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The clock keeps ticking toward September 30, and the stakes are particularly high given that Congress is out next week for the Rosh Hashanah holiday. This week, the stakes feel particularly high. All eyes are on Senate Minority Leader Chuck Schumer (D-NY) as he has taken a strong stance on what he wants for his support on must-pass government funding legislation. The central question: Will Congress find a path forward on critical health care provisions, or are we headed toward yet another shutdown showdown? So – let’s get into it, welcome to the Week Ahead!
The Administration
It’s politics and prose with the administration this week. On the political side, President Trump and Vice President Vance are expected to continue focusing on the brutal murder of political activist Charlie Kirk. Both will be attending Kirk’s funeral, and the President has announced he will honor Kirk with a posthumous Presidential Medal of Freedom. In addition to eulogizing the fallen leader, the President has taken to excoriating progressive politicians and organizations and has said he will launch investigations into “groups of interest” that may have fed into the torment that led to the assassination.
On the prose front, the Centers for Medicare and Medicaid Services are pouring through stakeholder comments to the calendar year payment rules, including hospital outpatient, physician fee schedule, home health, and end-stage renal disease. While CMS often includes policies that health care providers seek to tone down during the comment period, of particular focus is the home health rule that takes $1 billion in payments away from home health providers, according to the National Home Care Alliance.
In other exciting news, CMS released guidance on September 15 for states to submit their applications for the $50B Rural Health Transformation Program. This guidance provides states with the official roadmap for accessing a major new federal investment aimed at strengthening health care in rural areas.
The Senate
The Senate is bracing for a fierce battle over advanced premium tax credits (APTCs), a cornerstone of affordable health coverage for millions of Americans. Schumer is holding firm, insisting that any continuing resolution (CR) to keep the government open must include an extension of these subsidies.
Schumer, who faced intense backlash from his caucus after siding with Republicans on a funding measure in March, is determined not to repeat that mistake. He has already made it clear to reporters—no APTCs, no CR.
Republicans, meanwhile, are pushing for a “clean CR” that would extend all existing programs and funding, including health extenders such as Medicare add-on payments for rural hospitals, funding for community health centers, the Teaching Health Center Graduate Medical Education program, and delays to Disproportionate Share Hospital (DSH) cuts.
Under normal circumstances, compromise might be within reach. But with the political climate highly charged, APTCs looming large, and open enrollment around the corner, Schumer appears unlikely to back down. The result? A heightened risk of a government shutdown—one that could leave both APTCs and health extenders hanging in the balance.
Senate Hearings this Week
- September 17: Senate Committee on Aging Hearing on Drug Safety, Supply Chains, and Risk to Aging Americans
- September 17: Senate HELP Hearing on “Restoring Trust Through Radical Transparency: Reviewing Recent Events at the Centers for Disease Control and Prevention and Implications for Children’s Health”
- September 17: Senate Committee on Veterans’ Affairs Hearing on Strengthening Services for Veterans with Spinal Cord Injury and Disorder
The House
Over on the House side, the question is whether leadership will try to force the Senate’s hand by moving its own appropriations bill. Democratic Leader Hakeem Jeffries (D-NY) has remained tightly aligned with Schumer, keeping the focus squarely on APTCs.
At the same time, Congress is feeling pressure from stakeholders to avoid any lapse in health extenders. Hospitals, health centers, and other providers depend on predictable funding to plan services, retain staff, and keep doors open—especially in rural and underserved areas. A disruption, even a temporary one, could have real-world consequences for patients.
Word is that some time on September 15 we will see the text of a “clean” CR that would run through November 20 or 21. House Republican leaders were said to be close to putting the final touches on a CR. The CR is said to extend expiring health provisions through the length of the CR and not include the APTC extension the Democrats have been calling for. House Republicans are reportedly eyeing September 17 for a vote on the CR.
Later this week, attention will be on the Medicaid and CHIP Payment Access Commission (MACPAC) as they meet for the first time since Congress passed the One Big Beautiful Bill Act. The meeting will include a review of the legislation and start to explore the work and community engagement requirements in Medicaid.
House Hearings this Week
- September 16: House Ways and Means Hearing on “Virtue Signaling vs. Vital Services: Where Tax-Exempt Hospitals are Spending Your Tax Dollars”
- September 18: House Energy and Commerce Health Subcommittee Hearing on Legislation to Expand Seniors’ Access to Innovative Medical Care
There You Have It
September marks Healthy Aging Month—a perfect reminder to celebrate every stage of life and enjoy the fall season. Make it a great week!
