Check out our expert take on key activity shaping health care policy

Insights

Featured Blogs

Week Ahead: The Real Housewives of Pennsylvania Avenue?

Date: June 9, 2025

In what seems like a premiere of the Real Housewives of Pennsylvania Avenue, Elon Musk and President Trump are splitting faster than members of Congress heading to recess. As Musk and Trump throw shade at each other, the Senate’s ‘Big Beautiful Bill’ might need a big, beautiful rescue plan. Let’s get into it. Welcome to the Week Ahead!

The Administration

The deadline is this week for the Centers for Medicare and Medicaid Services (CMS) request for information on regulatory burden, and the administration is looking for respondents to dish on how to best reduce the red tape. Health care groups have no shortage of ideas, but like a VIP party, we probably won’t see the guest list except for those who decide to share that they were there. And remember, this is just an RFI, not a new rule or regulation. The administration can decide to take suggestions or leave them as it suits them.

Meanwhile, Office of Management and Budget (OMB) Director Russell Vought, has told the House Appropriations Committee not to expect more details about the President’s budget request and to work with what they’ve got when it comes to the President’s budget for fiscal year 2026. But it’s already June, and before you know it, summer will be over, and the September 30 deadline to pass FY 26 funding bills will be here. We are already seeing some House Republican appropriators express concerns about the timeline. As summer drags on, that number of doubters could grow.

The Senate

Senate GOP leadership has one goal this week: get “pens down” on the Senate’s version of the One Big Beautiful Bill Act and start the next scene. But let’s be real—they’re still far from a finished product. And now what GOP leaders had hoped would be a steady march toward passage is a lot like a group dinner gone wrong. Some Committees are releasing legislative text, but no one agrees on the guest list, the menu, or the bill.

Republicans are looking at changes to the health section, including the possibility of adding changes to Medicare Advantage (MA) to help reduce the overall cost of the bill. Specifically, the Senate is looking at dialing back coding intensity adjustments that could net significant savings. Other potential changes to the menu could include:

Pushing back the December 31, 2026 effective date for new Medicaid work requirements, The House Energy & Commerce Committee had set the effective date for January 1, 2029 in its version of the bill.

Giving states more time before they are required to conduct Medicaid eligibility checks every 6 months instead of the current every 12 months for the expansion population. Currently, that provision is set to go into effect for renewals scheduled on or after December 31, 2026.

Extending the effective date for ending the incentives for states to expand Medicaid coverage. That date is currently set for January 1, 2026.

In addition to these considerations, the Senate could bend to pressure to weaken the House-passed bill’s prohibition on new provider taxes and its freeze on existing provider taxes. Senators from states with provider taxes in place have complained that these provisions leave a bitter aftertaste in their mouths.

The trick will be making sure the menu remains appealing to diners in both the House and Senate, some of whom have very different tastes. The menu could get a little less salty if Senate Republicans decide to trim the current state and local tax (SALT) deduction. The House SALT Caucus is demanding respect and threatening to walk if their concerns are not addressed in the final cut.

Will we see a markup? With all the Republican talk of using regular order, so far, the negotiations on tax and health care have been only within their own party. Senate Minority Leader Chuck Shumer (D-NY) and Finance Ranking Member Ron Wyden (D-OR) sent a letter demanding a markup, which suggests Finance may not have one. Democrats are ready to host the reunion and get the drama out in the open.

As for the rest of the Senate cast, they’re trying to act calm and collective, but the group chat is full of shade. Negotiations are happening behind closed doors, but the energy is “we’re not far apart” one minute and “we’re done here” the next.

And don’t forget the guest stars. Several fly-ins are happening this week, including key Medicaid constituencies such as nursing homes and children’s hospitals. They’re storming the Hill like Housewives entering a new season—scripted talking points, matching outfits, and a deep fear of being left out of the final edit.

