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The Week Ahead

Stay informed with our weekly buzz about what’s going on in Washington, DC.

Week Ahead: Snow Day Decisions

The idea of a snow day was always exciting as a kid: not going to school, playing in the snow, and getting a sugar rush from drinking hot chocolate. While Congress might wish for the childhood magic to return now that DC has been hit by a snow storm, it does not stop their growing to-do list for the week. So, let’s get into it. Welcome to the Week Ahead!

The Administration  

President Trump plans to meet with health insurance executives on the heels of their recent questioning during two House committee hearings.  

But what could President Trump actually have to say to them? We think it could go something like this: “Look, I like you people. I really do. You’re smart, you run big companies, very successful. But the system? The system is a mess. This is why I introduced my Great Healthcare Plan. We’re going to lower drug prices and insurance premiums, and you’re going to do it. We can help you but only if you help us, no excuses.”  

No matter the verbiage the president uses, expect him to make a big deal of this meeting and highlight his plan to show that his administration is doing something to address affordability concerns.   

It’s important to remember that in announcing the plan, President Trump called on Congress to enact his plan. So, it’s unclear what, if anything, the president plans on doing beyond pressuring Congress to put the principles in his plan into effect.   

The Senate  

The ball is now in the Senate’s court, after the House passed by a wide margin the minibus and the fiscal year 2026 (FY 26) Homeland Security funding bill last week to finish its work on the remaining FY26 funding bills. The minibus included over a dozen health care extenders (i.e., Medicare telehealth flexibilities, community health center funding) and 35 new health care policies (i.e., pharmacy benefit manager reform, Medicare coverage of multi-cancer early detection screening tests). There are a few procedural motions that need to happen before the Senate can vote on the bills to avoid a government shutdown on January 30.  

Minority Leader Chuck Schumer (D-NY) said that Democrats will block the minibus if it includes funding for the Department of Homeland Security, after the second fatal ICE shooting in Minnesota. This creates a wrinkle that will need to be ironed out if the Senate wants to avoid a partial government shutdown.  

So, what happened to those APTC conversations? With the funding bills taking up all the debate time, it seems that conversations about an APTC extension have been put on hold. With the end of January deadline from Leader John Thune (R-SD) fast approaching, the likelihood of an extension coming together is shrinking.  

Health Care Hearings This Week 

  • January 28: Senate VA Committee hearing on modernizing the VA health care system  
  • January 29: Senate Aging Committee hearing on drug labeling  

The House 

With the House out of session, let’s reflect on the recent Energy and Commerce and Ways and Means Committee hearings with health insurance executives.  While we saw passionate questioning from members on both sides of the aisle, there is more to come as Committee leaders have promised more hear care hearings hearings and future hearings with leaders from other areas of the health care sector. So, the question is: who’s next? hospital CEOs? pharma execs? If we were either, we would be look at our calendars and get ready to travel to DC.  

But what actually happened at the hearings? Although there was plenty of partisan fighting at the hearings, there was also strong support on both sides to tackle issues related to prior authorization and anger over the high compensation packages for insurance CEOs. While this could be the spark needed for bipartisan action on health care, expect the harsh winds of partisanship (especially during an election year) to make getting a fire going very difficult. 

There You Have It 

We hope everyone has stayed safe and warm with the snow. What is your favorite snow day tradition? Let us know. Make it a great week! 

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Week Ahead: 365 Days Later

As we approach the one-year anniversary of President Trump taking office for the second time, we have just as many questions about what the next 3 years will look like as we did on day one.  President Trump has already achieved one of his personal goals – a Nobel Peace prize – when Venezuelan opposition leader Maria Corina Machado gifted her Peace Prize medal during a White House visit. What else could President Trump check off from his bucket list? Let’s find out –welcome to the Week Ahead!