On September 4, 2025, the Senate Finance Committee held a hearing on the President’s 2026 health care agenda. Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. (RFK) testified to the committee. Democrats along with moderate Republicans raised concerns regarding vaccine mandates and guidelines while conservative Republicans applauded Sec. Kennedy’s actions addressing the chronic disease epidemic and the Rural Health Transformation Fund that was produced from the One Big Beautiful Bill Act.
Opening Statements
Witness Testimony
Member Discussion
Vaccines
During the hearing, several senators pressed Sec. Kennedy on his vaccine policies and his broader approach to science and trust in public health. Sen. Michael Bennet (D-CO) highlighted that in June, Kennedy dismissed the entire federal vaccine advisory panel and challenged him on whether he truly believed one of the replacement doctors who publicly claimed that mRNA vaccines cause HIV. Kennedy defended his decision, stating the doctor he appointed has done the research.
Sen. Bill Cassidy (R-LA) continued the line of questioning, pointing out that Kennedy had just told Sen. Bennet that the COVID-19 vaccine had killed more people than the virus itself. Sen. Cassidy noted
Kennedy’s role as a lead attorney in multiple lawsuits restricting access to COVID-19 vaccines and criticized his cancellation of $500 million in federal contracts tied to mRNA technology. Sec. Kennedy responded by praising Operation Warp Speed as a genius initiative that succeeded by delivering vaccines quickly without mandates, but he doubled down on his opposition to later vaccine requirements and contracts that, in his view, entrenched mRNA technology in federal policy. Sen. Cassidy pressed further on Kennedy’s stated commitment to avoid conflicts of interest within health agencies, pointing out that many of the individuals Kennedy has nominated for awards or advisory roles have received revenue as paid witnesses in lawsuits against vaccine manufacturers. Sec. Kennedy countered that such arrangements inherently create conflicts, arguing that “if we put people who are paid witnesses on suing vaccines, it is a conflict of interest.” Sen. Cassidy also reminded Kennedy that he had previously promised not to take vaccines away from the public, yet his policies have placed restrictions on COVID-19 vaccine use.
Sen. John Barrasso (R-WY) stated unequivocally that vaccines have saved 54 million lives and that he personally supports their continued use. He reminded Sec. Kennedy of his promise to uphold scientific standards in federal vaccine policy and expressed concern about the Secretary’s repeated skepticism. Sen. Barrasso pressed Kennedy to explain how he would ensure vaccine policy remains “clean and trustworthy.” Kennedy replied that children are currently receiving too many vaccines that, in his view, “have not even been tested,” suggesting that the administration would focus on reevaluating the pediatric vaccine schedule rather than endorsing it wholesale.
Sen. Maria Cantwell (D-WA) added to the critique, accusing Kennedy of undermining public trust in science by refusing to accept mRNA technology as legitimate. Kennedy believes that it has not undergone sufficient study.
Rural Health and Hospital Financing
Senators also focused heavily on the state of rural health care and hospital financing. Chairman Mike Crapo (R-ID) pointed to the inclusion of the Rural Health Transformation Fund in the One Big Beautiful Bill (OBBB), asking Secretary Kennedy to comment on its purpose and implementation. Kennedy framed the fund as a fulfillment of former President Trump’s campaign promise, describing it as a response to what he called a “crisis in rural health.” He noted that rural communities not only depend on hospitals for care but also for some of the highest-paying jobs in their regions, making the stability of these institutions vital to both health and local economies. Kennedy added that the administration has already directed roughly half of the fund’s investments into targeted rural initiatives.
Sen. Mark Warner (D-VA), however, raised concerns that despite these commitments, rural hospitals remain at risk of closure, particularly in the face of projected Medicaid cuts. He asked Kennedy whether he would support legislation to raise the area wage index floor to 80%, a measure intended to level reimbursement rates for rural hospitals and prevent destabilization. Kennedy responded that President Trump supports the wage index change, indicating alignment with congressional efforts to preserve rural hospital viability.
PBM Reform
Sen. James Lankford (R-OK) raised concerns that Medicare Advantage plans are withholding payments and asked Sec. Kennedy what actions HHS is taking to address pharmacy benefit managers (PBM) practices. Kennedy emphasized that PBM reform is a top priority for the president, noting that the administration is in active discussions with both PBMs and pharmaceutical companies to pursue meaningful changes. He underscored the administration’s intent to create a fairer system that does not disadvantage pharmacies, particularly in rural areas.