Senate Health Hearings

June 4: Senate Appropriations Labor-HHS Subcommittee hearing on FY 26 NIH Budget Request

The House

Over in the House, things are a little quieter—but not without drama. The Energy and Commerce Health Subcommittee is having a hearing on domestic manufacturing and the health care product supply chain on June 11. The hearing is expected to provide a high-level overview of a broad range of supply chain concerns, and explore the underlying background and contributing factors that have led to current disruptions—emphasizing a deeper understanding of the “what” and the “why” behind these issues. Expected topics include drug shortages, tariffs, international reference pricing, inspections of foreign drug manufacturing sites, and more. While we don’t expect the majority to push a proposal or fix it at the hearing, we do expect members to offer plenty of ideas.

Meanwhile, the House is watching the Senate with the same energy as a reunion special audience—waiting to see who flips, who cries, and whether groups such as the Freedom Caucus or SALT Caucus will throw the whole thing off track. Everyone’s whispering about it like it’s a secret affair we’re all pretending not to know about.

Additionally, a rescissions package that bill is causing slashes funding to HIV/AIDS programs like PEPFAR is expected on the floor this week. This will cause an uproar among public health groups, as well as both Republican and Democratic representatives who have been supportive of the program.

The reintroduction of the Improving Access to Medicare Coverage Act is likely this week. This bipartisan bill would count patients’ time spent under observation status in a hospital towards the three-day stay required for Medicare coverage of care in a skilled nursing facility. CMS had waived the requirement during the COVID-19 public health emergency (PHE), but with the PHE in the rearview mirror, supporters are hoping lessons learned from the PHE will help draw new interest and a willingness to explore including the legislation in a must-pass health care package this Congress.

Other Health Hearings This Week

June 10: House Appropriations Committee MILCON-VA Subcommittee Markup of FY 26 Allocations

June 11: House VA Oversight Subcommittee Legislative Hearing on H.R. 3482 Veterans Community Care Scheduling Improvement Act and H.R. 3494, VA Hospital Inventory Management System Authorization Act

June 12: House VA Health Subcommittee Legislative Hearing on H.R. 785, The Representing Our Seniors at VA Act of 2025; H.R. 2068, The Veterans Patient Advocacy Act; H.R. 2605, The Service Dogs Assisting Veterans (SAVES) Act; H.R. 3400, The Territorial Response and Access to Veterans’ Essential Lifecare (TRAVEL) Act of 2025; H.R. 3643, The VA Data Transparency and Trust Act; H.R. 1404, The CHAMPVA Children’s Care Protection Act of 2025; and H.R. 2148, The Veteran Caregiver Reeducation, Reemployment, and Retirement Act

There you Have it

A reminder that Father’s Day is June 15! Chamber Hill Strategies wishes all the Dads out there a very Happy Father’s Day.

Identifying and Engaging the Right Partners

Date: June 4, 2025

Identifying the right partners is a cornerstone of any successful coalition building. Even the most compelling policy goals need the support of trusted allies to gain traction with key stakeholders and decision-makers. When you’re building a formal coalition, you have to know who to bring to the table and how to engage them.

Finding the Right Policy Partners: A Strategic Approach to Coalition Building

Once you have defined your policy goal, the next critical step is identifying the right partners to help you achieve it. Building an effective coalition requires more than shared interests—it requires strategic thinking, creativity, and the ability to engage stakeholders with diverse perspectives.

Start with Stakeholder Mapping

Begin by performing stakeholder mapping to determine who could bring valuable influence, expertise, or networks to your cause. If your organization lacks access to key policymakers, look for partners that can help close that gap—particularly those with strong grassroots or grass tops connections. Identifying who has the credibility and connections you need can strengthen your overall effort.

Look Beyond the Obvious

When researching potential partners, do not just focus on those who share your exact point of view. Some of the most impactful coalitions are formed through alliances with organizations that approach the same issue from a different angle. For instance, if your argument focuses on the economic impact of a proposed policy, consider reaching out to health or caregiving groups whose members would also be affected. This diversity of thought can expand your message and appeal to a broader range of stakeholders.