The Administration

President Trump released his Great Healthcare Plan which calls for lowering prescription drug prices and insurance premiums, and increasing transparency in health care costs and insurance benefits. The lack of details in the fact sheet creates more questions than it answers, but it’s clear the plan targets pharmacy benefit managers (PBMs) and health insurance companies, calling out those entities for deceptive practices and for accepting subsidies that the administration argues raise the cost of health insurance. Pharmaceutical companies are also under a microscope, with calls to codify most-favored-nation (MFN) pricing agreements and increase access to over-the-counter drugs. Many of the specific proposals in the plan, such as codifying MFN deals and PBM reform will require Congress to act. As we’ve seen, getting this Congress to act on health care is not easy, but getting the White House involvement is a necessary first step to unify the Republican majorities in both chambers.

The White House has promoted Farnoosh Faezi-Marian to Chief of the Health and Human Services (HHS) Branch at Office of Management and Budget (OMB). Faezi-Marian previously serviced as a Program Examiner at OMB, where she worked on budget development and execution for the Administration for Strategic Preparedness and Response. The promotion now has her leading the OMB office that is responsible for examining budget requests and making funding recommendations for HHS agencies so she will be an important voice in developing the President’s upcoming budget request to Congress for HHS.

The Senate

The Senate has left town without reaching an agreement on an extension of the enhanced advance premium tax credits (APTCs). The Open Enrollment period has already closed for most states, but a handful have deadlines to sign up for coverage through the end of January, which provides external pressure to reach an agreement. Senate Majority Leader Thune (R-SD) also previously told Punchbowl News that a deal would need to come together by the end of January, creating internal political pressure to move things along. Sen. Susan Collins (R-ME) who has been involved with negotiations on a bipartisan agreement has said negotiations will continue over the recess, but Leader Thune has cast doubt on the talks saying, “it doesn’t look like they’re close.”

The House

With the House scheduled to be out of session next week, it’s crunch time to pass the six remaining  appropriations bills to avoid at least a partial government shutdown on January 30. Although reports indicate neither side wants another shutdown, the remaining bills are some of the trickiest. These include Labor-HHS, Defense, and Homeland Security. The House has been working to pass appropriations bills in the form of minibus packages, and we expect that to continue. However, the controversy over ICE involved shootings in Minneapolis has made many believe that Homeland Security funding may need to be passed through a continuing resolution (CR).

Adding to the frenzy, over a dozen health care extenders, including telehealth flexibilities, community health center funding, and more, are set to expire at the end of the month. These have often been tied to government funding bills, but the possibility of a minibus for most and a CR for the Homeland Security bill raises questions as to whether the House has the stomach to authorize a longer-term extension for health care extenders or if they will keep kicking the can down the road. Extending funding for a year or two could provide stability for crucial health programs but would require more discussion than a shorter-term funding decision.

The House Budget Committee is holding a hearing on Health Care Costs that will feature witnesses from the Foundation for Research on Equal Opportunity and the Council for Affordable Health Coverage, both of whom might as well have offices in the Capitol Building for how often they’ve appeared in the last 4 months. But while there has been a lot of testimony, we have not seen any legislation as a result.

 Other Health Care Hearings This Week

  • January 22: House Energy and Commerce Health Subcommittee hearing on health insurance affordability
  • January 22: House Ways and Means Committee hearing with health insurance CEOs

There You Have It

With the NFL and College football playoffs happening, we’re seeing the season end for teams week after week. Are you prepared for the post-football seasonal depression? Let us know. Make it a great week!

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Week Ahead: Republicans Revolt

Lawmakers return to Washington following a week of Republican rebellion, including a bipartisan Senate War Powers Resolution to limit future military action against Venezuela and a House bill to extend Obamacare subsidies with more than a dozen House Republicans voting yes.  2026 is off to a rough start for party unity but let’s see what happens this week! Welcome to the Week Ahead!

The Administration

Speaking of Republicans sticking together, did you see this one?  The President casually mentioned he might veto an extension of enhanced Advance Premium Tax Credits (APTCs) if the Senate passed one.  Wait, what?

It’s one thing to break with leaders on Hyde Amendment restrictions – the President doesn’t necessarily agree with his party on that one – but comments like these make the already-difficult path ahead on the insurance subsidies just that much harder.