Sen. Catherine Cortez Masto (D-NV) shifted the focus to the direct impact on patients, asking Kennedy how much Medicare Part D enrollees should expect to pay for their prescription drugs in the coming year and what the projected premium increases would be. Kennedy acknowledged that these details remain unsettled, conceding that the administration does not yet have definitive numbers. His response suggested ongoing debate within the administration and Congress over how costs will be shared between the federal government, insurers, and beneficiaries.
Sen. Marsha Blackburn (R-TN) reinforced the bipartisan concern about PBM practices by pointing to the PBM Act, which she and Ranking Member Ron Wyden (D-OR) co-authored, and highlighted its role in keeping rural pharmacies from shutting down. She asked Kennedy to confirm whether this legislation would reach President Trump’s desk for signature. Kennedy assured her that it would, signaling alignment between the administration and Congress on moving PBM reform forward.
Other Topics in the Discussion
- Sen. Cantwell asked whether Sec. Kennedy supported maintaining the Affordable Care Act’s Advance Premium Tax Credits (APTCs), which are scheduled to expire. Kennedy responded that Democrats had failed to make the APTCs permanent, and while he supports fixing the system, his focus is on lowering premiums more broadly rather than extending temporary relief.
- Sen. David Daines (R-MT) asked if HHS would consider Montana’s waiver to expand Medicaid with work requirements for able-bodied adults. Kennedy said yes.
- Multiple Democrats asked about the decision to fire the CDC Director, Susan Monarez.
- Sen. Blackburn asked about CMS’s new interoperability framework and how it aligns with existing frameworks. Kennedy admitted alignment is still uncertain.
- Sen. Sheldon Whitehouse (D-RI) raised the “two-midnight” hospital stay requirement before patients qualify for skilled nursing care. Kennedy offered to work with senators directly on the issue.
We remember learning in school that an apple a day keeps the doctor away, but we don’t remember learning in civics class that health care would be so political! The politics of health and health care are dominating DC this week – and honestly we love it! Let’s get into it – welcome to the Week Ahead!
The Administration
While we expected vaccine policy to dominate HHS Secretary Robert F. Kennedy Jr.’s appearance before the Senate Finance Committee on September 4, we weren’t necessarily expecting the announcement coming of the State of Florida on working to end vaccine requirements for children in school. Vax politics seem to just be getting started with red and blue states moving forward with their own mandates.
One thing that brings red and blue states together is rural health. States are eagerly awaiting the funding notice of the Rural Health Transformation Fund – the $50 billion initiative aimed at spurring innovation and strengthening rural health care. Congress gifted this opportunity to the administration in the Big, Beautiful Bill, but they seem to be downplaying its potential political benefit in red and purple states with large rural areas. So far.
The Senate
With government funding running out on September 30, the Senate is focused on negotiating a continuing resolution (CR) to fund the government for a short period of time, and Republicans will need Democratic support to avoid a shutdown. Conversations are revolving around a short-term extension into November or December.
Senate Majority Leader Chuck Schumer (D-NY) faces a critical test. After facing backlash from within his own party in the last round of negotiations to fund the government, he may be willing to risk a shutdown to gain leverage. The Trump administration’s pocket rescission package has already heightened tensions, increasing the likelihood of a standoff. Schumer’s price for supporting the CR could be securing an extension of the advanced premium tax credits (APTCs, more on that later) or including language to restrict consideration of another rescissions package.
Congress could theoretically include language in a CR to block consideration of a future rescission package, but doing so would be procedurally difficult and politically risky. Such a move would require adding a “rider” to the CR, which is often controversial because appropriations bills are meant to fund the government, not legislate policy. Riders also face hurdles under House and Senate rules, potential challenges under the Impoundment Control Act of 1974, and even constitutional disputes over separation of powers.
Don’t forget – we haven’t – that all those health care extenders also expire on September 30. A likely scenario is that the policies get extended for the same amount of time as the CR. Been there, done that before.
Senate Health Hearings
- September 9: Senate Homeland Security & Government Affairs Permanent Subcommittee on Investigations Hearing on “How the Corruption of Science has Impacted Public Perception and Policies Regarding Vaccines”
The House
A bipartisan bill to extend the APTCs was introduced in the House September 4, but its prospects for movement are unclear. The proposal is rumored to score upwards of $26 billion, a cost that could complicate efforts to secure broader support, especially at a time when lawmakers are divided over spending priorities and deficit concerns loom large.
While stakeholders—including insurers, consumer groups, and state officials—and many House members are urging action in September, it is unclear at best if an APTC extension will move forward this month. To stand a chance, any legislative effort may need to be narrowly crafted to draw bipartisan backing and fit within the broader fiscal environment.