Engage with Decision-Makers

Once you have identified potential allies, initiate conversations with key decision-makers within those organizations. These are the people who can commit their organization’s resources and voice to your cause. Lead with your shared policy goals but be sensitive to any differences in mission or priorities. Emphasize where your goals align and how collaboration could create a stronger, unified message.

Be direct: express your desire to have them join the coalition. If possible, leave the meeting with a concrete next step—or better yet, a commitment to a partner.

Final Thoughts

By identifying the right partners, embracing diverse perspectives, and engaging decision-makers thoughtfully, you can build a coalition that brings both power and credibility to your policy efforts. Look for our next blog about mastering a meeting!

Chamber Hill Strategies

When it comes to coalition building, Chamber Hill Strategies stands out among lobbying firms in DC. Our comprehensive approach helps clients achieve their advocacy goals. With strong relationships on Capitol Hill and a track record of shaping health policy, we turn complex challenges into real-world wins.

Let our expertise in Washington, DC guide your efforts towards successful and meaningful stakeholder engagement.

HHS Budget Request for Fiscal Year 2026

Date: June 3, 2025

On May 30, the Department of Health and Human Services (HHS) released its Fiscal Year 2026 (FY26) discretionary budget request. This summary provides an overview of key agency estimates and justifications, including HHS, Centers for Medicare and Medicaid Services (CMS), the Food and Drug Administration (FDA), the HHS Office of Inspector General.

WHY THIS MATTERS

The annual budget request demonstrates the priorities of the administration – how they intend to staff their agencies, what policies they will work on and what programs they intend to shutter from the previous year. Congress then takes these requests and determines what will be funded through the appropriations bills. Both the House and Senate will start marking up their appropriations bills in June.

REORGANIZATION

The budget repeatedly notes the intention of HHS to drive operational efficiencies by eliminating duplicative functions and consolidating programs that have similar aims.

The budget centralizes administrative functions, reduces 28 operating divisions to 15, closes five regional offices, reduces the level of full-time employees to 90 percent of pre-COVID levels, and ending or downsizing 5,000 contracts.

Administration for a Healthy America

HHS plans to create the Administration for a Healthy America (AHA) by combining:

Health Resources and Services Administration (HRSA)
Substance Abuse and Mental Health Services Administration (SAMHSA)
Office of the Assistant Secretary for Health (OASH)
National Institute for Environmental Health Sciences (NIEHS)
Centers for Disease Control and Prevention (CDC) – certain programs

AHA will focus on prevention including:

primary care
maternal and child health
mental health
substance use prevention and treatment
environmental health
HIV/AIDS
workforce development
policy, research, and oversight

The Administration for Children, Families, and Communities (ACFC) will be a new division at HHS and will focus on:

Head Start
Child Care and Development Block Grant
social services for children
program formerly housed in the Administration for Community Living (ACL) such as nutrition services, falls prevention services, home and community-based support, and caregiver support
National Institute on Disability, Independent Living, and Rehab Research

The budget eliminates the following programs:

Previously in HRSA: Healthy Start, Newborn Screening for Heritable Disorders, Early Hearing Detection and Intervention, Emergency Medical Services for Children, Ryan White Part F, Rural Hospital Flexibility Grants, State Offices of Rural Health, Rural Hospital Stabilization, Family Planning, and 15 workforce programs including some Nursing workforce programs and Medical Student Education.

Previously in CDC: Youth Violence Prevention, Adverse Childhood Experiences, Firearm Injury and Mortality Prevention Research, Traumatic Brain Injury, Elderly Falls, Drowning, Other Injury Prevention Activities, Injury Control Research Centers, the National Occupational Research Agenda, Education and Research Centers, Personal Protective Technology, Other Occupational Safety and Health Research (Total Worker Health), the Amyotrophic Lateral Sclerosis (ALS) Registry, Climate and Health, Trevor’s Law, Environmental and Health Outcome Tracking Network, and Asthma.

