Check out our expert take on key activity shaping health care policy
Insights
Featured Blogs
Yep, we are using the title of the great Charles Dickens’ novel to describe the Senate and House this week. Their visions for a budget are vastly different and they need to come together to make “one big, beautiful bill.” Will they choose “the age of wisdom” or “the age of foolishness?” It’s all in the eyes of the beholder, isn’t it? With that, let’s get into it. Welcome to the Week Ahead!
The Administration
SOTU? Nope…it’s actually called a joint address to Congress. President Trump will address a joint session of Congress on March 4, marking his first major speech since beginning his second term. (While often referred to as a State of the Union (SOTU), a president never delivers an official SOTU address in the first year of a new term.) President Trump is expected to outline his administration’s policy priorities, including recent plans to impose new tariffs on imports from China, Mexico, and Canada, as well as his approach to foreign relations, particularly concerning Ukraine.
We are wondering about what scooby-snacks the President will hand out this year. Recall previous made-for-television addresses where he would announce special awards to gallery attendees….
Democrat response… who’s the party’s next rising star? Senator Elissa Slotkin of Michigan, who previously served in the House and flipped a red district in 2018 before narrowly winning her Senate seat in a state that Trump also carried, will deliver the party’s response. She will highlight alternative policy perspectives with a focus on kitchen-table issues and protecting Medicaid and Medicare. The speech is often a launching pad for a rising star to spotlight party priorities and establish a national presence.
Overturning 50 years of precedent, HHS posted a policy that exempts from public comment matters related to “agency management or to public property, loans, grants, benefits, or contracts,” calling the process inefficient to the operation of the Department. Notice and public comment will continue for all matters required by statute.
Connect the dots with a DOGE executive order for a 30-day sprint to review and reduce Federal contracts, grants, and loans related to immigration, law enforcement, the military, public safety, and the intelligence community.
DOGE is coming for you, HHS. Think CMMI contracts, HRSA grants and loans, NIH.
The Senate
Order up, it’s health care nominations in the Senate. We will hear from Jayanta Bhattacharya, nominee to head the National Institutes of Health on March 5, and Dr. Marty Makary to lead the Food and Drug Administration on March 6.
What should we expect? For NIH, hot topics will include the slashing of indirect costs for researchers, job eliminations in the federal government, and what the research agenda will be for the administration. For FDA, well yes, vaccine safety and efficacy, but don’t forget about the drug and device approval process, supply chain and US manufacturing of drugs, and the controversial lab-developed test rule.
And don’t forget (how could we) that the government funding runs out March 14, and the health care extenders at the end of March. While Republicans and Democrats were working to complete their FY 2025 bills, it’s looking increasingly likely another continuing resolution is in the offing. This time, the extension would run through September 30 with another extension. Riding along would be the health care extenders through September 30 and December 31.
Senate hearings this week
- March 5: Senate HELP confirmation hearing of Jayanta Bhattacharya for NIH
- March 6: Senate HELP confirmation hearing of Jayanta Bhattacharya for NIH
- (and don’t forget March 6-7 is MedPAC)
The House
The hard work of hammering out a budget bill begins. While the Speaker delivered “one big, beautiful bill,” he signaled his support for the Senate Republican leadership’s approach to taxes. Can Speaker Johnson get his fiscal hardliners on board? Senate and House Republican leaders will be meeting this week (and beyond) to determine how best to craft a budget resolution that achieves the President’s domestic agenda AND pass both chambers.
Don’t forget, they must pass the same budget, then the committees have to figure out which policies to fit the budget, then both chambers have to pass that whole budget reconciliation package. The Speaker has stated his goal of delivering a final reconciliation package to the President in May.
One person to keep an eye on is Rep. Elise Stefanik (R-NY) as Senate Republicans have yet to confirm her for the U.S. Ambassador to the United Nations. Her vote has been an important one for Speaker Johnson as Republicans have 2 vacancies in Florida that will not be filled until early April. But with the world scene heating up, how much longer the White House is willing to wait for her nomination is unclear.
In an effort of bipartisanship, the House will take up the Chronic Disease Flexible Coverage Act . Sponsored by Reps. Vern Buchanan (R-FL) and Jimmy Panetta (D-CA), the bill would codify an IRS policy stating that employers who offer high-deductible health plan coverage for their employees the option of including pre-deductible coverage for chronic illnesses.
There You Have It
Did you know that A Tale of Two Cities is considered historical fiction? We in DC feel sometimes we are both working on history and fiction at the same time! What’s your favorite genre? Let us know! Make it a great week!
