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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.
As Congress enters the final stretch of fiscal year 2025, a wide range of health care programs are set to expire on September 30, 2025, unless Congress takes action. These “health care extenders” cover everything from primary care and rural hospitals to Medicare telehealth services and workforce programs. Many of them have been renewed on a short-term basis for years—often tucked into year-end spending bills. But as the deadline looms, uncertainty grows for providers, patients, and public health programs.
Here’s a breakdown of what’s expiring.
Primary Care and Workforce Programs
Several major programs aimed at improving access to care in underserved areas are set to expire:
Community Health Centers (CHCs): CHCs provide essential primary care to nearly 30 million patients annually. Their core funding—known as the 330 Grant—is set to lapse without an extension of the Community Health Center Fund.
National Health Service Corps (NHSC): The NHSC supports primary care clinicians who work in shortage areas through scholarships and loan repayment. It relies heavily on the same fund that supports CHCs.
Teaching Health Centers Graduate Medical Education: Teaching Health Centers train medical residents in community-based settings. Without renewed funding, many could lose the ability to continue their residency programs.
Public Health Programs
Critical public health initiatives are also facing the end of federal funding:
Special Diabetes Programs: The Type 1 Diabetes program funds NIH research and the program for Indians supports tribal and Indian Health Service services.
Personal Responsibility Education Program: This program funds evidence-based initiatives to reduce teen pregnancy and promote adolescent health.
Medicare Extenders
Several Medicare provisions with significant implications for rural providers and seniors will expire:
Medicare-Dependent Hospital (MDH) Program: Provides additional funding to rural hospitals where a high percentage of patients are on Medicare
Low-Volume Hospital Payment Adjustment: Supports rural hospitals with limited inpatient volume to help them remain financially viable
Work Geographic Practice Cost Index (GPCI) Floor: Ensures that Medicare payments to rural physicians aren’t reduced unfairly based on geographic payment formulas
Telehealth Flexibilities: These pandemic-era provisions include waivers for geographic restrictions, audio-only telehealth, and expanded provider eligibility
Hospital at Home Waiver: CMS authority to allow acute-level care to be delivered at home under Medicare
Ground Ambulance Add-On Payments: Payment increases for rural and super-rural ambulance services
Medicare Quality Measurement Support: CMS funding for developing and endorsing Medicare quality metrics
Medicare Outreach and Enrollment Support: Assistance programs that help low-income seniors navigate Medicare
Medicaid and Behavioral Health
Medicaid Disproportionate Share Hospital (DSH) Payment Cuts: Delayed cuts to safety-net hospitals are scheduled to take effect. Without another delay, hospitals serving large numbers of low-income or uninsured patients would lose significant funding.
Certified Community Behavioral Health Clinics (CCBHCs): The original demonstration authority for CCBHCs in 2016 states will expire. While the program is now an optional Medicaid benefit, not all states have opted in.
Other Key Programs
Conrad 30 Waiver Program: Allows international medical graduates on J-1 visas to stay in the U.S. in exchange for practicing in underserved areas
Children’s Hospital Graduate Medical Education (CHGME): Supports pediatric residency programs
What Happens Next?
With dozens of health care programs scheduled to expire on September 30, 2025, Congress faces a significant number of time-sensitive decisions. Here are their options:
- Make some or all of these programs permanent
- Extend some or all of these programs for a year or more
- Align the extension of some or all of these programs with a continuing resolution to fund the entire federal government past September 30, 2025
If past is prologue, Congress will delay making permanent decisions on these programs and opt for some sort of extension. While health care providers need certainty to continue or revise programs, unfortunately Congress – regardless of which party is in control – has disappointed the health care sector before. But if faced with no extension or elimination of funding and authority, health care providers will be forced to support short-term patches.