Previously in SAMHSA: Mental Health Awareness Training, Healthy Transitions, Infant and Early Childhood Mental Health, Mental Health Children and Family Programs, Consumer and Family Network Grants, Mental Health System Transformation, Project LAUNCH, Primary and Behavioral Health Care Integration Programs, Mental Health Crisis Response Partnership Program, Homelessness Prevention, Mental Health Criminal and Juvenile Justice Programs, Assertive Community Treatment for Individuals with Serious Mental Health Illness, Homelessness Technical Assistance, Minority AIDS, Seclusion and Restraint, Minority Fellowship Program, Tribal Behavioral Health Grants, Interagency Task Force on Trauma Informed Care, Strategic Prevention Framework, Sober Truth on Prevention Underage Drinking, Screening, Brief Intervention and Referral to Treatment, Targeted Capacity Expansion, Grants to Prevent Prescription Drug and Opioid Overdose-Related Deaths, First Responder Training, Improving Access to Overdose Treatment, Pregnant and Postpartum Women, Recovery Community Services Program, Substance Abuse Treatment Children and Families, Treatment Systems for Homeless, Building

Communities of Recovery, Substance Abuse Treatment Criminal Justice activities, Emergency Department Alternatives to Opioids, Treatment, Recovery, and Workforce Support, Peer Support Technical Assistance Center, Comprehensive Opioid Recovery Centers, Youth Prevention and Recovery Initiative, and Drug Abuse Warning Network.

Previously in OASH: Office of Population Affairs, Teen Pregnancy Prevention, Secretary’s Minority HIV/ AIDS Fund, Kidney X, Stillbirth Task Force, and Sexual Risk Avoidance.

National Institutes of Health

The National Institutes of Health will be reorganized into eight institutes. Reiterating the administration’s commitment to “gold standard science,” transparency, and the restoration of scientific integrity, the request prioritizes research related to research on nutrition and environmental factors that cause chronic disease and as well the rise in autism spectrum disorder.

Assistant Secretary for a Healthy Future

The budget creates an Assistant Secretary for a Healthy Future to bring together the Administration for Strategic Preparedness and Response and the Advanced Research Project Agency for Health (ARPA-H) into the. The Assistant Secretary’s mandate includes:

addressing chronic disease
America-made manufacturing and rural access
proactive approaches to healthy well-being
healthcare security, efficiency, and transparency
American leadership in frontier health technologies

Consumer Product Safety Commission

The budget also changes the status of the Consumer Product Safety Commission (CPSC) from an independent agency and moves the functions of the commission into the HHS Office of the Secretary.

MEDICARE

The budget mentions $119 million for a new Prevention Innovation Program to promote broadband access to nutrition and physical activity and reduce dependence on medication. Included are $20 million for the Chronic Care Telehealth Centers for Excellence Program and $8 million for the Telehealth Nutrition Services Network Grant Program.

On prior authorization, CMS will continue to test and implement AI activities in medical review and prior authorization of the Medicare fee-for-service program, including AI to review medical records and make a recommendation regarding payment. CMS will also continue to look for services or items showing unnecessary increases in volume or utilization due to fraud, waste, or abuse, for which prior authorization would be appropriate. While CMS has focused on DMEPOS items and power mobility devices, the agency notes its success in requiring prior authorization for certain outpatient hospital department services which started in FY20.

CMS is working to expedite Medicare Advantage Risk Adjustment Data Validation (RADV) audits so the agency will be current with its audits of prior payment years and new audits will be started as close to the most recent payment year as possible. CMS is also developing a strategy to make it more efficient at identifying the approximately $17 billion in overpayments while reducing agency burden by providing more effective oversight of the MA program. Recently, CMS began conducting utilization management audits for MA plans that were effective Calendar Year 2024.

The budget includes $22 million to restart the durable medical equipment, prosthetics, orthotics, and supplies competitive bidding program.

ACA MARKETPLACE

The budget assumes the enhanced premium tax credits are not extended beyond 2025. Regardless of the administration’s assumptions, extending the tax credits requires Congressional action.

In FY 2025, CMS announced a reduction in funding for the Navigator program to $10 million per year and estimates that $360 million will be saved over the next four years.