The Trump administration has put vaccine policy back in the spotlight. With changes in leadership and executive orders multiplying, everyone wants to know – where are we going?
Vaccine Mandates – Where Are We?
Military Vaccine Mandates
President Trump has signed executive orders aimed at reinstating service members who were discharged for refusing COVID-19 vaccinations. The measures include restoring rank and providing back pay. While some argue this move is necessary to rectify unfair dismissals, others like the National Institute of Health (NIH) worry about its implications for military readiness and health protocols.
Educational Institutions
In a recent executive order, President Trump directed the Department of Education to withdraw federal discretionary funding from educational institutions – schools and universities – requiring students to have a COVID-19 vaccine to attend in-person classes. This policy marks a stark departure from previous public health initiatives that aimed at curbing vaccine-preventable diseases in educational settings. Experts warn that such measures could lead to lower vaccination rates among school-aged children, increasing the risk of outbreaks.
Health Care Workers
The Trump administration has not yet issued any executive orders relating to health care workers and their vaccination status. Health care workers are advised to receive several vaccines, including Hepatitis B, flu, COVID-19, varicella, MMR, Tdap/Td, and meningococcal. While some states require health care employers to offer the flu vaccine, it is not mandatory. The Occupational Safety and Health Administration (OSHA) mandates that employers offer the Hepatitis B vaccine to workers with occupational exposure. The Centers for Disease Control and Prevention (CDC) recommends annual flu shots, COVID-19 vaccines, and other immunizations to prevent outbreaks in health care settings.
A New Dose of Debate: Vaccine Policy Issues on the Horizon
Secretary of Health and Human Services Robert F. Kennedy, Jr.
Secretary of Health and Human Services Robert F. Kennedy, Jr. made his case during his confirmation hearings that he is not anti- or pro-vaccine but pro-safety. Although he didn’t win over the vote of Senate Democrats, he did win the crucial vote of Sen. Bill Cassidy (R-LA), a physician by training, and chair of the powerful Senate HELP Committee. Sen. Cassidy remained clear that Sec. Kennedy promised him that he would uphold the public health value of vaccines.
Make America Healthy Again Commission
Speaking of Sec. Kennedy, he will head the newly formed “Make America Healthy Again Commission,” an effort to bring high-level attention to and government collaboration on preventing chronic diseases in children. While the Commission could have addressed vaccine safety and vaccine mandates for children, the executive order establishing the effort does not mention vaccines.
ACIP Panel Is Delayed
The Advisory Committee on Immunization Practices, a group of health experts who develop recommendations on the use of vaccines at the CDC, recently announced a delay in one of their regular meetings. The committee, which meets only three times a year, explained that the delay was due to the need for additional time for public comment. The delay came days after Sec. Kennedy stated he would investigate if childhood vaccine and anti-depressant medications are linked to chronic disease. The committee’s meeting agenda is set to cover numerous vaccines including meningococcal, influenza, and chikungunya.
Who is Calling the Shots?
The nominations of Dr. Dave Weldon as the CDC Director and Dr. Marty Makary as the Federal Drug Administration (FDA) Commissioner have raised concerns among public health experts due to their critical or skeptical views on vaccine mandates.
Weldon, a former congressman and medical doctor, has questioned the safety of vaccines and has been particularly outspoken on the now-debunked view that vaccines can cause autism. Makary, a surgeon and author, opposed vaccine mandates and some other public health measures during the COVID-19 pandemic.
If confirmed, their leadership could signal a shift in public health strategy, potentially moving away from stringent vaccine mandates toward a more flexible and individualized approach. This change may result in revised communication strategies, potentially altering public perception and compliance with vaccine recommendations. These approaches to vaccine communication and policy could dramatically influence compliance rates and overall public health outcomes
Implications for the Public and Health Care Providers
Public Health Outcomes
One of the major concerns about rolling back vaccine mandates is the potential resurgence of vaccine-preventable diseases.
In 2024, Oregon experienced its most significant measles outbreak since the early 1990s, with 31 confirmed cases—the highest in over three decades. All cases occurred among unvaccinated individuals, predominantly children under 18. The Oregon Health Authority noted that the first cases were identified in June, with no new cases reported after August 11, 2024. As children returned to school and the respiratory virus season approached, health officials emphasized the critical importance of vaccination.
Historically, school vaccine mandates played a crucial role in eliminating diseases like measles in the U.S. If vaccination rates decline, outbreaks of diseases once thought to be under control could become a pressing public health crisis.