Delaying past September is problematic as health plans are legally required to finalize and publish their 2026 premium rates in October, and those rates depend heavily on whether APTCs are extended. Without clarity from Congress, insurers face a moving target, making it difficult to set prices and communicate accurate information to consumers.
If lawmakers fail to act in September, the issue could become entangled in larger, high-stakes negotiations over appropriations and how to keep the government funded into 2026. While there is bipartisan support for extending APTCs, the combination of cost, timing, and political dynamics makes the path forward highly uncertain—and stakeholders are growing more nervous by the day. That group includes vulnerable Republican House members thinking about their 2026 re-election bids.
House Health Hearings
- September 9: House Appropriations Subcommittee on Labor, HHS, Education and Related Agencies Full Markup
There You Have It
When it comes to the politics of health care, check out KFF’s Public Opinion tracking site. Currently trending is their research on who may or may not get the COVID-19 this fall and whether parents – including self-identified MAGA parents – agree with Florida’s move on vaccines for school entrance. Make it a great week!
With Congress back, the long recess is giving way to high-stakes maneuvering. Congress returns with less than a month to hash out a continuing resolution (CR) before government funding lapses, and deadlines across health policy are stacking up. So, let’s get into it – welcome to the Week Ahead!
The Administration
The CDC is grappling with a sudden leadership vacuum after Director Susan Monarez was fired just weeks after her confirmation. Multiple senior officials resigned in protest, and protest actions erupted among CDC staff. For now, Deputy HHS Secretary Jim O’Neill has assumed the role of acting CDC director. Will the administration seek a new head that aligns with the vaccine policies of Secretary of Health and Human Services (HHS) Robert F. Kennedy Jr., or hold for now? Don’t forget – the CDC director used to simply be appointed and not Senate confirmed.
September isn’t just back to school season; it’s also crunch time for the Rural Health Transformation Fund. States are eagerly waiting for the administration to start publish guidelines and next steps for applications. The clock is ticking toward the December 31, 2025 deadline, so once guidance is out, the scramble to put together strong proposals will begin.
Several states aren’t waiting around—no less than 20 states have already signaled their interest with early requests for information (Alaska, Georgia, Hawaii, Illinois, Indiana, Mississippi, Missouri, Montana, Nevada, North Carolina, North Dakota, Pennsylvania, Oklahoma, Oregon, South Carolina, South Dakota, Texas, Utah, Washington and Wisconsin). Their enthusiasm shows just how much demand there is for federal support to strengthen rural health care, whether through workforce investments, telehealth, or new models of care.
The Senate
Secretary RFK Jr. will be at the head of the classroom when he heads to the Senate Finance Committee on September 4 to walk through the President’s health agenda. Expect Senate Republicans to grade his progress on the Make America Healthy Again (MAHA) initiative, while Democrats are likely to raise their hands with tough questions on the new COVID-19 vaccine guidelines.
But Sec. Kennedy isn’t the only one getting homework this fall. Senate Majority Leader Chuck Schumer (D-NY) has been pushing Republicans to extend advanced premium tax credits (APTCs) that are set to expire at year’s end. Health plans, meanwhile, are sweating it trying to figure out how these changes might expand coverage and how to structure their plans for PY2026.
Where are Senate Republicans on this? At least five or six have openly discussed the importance of extending APTCs—but one question is whether Republicans will insist on paying for the tax credits with offsets or look to the study guide of the One Big, Beautiful bill which didn’t offset many of the Trump-era tax cuts. Either way, the debate this month could shape the contours of coverage and costs for years to come.
The House
The House is back in session with just 14 legislative days left before the continuing resolution (CR) expires. Think of it as the final exam no one can afford to fail. Their task is to keep the government funded with a swath of health extendersset to expire on September 30 as well.
With special elections happening in Virginia and Arizona – and what is expected to be a two-seat pick up for Democrats – and Rep. Kat Cammack (R-FL-3) going on maternity leave, House Republicans are facing what could soon be a one-seat margin. The real question: Can House Republican leaders keep their conference together long enough to turn in a passing grade by September 30? Remember the CR needs bipartisan Senate support to pass, and Senate Democrats are already upset at the President’s pocket recissions package announced on August 29.
House Health Hearings
- September 3: House Energy and Commerce Health Subcommittee hearing on advancing health care through AI
There You Have It
Back-to-school season is here! And that means MedPAC and MACPAC start their new sessions as well. Chamber Hill Strategies sends everyone best wishes for a healthy and successful year ahead.