And on the AI front, the President also praised the Meta’s hiring of Dina Powell McCormick in a new role to impact governments and sovereigns on AI.  Reporting directly to Mark Zuckerberg, Powell McCormick has been a leader in global finance since her post with President George W. Bush, and also happens to be the wife of Sen. Dave McCormick of Pennsylvania.

The Senate

The Senate is feeling the heat to act on APTCs, given the House passage of a 3-year extension of the enhanced APTCs with a whopping 17 GOP members voting for it.  As we mentioned previously, this bill has no chance in the Senate, but there has been discussion of using it as a vehicle for the bipartisan proposal.

Now, the details of what that bipartisan package could look like are starting to come into focus. It’s expected that the bipartisan bill would include a 2-year extension of the enhanced APTCs, with reforms such as an income cap, the elimination of zero-premium plans, and expanded access to health savings accounts.

The talks over this proposal have been complicated by the fact that Republicans want to include language called the Hyde Amendment which prevents tax dollars from going to plans that provide abortions.  Although some Senate Republicans have reportedly indicated a willingness to be flexible on this point, our conversations on the Hill indicate that this remains a potential pitfall. Democratic Senators, including Senate Finance Committee Chair Ron Wyden (D-OR), have also raised concerns that eliminating zero-premium plans would harm low-income enrollees.

The Senate Appropriations Committee released text for a Fiscal Year minibus for State and Financial Services programs, a step towards preventing a government shutdown at the end of the month. However, the package notably does not fund the Department of Homeland Security, which was reportedly under consideration. This may mean there is disagreement, or this may be a reaction to the continuing controversial actions by the U.S. Immigration and Customs Enforcement.

Health Care Hearings This Week

  • January 15: Senate HELP Committee Executive Session to consider legislation on lung cancer research, ED fentanyl testing, rural hospital cybersecurity, and infant formula safety

The House

The House made progress on appropriations by passing H.R.6938 to fund Commerce, Energy and Water, and Interior.  House Majority Leader Steve Scalise’s (R-LA) schedule for the week of January 12  says “consideration of items related to FY26 Appropriations are possible” as leaders work to combine the remaining appropriations bills into at least two separate minibuses.

In case you’ve lost count, there are still six appropriations bills left to pass before January 30 to avoid a partial government shutdown, including the bill that funds the Department of Health and Human Services (HHS).

House health care committee leaders are busy prepping for their affordability hearing on January 22.  The Energy and Commerce and Ways and Means Committees announced they would haul in 5 of the largest insurance companies to face questions about lower costs in the commercial market.

 Health Care Hearings This Week

  • January 13: House Oversight Subcommittee on Gov Operations hearing on preventing fraud in federal programs
  • January 13: House VA Health Subcommittee legislative hearing

There You Have It

Did you watch the Golden Globes?  Hamnet, a recently released dramatic tale about Shakespeare and his family, won Best Picture and Best Female Actor.  Have you seen it?  Tell us if you would have voted for it!  Make it a great week.

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Week Ahead: Health Care New Year’s Resolutions

Lawmakers have returned to Washington, still trying to make sense of the surprising raid that led to the capture of Venezuelan President Nicolás Maduro and his wife. Meanwhile, House Speaker Mike Johnson (R-LA) has a New Year’s Eve resolution to show voters House Republicans are serious about lowering health care costs after the expiration of enhanced ACA premium tax credits (APTCs). As with all New Year’s resolutions, it’s easier said than done. It’s going to be a crazy year, so let’s get back into it. Welcome to the Week Ahead!  

The Administration  

The much-anticipated Rural Health Transformation Program awards are out and the White House is wasting no time touting the initial funding with newspaper clippings from all 50 states.  In addition to expected public events on how the funding is advancing the Make America Healthy Again agenda, be on the lookout for the first annual CMS Rural Health Summit in March during the 2026 CMS Quality Conference. 

States and stakeholders are also eagerly awaiting clarifications from the Centers for Medicare and Medicaid Services (CMS) on Medicaid work requirements that are expected to be finalized in June 2026. The qualifying activities, and more importantly, the exemptions to work requirements, will drastically shape who will be eligible for services.  

