform and reduce the cost of prescription drugs in the 118th Congress.
The House
The House continues to buzz with talk of budget reconciliation and what could be considered as a part of the one (or two) bill effort. A menu produced by the House Budget Committee outlines a litany of policy options that could be considered as part of reconciliation legislation. Health care policies on that list include:
- Revoking the eligibility of non-citizens without legal status to participate in federal health programs
- Medicare site neutrality
- Limiting Obamacare premium subsidies
Keep in mind this list is meant to be a comprehensive list of possible options, so just because something is on this list does not mean it will be included in a reconciliation bill. However, it demonstrates the vast array of options that Republicans may consider as they plan to move forward with the reconciliation process.
Of course, Representatives have other choices regarding what policies to pursue. We are hearing that Ways and Means Committee Chair Jason Smith (R-MO-8) is looking to keep up the Committee’s focus on rural health care after being disappointed in the number of rural health bills that the Committee considered but were not passed into law in the last Congress. This list includes legislation allowing critical access hospitals that have shut down to reopen as rural emergency hospitals and legislation to ensure more graduate medical students complete their residency in rural hospitals.
Also, this week, the House Veterans’ Affairs Health Subcommittee will hold an oversight hearing on the Department of Veterans Affairs (VA) Community Care Program and Community Care Network on January 22.
There You Have It
The Washington Commanders defeated the Detroit Lions on January 18, earning them their first trip to the NFC Championship in 33 years. Only one more round until we get to the Super Bowl. Who do you want to head to the big game? Let us know! Make it a great week!