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Lawmakers return to D.C. following tragic plane crashes in Arlington, VA and Philadelphia, PA, amid a number of questions regarding airline safety. Congress continues consideration of President Trump’s cabinet nominees as well as discussions on budget reconciliation and government funding. So, with that, let’s get into it. Welcome to the Week Ahead!
The Administration
The Centers for Medicare and Medicaid Services (CMS) issued a presser on January 29 commenting on the Biden administration’s recent release of the next 15 drugs to be included in the second cycle of Medicare prescription drug price negotiations. CMS intends to “provide opportunities for stakeholders to offer specific ideas to improve the Negotiation Program consistent with the goals of achieving greater value for beneficiaries and taxpayers and continuing to foster innovation.”
Allowing the government direct negotiating power in the Medicare prescription drug program (Part D) was a signature achievement of the Inflation Reduction Act and has been a policy goal for Democrats going back to the creation of the Part D program. President Trump’s position on Medicare drug price negotiations is murky at best. While he hasn’t always held to traditional conservative positions on drug policy, Democratic Members of Congress aren’t taking any chances and are asking for Trump to reject any effort to undo the Medicare negotiation policy.
The Senate
The name of the game for the Senate continues to be confirming President Trump’s nominees. On February 4, the Senate Finance Committee will hold an Executive Session to vote on the nomination of RFK Jr. to be the Secretary of the Department of Health and Human Services (HHS). This vote follows hearings at both the Senate Finance Committee and the Senate Health, Education, Labor, and Pensions (HELP Committee) where RFK Jr. received widespread support from Republicans (although there were some grumblings from a few HELP GOP Members about Kennedy’s position on vaccine safety and efficacy). Since the Senate Finance Committee is the only committee that will vote on Kennedy’s nomination, the next step after the February 4 vote (assuming the committee advances the nomination) will be a vote on the Senate floor for confirmation.
The Senate Finance Committee will also consider Jamieson Greer for U.S. Trade Representative on February 6. The U.S. Trade Representative can have a significant impact on health care policy as they work to implement the President’s trade agenda.
In Trump’s case, that agenda includes the use of tariffs. Even though the Constitution gives Congress the authority to lay and collect duties on imported goods, Congress has given the President authority to change tariff rates if the administration can make the case that doing so is in response to specific national security or foreign policy interests.
President Trump made use of these authorities during his first administration and has promised to impose tariffs on imported products including medical supplies and prescription drugs. The Trump Administration and other Republicans argue that these tariffs are necessary to protect American industry and reduce the nation’s dependence on foreign countries for critical supplies such as medicines. Opponents raise concerns that tariffs may lead to increased prices and more shortages of generic drugs. We expect tariffs to be a major topic of conversation at Greer’s hearing.
The House
Rep. Greg Murphy (R-NC) and a bipartisan group of lawmakers introduced the Medicare Patient Access and Practice Stabilization Act of 2025 on January 31. This bill would provide physicians with a 6.62% increase in Medicare reimbursement rates that would be retroactive to the start of 2025 when a 2.8% reimbursement rate reduction went into effect. Addressing concerns about the Medicare reimbursement rates for physicians has long been a priority for doctors. When Congress didn’t step in to mitigate the impact of the reimbursement rate reduction at the beginning of the year, physician groups were disappointed. But the introduction of this bill gives some hope that some relief from the payment cut that took effect on January could happen. That said, introducing the bill is just the first step in a year packed with government funding decisions and budget reconciliation.
Speaking of budget reconciliation, it is unlikely that House Speaker Mike Johnson (R-LA) will be able to meet his optimistic goal of passing a budget resolution by February 27. This is especially true given reports of a phone call between members of the House Budget Committee that apparently failed to produce a date for marking up the resolution. Speaker Johnson is now reportedly pushing expectations back to May 2025, a timeline more in line with recent Congresses. A later date is also an acknowledgment of the difficulty of passing a partisan resolution where just one or a few GOP defectors could be spoilers.
Also Happening This Week
- 2/5: House Natural Resources Subcommittee on Indian and Insular Affairs legislative hearing on bills including H.R. 741, to elevate the Director of the Indian Health Service (IHS) to an Assistant Secretary position (Note: RFK Jr. has said he will elevate the IHS Director to an Assistant Secretary position if confirmed as HHS Secretary).