CMS has also entered the annual Medicare Advantage policy and payment cycle. The agency issued the Contract Year 2027 MA and Part D policy and technical changes proposed rule on November 25, 2025, with comments due January 26, 2026.  The proposed Advance Notice is still pending at the Office of Management and Budget.   

The Senate  

Despite failing to pass either GOP and Democratic health care bill before the break, Senators continued bipartisan talks over the holidays. These talks have involved Sens. Bernie Moreno (R-OH), Susan Collins (R-ME), and Jeanne Shaheen (D-NH), among others. Notably, Sens. Moreno and Collins have been pushing for a proposed two-year extension of the tax credits, along with measures to address concerns about fraudulent activity in the ACA marketplace.   

These bipartisan talks are important to watch, as the real challenge is taking up a measure that can meet the Senate’s 60-vote threshold.  While the House will be taking up a three-year, clean extension of the enhanced APTCs in January, that bill is DOA in the Senate.  There have been discussions, however, that the House bill could be used as a vehicle for a bipartisan package in the Senate. 

There’s also that pesky upcoming government funding deadline – January 30 – that will require attention. This has major implications for health care extenders, such as the Medicare telehealth flexibilities and funding for community health centers, which are tied to the soon-to-expire government funding. Congressional GOP appropriators in the House and Senate did reach an agreement on topline funding over the holidays, causing Senate Majority Leader Thune (R-SD) to suggest he may not continue pursuing the five-bill minibus he has been trying to move.  

The real question remains as to each side’s stomach for another government shutdown with precious little time left before the deadline for members of Congress to work out their differences.  Nothing has really changed since the previous shutdown, though maintaining government funding during an active period of foreign policy could change the dynamic. 

The House 

Speaker Johnson intends to make health care a focus in 2026 for his conference, and he believes that a partisan reconciliation package could be used to advance those policies.  While Speaker Johnson would rather talk about expanding health savings accounts and association health plans, he can’t escape the divisive issue in his conference on what to do with the expired APTCs.  We expect Democrats to continue attacking moderate and vulnerable Republican members about their failure to address health care costs – a fact that will ensure these GOP members continue to press for legislation on APTCs. 

Meanwhile, a three-year APTC extension will be put to a vote, reportedly as soon as January 9, thanks to a discharge petition brought by House Democratic leadership that has gained the support of four moderate House Republicans.  

The House Energy and Commerce Health Subcommittee is wasting no time by jumping right back into health care policy with a legislative hearing on 10 proposals to support access to Medicare services, including clinical lab testing, quality reporting, supplemental oxygen and CMS’ new WISeR Model. 

There You Have It 

If you like college football, we can’t imagine you were disappointed with the games in the College Football Playoff series – unless, of course, your team lost.  This week’s games will be awesome!  Do you think Indiana can keep it going?  Let us know. Make it a great week!  

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Week Ahead: Eyeing the Exits

“Eyeing the exits” according to Google AI means “people are looking to leave a situation, often due to dissatisfaction or high stress, like lawmakers sensing a negative trend or escaping political turmoil.  That couldn’t be more true this week in DC!  We can smell jet fuel from the tarmac – let’s see what Congress can get done before heading home for the rest of the year.  Welcome to the Week Ahead! 

The Administration  

The administration is looking ahead to 2026, preparing to send Rural Health Transformation Program funding to the states and providing guidance on implementing Medicaid work requirements. 

On RHTP implementation, HHS officials have told us they are on track to meet the December 31 deadline to announce awardee decisions.  The real work begins in 2026, when states try to workout how to navigate their own legislative and procurement processes.  We expect the Centers for Medicare and Medicaid Services (CMS) to keep in constant contact with the States, ensuring they meet the MAHA goals. 

On the Medicaid work requirement guidance, stakeholders have a lot of questions, as you might expect. For example, the guidance says that “CMS (Centers for Medicare and Medicaid Services) continues to evaluate which existing state section 1115 demonstration populations meet the definition of an ‘applicable individual.’” Since nearly all states have at least one active Section 1115 Waiver, this is an important question! 