In FY 2026, CMS is proposing a Marketplace Integrity rule which would:

revise three standards relating to past-due premium payments
exclude Deferred Action for Childhood Arrivals recipients from the definition of “lawfully present”
define the evidentiary standard HHS uses to assess an agent’s, broker’s, or web-broker’s potential noncompliance
reinstate the one year requirement for failure to file and reconcile
strengthen income eligibility verifications for premium tax credits and cost-sharing reductions
amend annual eligibility redeterminations for consumers in $0 premium plans
eliminate the special enrollment period for consumers with annual household incomes below 150 percent of the federal poverty level
amend the automatic reenrollment hierarchy
shorten the annual open enrollment period
tighten special enrollment periods
widen the de minimis thresholds for the actuarial value for plans subject to essential health benefits
(EHB) requirements and for income-based cost sharing reduction plan variations
amend the premium adjustment percentage methodology,
prohibit inclusion of gender affirming care as an essential health benefit

MEDICAID

CMS is prioritizing 1115 waiver budget neutrality policy and oversight, and monitoring and evaluation of demonstration financial and programmatic outcomes. The agency has updated its approach to budget neutrality formulation and is providing technical assistance to states as well as conducting reviews of states’ reported demonstration expenditures.

CMS will also try to ensure proper billing and rate reimbursement in the Home and Community Based Services (HCBS) waiver and state plan programs, including rate setting and financial reporting for PACE. The focus will be on ensuring compliance, providing technical assistance, and fraud and abuse in the delivery of personal care and other HCBS services.

Through the proposed rule called “Preserving Medicaid Funding for Vulnerable Populations – Closing a Health Care-Related Tax Loophole,” CMS is proposing to update the legal requirements in State proposals for Medicaid tax waivers to ensure that proposals using what the administration calls an algorithmic loophole are not approvable. The focus of this proposed rule is on taxes on managed care organizations.

The budget recommends shifting the 340B Drug Pricing Program to CMS to allow for “streamlined processes and the ability to utilize inhouse drug-pricing resources and expertise.”

CMS PERFORMANCE MEASURES

CMS indicates the agency will develop new performance measures that support the MAHA initiative. The status of current CMS performance measures can be found on electronic pages 144-166 of this document. CMS is discontinuing several measures (see electronic pages 167ff), including:

ensure beneficiary telephone customer service
increase Marketplace enrollment nationwide
increase Federally facilitated Marketplace enrollment among underrepresented populations
increase the national rate of low-income children and adolescents, who are enrolled in Medicaid and Medicaid expansion Children’s Health Insurance Programs (CHIP), who receive any preventive dental service
increase the proportion of providers performing initial enrollment in the Medicare Program online
reduce the infection control survey deficiencies (of F880) for nursing homes that have received a Targeted Response Quality Improvement Initiative (TR-QII)
reduce Healthcare Associated Infections [HAIs] in Critical Access Hospitals (CAH)
maintain or exceed percent of beneficiaries in Medicare fee-for-service who report access to care
maintain or exceed percent of beneficiaries in Medicare Advantage (MA) who report access to care
reduce the average out-of-pocket share of prescription drug costs while in the Medicare Part D coverage gap
percentage of CMMI model awardees participating in learning activities
percentage of Original Medicare beneficiaries in an accountable care relationship

FDA AND PCORI

The budget decreases FDA’s discretionary request by 11.4 percent from FY25 due to focusing the agency on its core functions, reducing its physical footprint, and reducing the number of full-time employees by 1,940. The agency proposes MAHA activities to address chronic disease, restore trust in the food system and strengthen the country’s nutritional and food safety. The budget increases by 4 percent the medical device user fee program to review new medical devices.

The budget proposes to eliminate the Patient-Centered Outcomes Research Institute (PCORI). Established under the ACA, PCORI funds patient-centered comparative clinical effectiveness research.

Week Ahead: Senate on Deck

Date: June 2, 2025

Congress returns to Washington following weekend storms in the D.C. area. The forecast this week calls for potentially clearer skies and a busy week for both Congress and the White House. With that, let’s get into it. Welcome to the Week Ahead!