- 2/6: House Energy and Commerce Health Subcommittee hearing on the threat of illicit drugs.
There You Have It
The 2025 GRAMMYs were awarded on February 2, with a special effort to raise funds for those impacted by the L.A. wildfires. Did your favorites win? Let us know! Make it a great week!
Medicare Advantage (MA) plans have become increasingly popular in recent years, offering seniors and those with disabilities an alternative to traditional Fee-For-Service (FFS) Medicare by providing additional benefits such as vision, dental, and wellness programs. As the program’s popularity grows, its future is becoming a critical issue in the health care policy arena. The upcoming finalization of the 2026 MA rule by the Trump Administration underscores the timeliness of this discussion. Furthermore, remarks from Republican leaders, including support from figures like Centers for Medicare and Medicaid Services (CMS) Administrator nominee Dr. Mehmet Oz, have floated the possibility of expanding the program. However, while expansion may seem attractive, there are significant practical and political challenges that must be addressed to succeed.
Practical Challenges
Although MA plans offer appealing benefits, their expansion presents several practical hurdles. These challenges raise concerns across the political spectrum and could complicate efforts to broaden the program’s reach.
Provider Network Limitations
One key issue is the restriction of provider networks within MA plans. Critics argue that these limitations can jeopardize seniors’ access to their preferred doctors or hospitals, particularly in rural areas with limited provider options. Ensuring that concerns about network adequacy are addressed will be critical for any attempts to expand MA.
Complexity in Choosing Plans
The rapid proliferation of MA options has introduced another challenge: choice overload. With so many plans available, it can be challenging for seniors to navigate their options and fully understand what each plan offers. Lawmakers and stakeholders have voiced concerns about whether beneficiaries have the necessary information to make informed decisions. Expanding the MA program could compound this challenge.
Cost Concerns
Expanding MA could place additional strain on federal budgets. In its 2024 MA status report to Congress, the Medicare Payment Advisory Commission (MedPAC) estimated that MA plans would receive $83 billion more in payments than traditional Medicare. Program critics could resist proposals for expansion unless it’s clear how costs will be managed without sacrificing the quality or scope of coverage.
Prior Authorization Reform
Another practical challenge is prior authorization requirements within MA plans. Republicans and Democrats have criticized these requirements for leading to improper coverage denials and delaying or denying beneficiaries access to necessary care. The bipartisan interest in prior authorization reform—evidenced by widespread support for related legislation in the last Congress—will likely need to be addressed before any meaningful expansion can proceed.
Political Challenges
The practical challenges of expanding MA also translate into political obstacles, which could hinder further efforts to grow the program.
Resistance from Seniors
Some seniors, a key voting bloc, may resist changes to MA, particularly if they perceive reforms as threatening their access to care. Concerns about limited networks and burdensome prior authorization requirements have already drawn criticism. These issues and lingering memories of political fallout from previous health care reform efforts (such as the Affordable Care Act’s repeal-and-replace saga) may bring political risks for those who want to expand the program.
Opposition from Health Care Providers
Some health care providers, especially those in rural areas, have voiced opposition to MA due to lower reimbursement rates and coverage limitations. Rural hospitals and providers are significant voices in rural communities, and addressing any concerns they raise will be essential to gaining political support for expansion. Without buy-in from these stakeholders, efforts to expand the program could be derailed.
Partisan Divisions
MA has historically aligned with conservative ideals of promoting private sector involvement in Medicare, while program skeptics, particularly among liberals, have raised concerns about the program’s cost and accessibility. Although ideological divisions on MA have softened since the program’s inception, how much Democratic support there might be for expanding MA is unclear. Given the razor-thin Republican majority in the House and the need for bipartisan support in the Senate (where filibuster rules require 60 votes for most legislation), political divisions could make passing expansion measures particularly challenging.
Conclusion
Expanding MA may offer potential benefits for seniors, but it also may present practical and political challenges. From concerns about provider networks and plan complexity to disagreements over costs and program oversight, these hurdles must be addressed before any expansion effort can gain traction. For those who might support expansion, crafting policies that mitigate these challenges will be key to moving forward with any proposals to grow MA. Ultimately, success will depend on balancing the needs of beneficiaries, health care providers, and political stakeholders while ensuring the program remains sustainable and accessible.
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.