Health Care Providers
Lower vaccination rates could result in increased health care utilization as preventable diseases reemerge, placing a significant strain on hospitals and providers. A surge in vaccine-preventable illnesses may lead to overcrowded emergency departments, higher hospitalization rates, and increased demand for intensive care services, stretching already limited resources. Additionally, as health systems allocate more time and funding to managing outbreaks, routine and elective care may be disrupted, further compromising patient outcomes.
The Vaccine Gamble Ahead
The election of President Trump and the confirmation of Sec. Kennedy signal a new era for vaccine policy in the US. Further review of vaccine safety and efficacy, as well as a potential reversal of decades of public health initiatives, seems like the future. As the FDA and CDC heads go through the confirmation process and get installed in their agencies, it seems like the future is now.
Valentine’s Day may be past, but congrats to our very own Zach Schulz who got married over the weekend! With tensions high on Capitol Hill, we could use some newlywed love around here. Let’s get into it, welcome to the Week Ahead!
The Administration
We have two questions for President Trump on the budget reconciliation debate. (Well, we have a lot more than 2 questions, and want to know way more than just what he thinks about the budget, but let’s stay focused, people.)
First, about that “one big, beautiful bill.” The President surprised a lot of folks – including Senate Majority Leader John Thune (R-SD) and Budget Chairman Lindsey Graham (R-SC) – when he publicly endorsed the House bill over the Senate bill. At this point, he has expressed openness to multiple different budget bills to finance $4.5 trillion in tax cuts and achieve his domestic agenda.
The Senate approach takes 2 bites at the apple and is ostensibly an easier path. The Senate bill that passed February 20 is much cheaper ($340 billion), requiring less government spending offsets. The House takes 1 bite and loads up on Medicaid cuts to offset the costs of making the 2017 tax cuts permanent.
Second, where is he on Medicare and Medicaid? In a statement to Politico on February 19, the White House said they were “committed to protecting Medicare and Medicaid while slashing the waste, fraud, and abuse within those programs.” Later that day, an updated statement was released leaving out the word Medicare. Then the endorsement of the House bill which contemplates an eye-popping $880B of changes to Medicaid.
Feeling some whiplash? So are we.
So where is his head? The President wants what he wants right away. While complicating the legislative process, he’s been completely consistent about driving the conversation and letting the Republican Congress deal with the mess. Expect more unexpected.
The Senate
The Senate budget has no explicit reforms to Medicaid and Medicare but does include direction to the Senate Finance Committee to identify at least $1billion in savings. While Senate Republicans point to their fervent interest in repealing the minimum staffing rule for nursing homes to achieve their budget target, Senate Democrats and advocates warn the Senate approach may lead to cuts in Medicaid and Medicare.
Now what? The Senate moves on this week to nominations – noms, noms, and more noms – as they eagerly watch the drama over in the House. In case you missed, Sen. Mitch McConnell (R-KY), the strategist behind Senate judicial nominations – announced he won’t seek re-election in 2026.
What about the March 14 government funding deadline? With rumors that the Senate and House Appropriations leads have reached a deal on the overall dollar figure, Ranking Member Patty Murray (D-WA) warned against a long-term continued funding resolution where Congress would relinquish the power of the purse to President Trump and Elon Musk.
Senate hearings this week
- 2/26: Senate Aging Committee hearing on Combating the Opioid Epidemic
The House
The House is coming back to DC from time in their districts hearing from constituents about President Trump’s recent actions and the House budget. They are getting an earful about the impact that potential cuts could have on access to health care for the millions who rely on the Medicaid safety net.
Speaker Mike Johnson (R-LA) and House Republican leadership don’t seem deterred and are set to vote on the budget February 25.
Will it pass? Well, that President Trump endorsement certainly will help.
With 218 Republicans in the House, they can only afford one Republican defection if they want to pass the bill. Even Republicans who have aired concerns about the impact on Medicaid and Medicare are expected to vote to pass the budget to move the process forward
Don’t expect House Republicans to hold together for long. Keeping Republicans on board with that plan will only get more challenging as the House and Senate try to iron out the differences in their budget approaches, and then craft the program changes the budget requires.
House hearings this week
- 2/24: House Rules Committee hearing on the House budget bill
- 2/26: House Energy and Commerce Health Subcommittee hearing on Pharmacy Benefit Manager Practices
There You Have It
What advice do you have for Zach and Debra? ChatGPT advises learning to compromise, communicating openly, and supporting each other through conflict. What’s yours? Let us know! Make it a great week!
On February 11, 2025, the House Ways and Means Health Subcommittee held a hearing on “Modernizing American Health Care: Creating Healthier Options and Better Incentives.” The committee discussed the rise in chronic diseases in the U.S. and addressed the importance of preventative screening and services.