Caprice Knapp, Principal Deputy at the Center for Medicaid and CHIP Services, said during the Medicaid and CHIP Payment and Access Commission (MACPAC) December meeting that CMS expects to publish additional guidance in June 2026.  Ms. Knapp declined to say whether stakeholders might expect additional guidance before June, but she did say that CMS will hold monthly informational calls and all state calls on implementation. 

Be on the lookout for the 4th extension of the temporary Drug Enforcement Administration rule allowing controlled substances to be prescribed via telehealth.  The proposed rule has left OMB and should be published imminently.  

The Senate  

Following the Senate’s failure to pass either the GOP health care reform bill or the Democratic enhanced advance premium tax credit (APTC) extension bill, Senate leadership is turning its attention to consideration of the annual National Defense Authorization Act (NDAA). The Senate is showing few, if any, signs that it is considering additional legislation to extend the enhanced APTCs or to make other major health care reforms before the end of the year. 

The issue of the expiring APTCs is far from dead. With almost half (47%) of U.S. adults expressing concerns about their ability to afford necessary health care in 2026, we expect Senators on both sides of the aisle to continue working to show they are responding to what their constituents care about. Additionally, Senate Democratic leadership will likely be looking to see if any additional Republican Senators will join the four who crossed over party lines on December 11 to support enhanced APTC extension legislation.  

Yes, indeed, the repeat showdown on APTCs will come quickly in the new year.  January 30 is the next likely flash point when Congress must act on government funding and expiring health care extenders.   

The House 

House Republican leadership is working to put a health care reform bill on the floor this week (wait, what? I thought we were only working on APTCs?). On December 12, House Republican leadership unveiled the Lower Health Care Premiums for All Americans Act, which includes:  

  • A “stop-loss” provision to allow small businesses that fund their own health insurance to purchase policies to protect against unexpectedly high insurance claims 
  • Codification of association health plans  
  • Funding to pay for “cost-sharing reductions” in Obamacare 
  • A provision designed to bring increased transparency to the role pharmacy benefit managers (PBMs) play in the cost of prescriptions. 

Notably, the bill does not include an extension of the enhanced APTCs.  

House Republican moderates had been promised a vote on an amendment that would extend the enhanced APTCs. However, that deal has collapsed because of disagreements over the amendment’s text. Reps. Brian Fitzpatrick (R-PA), Jen Kiggans (R-VA), Mike Lawler (R-NY), and David Valadao (R-CA) are reportedly planning on offering an amendment like Fitzpatrick’s bipartisan legislation at the Rules Committee hearing on December 16. This amendment to extend enhanced APTCs for 2 years with certain reforms to address fraud concerns would require Democratic support, which may be hard to get if Democrats want to keep pushing for a clean extension. Statements from Democratic leaders, such as House Ways and Means Ranking Member Richard Neal (D-MA) suggest they are sticking to their guns. And even if the amendment passes, GOP representatives who oppose the enhanced APTCs could still kill the underlying bill. 

If the amendment fails, it’s an open question what GOP House moderates will do. Do they still go along with the broader health care bill? Do they support the Democratic discharge petition, which needs another 4 votes to force a vote on a three-year extension of the enhanced APTCs? In all likelihood, it doesn’t matter since the discharge petition would likely require a 7 legislative day waiting period before getting a vote (time the House does not have). 

Mirroring pending proposed rules at OMB, the House Rules Committee will also be considering this week H.R.498, to prohibit federal Medicaid funding for gender transition procedures for minors, and H.R.3492, to prohibit gender affirming care on minors.  

Other Health Care Hearings This Week 

  • December 15: House VA Tech Modernization Subcommittee hearing on EHR Modernization 
  • December 17: U.S. Congress Joint Economic Committee hearing on improving health care outcomes and reducing costs  

There You Have It 

With that, we will be back online with the Week Ahead when Congress comes back in 2026.  Have you enjoyed our weekly updates?  Let us know!  We at Chamber Hill Strategies wish you and yours a very happy and healthy New Year! 

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