The Administration

Nearly a month after releasing its FY 26 skinny budget, the Department of Health and Human Services (HHS) has released its FY 26 Budget in Brief, which outlines a massive reorganization and shuttering of existing agencies to align with the administration’s “Make America Healthy Again” agenda.

As hard as issuing a budget request is, the real work is just beginning. Sec. Kennedy will now need to defend the full budget request against attacks from critics who argue that the reorganization is nothing more than a cut in disguise. Along with explaining the potentially bogus science in the recently published MAHA Report and plans to start publishing scientific research in-house, Sec. Kennedy has his work cut out for him.

The Senate

Senate Republicans return to Washington with only 13 legislative days to pass their version of the “One Big Beautiful Bill Act” before the self-imposed July 4 deadline. However, there are a lot of questions about how the Senate will move forward and what changes might be made to the bill. Some questions include:

What will the Byrd Bath look like? The House-passed bill includes several provisions that may not pass the Senate’s Byrd Rule, which prohibits the inclusion of provisions unrelated to the federal budget. This could kill House provisions such as a moratorium on state regulations on artificial intelligence, a ban on courts enforcing certain injunctions, and language defunding Planned Parenthood.

Will the Senate make changes to address concerns from fiscal hawks? The House bill would increase the debt limit by $4 trillion and extend borrowing authority beyond the 2026 midterms. That’s enough for Sen. Rand Paul (R-KY) to reject the bill. Additionally, Sen. Ron Johnson (R-WI) has called for more cuts if he is to support the bill. Other fiscal hawks may balk at the recent Congressional Budget Office estimate that the House bill’s tax changes would increase the deficit by $3.8 trillion.

Will the Senate bump back Medicaid work requirements? To appease House Freedom Caucus members, the implementation date for Medicaid work requirements was moved forward from 2029 to 2026. However, concerns have been raised by some, including Sen. Lisa Murkowski (R-AK), that it will be challenging for some states, including hers, to meet the new timetable.

Will the Senate remove Medicaid copays? Sen. Josh Hawley (R-MO) has criticized the House bill’s Medicaid copay provision as a “hidden tax on working poor people trying to get health care.” Other Republicans who supported Democratic amendments to protect Medicaid, like Murkowski and Sen. Susan Collins (R-ME), may share his concerns.

Will the Senate change the Medicaid provider tax provision? The House bill prohibits states from putting in place new provider taxes and freezes existing provider taxes at current rates. However, some Republicans, such as Sen. Hawley, have expressed concerns about how that provision of the House bill will impact their states.

Will we see committee markups? Initially, it sounded like the Senate might skip the committee process altogether. However, more recently, our intelligence from the Hill suggests committees such as the Senate Finance Committee might want to mark up the Senate bill. That opens the door for more proposed changes to the bill and slows things down for Republicans looking to get this bill passed.

Will the SALT deduction be touched? House Republicans from high-tax states fought hard to increase the cap on how much their constituents can deduct from federal income taxes. Senate Republicans don’t have the same incentive to defend this provision, given that they generally represent lower-tax states.

Senate Health Care Hearings

June 4: Senate HELP hearing on reauthorization of the over-the-counter monograph drug user fee program

The House

The House Appropriations Committee is kicking off the markup process for FY 26. First up are subcommittee markups for the funding bills for the Department of Veterans Affairs and the Food and Drug Administration on June 5.

Members of the House Appropriations Ag and FDA subcommittee won’t have much time to review the recently released FDA budget request before its June 5 markup. FDA highlights include:

$3.2B in discretionary budget authority (11.4% decrease from FY 25). FDA justifies this by:

Consolidating work to focus on core functions

Reducing the number of full-time equivalents by 1,940

$3.6B in user fees (4% increase over FY 25)

$234.6M to support MAHA efforts related to chronic disease and food.

If the past is any gauge, we expect Republican members of the subcommittee to praise FDA’s efforts to address chronic disease rates by improving food quality and safety, and Democratic members to criticize planned reductions in force and funding cuts as a threat to public health.

Other House Health Care Hearings