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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.
Congress is back in town, and the race is on to meet House Speaker Mike Johnson’s ambitious goal of passing a budget reconciliation bill by Memorial Day. Meanwhile, the Trump administration is busy with plans to change civil service classification and restructure the Department of Health and Human Services. So, with that, let’s get into it. Welcome to the Week Ahead!
The Administration
The Treasury Department is expected this week to provide an estimate of when the X Day will occur – the day on which the federal government will have exhausted its ability to pay its bills. This date is expected to be sometime in the summer or early fall of 2025.
Remember, Republican leaders in Congress included raising the debt ceiling in the reconciliation bill they are trying to pass. An earlier X Day means an earlier deadline for when Congress would need to raise the debt ceiling.
The Trump administration is also dealing with the fallout of a leaked copy of the proposed fiscal year 2026 (FY 26) budget for HHS to the Washington Post. Health care advocacy groups are concerned about the proposed $80B in cuts to discretionary spending, plans to eliminate funding for several agencies and programs, and the restructuring of several parts of the department into a new “Administration for a Healthy America.” The official budget is expected in May, and the president’s proposed budget is just that, a proposal that Congress can change or even ignore.
Proposed cuts to spending and reorganizing federal agencies are nothing new for an administration’s budget proposals. However, these proposals hit differently coming from an administration that has not been shy about exerting executive branch authority to move forward with its agenda. Case in point: the Trump administration plans to move forward with a plan to reclassify civil servants to make it easier for them to be removed.
The Senate
We don’t have dates yet for the Senate committee markups for their budget reconciliation legislation, but they are under pressure to get a reconciliation bill passed by Memorial Day. We are paying particular attention to the Senate Committee on Health, Education, Labor, and Pensions (HELP), as this committee has been instructed to find at least $1 billion in savings over ten years.
Senate Hearings
- April 29: Senate Veterans’ Affairs Committee hearing on veterans’ mental health
- April 30: Senate Appropriations Committee hearing on biomedical research
The House
The House Committees on Armed Services, Education and Workforce, and Homeland Security will kick off the reconciliation markup process on April 29. House Energy and Commerce Committee is still working to find $880B in savings including what and how much Medicaid spending will be cut.
Based on conversations with the Hill, Republican leadership thinks it can get to $500B over ten years by addressing “waste, fraud, and abuse” within the Medicaid program, according to previous work from the Government Accountability Office.
Other potential sources of savings within the Medicaid program that have been mentioned include work requirements, changes to provider taxes, and penalties on states that provide care for undocumented immigrants. Republicans are saying other non-Medicaid policies, such as cuts to Medicare Advantage plans and policies to address Medicare reimbursement for physicians, are unlikely for reconciliation but could come later in the year.
House Hearings
- April 29: House Education & Workforce Committee markup of reconciliation directives and H. Res. 344, a resolution directing President Trump and HHS Sec. Kennedy to provide documents related to the elimination of the Administration for Community Living
- April 29: House Energy and Commerce Committee markup of 6 health care bills (not reconciliation)
- April 29: House Veterans’ Affairs Health Subcommittee hearing on reforming state veterans homes
- April 30: House Veterans’ Affairs Oversight and Investigations Subcommittee hearing on the VA’s mental health policies
- April 30: House Education & Workforce HELP Subcommittee hearing on ERISA
There You Have It
If you need a break from betting on the likelihood that Congress will pass a reconciliation bill by Memorial Day, the 151st Kentucky Derby takes place on May 3. Do you have plans to watch? Make it a great week!
