The Week Ahead

As a polar vortex threatens the Northeast and Midwest with cold temperatures, lawmakers looking to extend the expiring enhanced advance premium tax credits (APTCs) are feeling the heat. With only eight days left before Congress is set to leave for the holiday recess, advocates are hoping for a cooling of relations between party leadership to avoid a blue Christmas. So, let’s get into it. Welcome to the Week Ahead!

The Administration

It’s all about moving forward at the Department of Health and Human Services (HHS) these days.  HHS announced its major AI strategy, “OneHHS” where all divisions will work together on a Department-wide AI infrastructure to boost internal operations, research, and public health.  But that isn’t the only collab HHS is working on.

Turning heads, a new Center for Medicare and Medicaid Innovation model called ACCESS was announced, which will test expanded access to new technologies by offering outcome-based payment incentives to primary care clinicians.  Bolstering this model will be the Food and Drug Administration’s TEMPO pilot, which will evaluate a risk-based enforcement approach to new digital health devices.  Together, the two models will help the agencies understand the interaction between access, cost, and improved care.

Speaking of models, CMS teased a new Accountable Care Organization (ACO) model called LEAD to be released in December.  The 10-year model will use an updated financial benchmarking approach, risk arrangements, and wellness incentives.

But, wait, where is the administration on APTCs??  The future is now.

The Senate

The Senate is expected to consider legislation to extend the enhanced APTCs this week, fulfilling Senate Majority Leader John Thune’s promise to Democrats in exchange for their votes to reopen the government. Senate Democrats are planning on bringing forward a three-year clean extension of the subsidies – legislation that mirrors the bill House Democrats have been trying to get enough signatures for to force a House floor vote.

There has also been talk about Senate Republicans bringing a bill forward that would redirect enhanced APTC funding to health savings accounts (HSAs), but only for marketplace enrollees with bronze or catastrophic plans, since they are now eligible for HSAs under the One Big Beautiful Bill Act.   Then there is the latest float by Republican Senators Bernie Moreno (OH) and Susan Collins (ME) that  would eliminate zero-premium plans and cap income eligibility for APTCs.

However, Leader Thune has not yet announced plans to move forward on this bill. Based on our conversation, both bills would fail to reach the 60-vote threshold required to pass the Senate. And even if the Democratic bill passed the Senate, it would be DOA in the House.

It will also be important to watch what happens at the Senate Homeland Security and Governmental Affairs Investigations Subcommittee hearing entitled, “Defining Our Healthcare Problem and Principles We Should Follow to Solve It.” This hearing, scheduled for December 10, is likely to see some fireworks, as Sen. Ron Johnson (R-WI), an avid Affordable Care Act critic, chairs the subcommittee. We will also be watching for potential wild cards, such as Sen. Bernie Moreno (R-OH), who is working on a short-term enhanced APTC extension provided reforms are made, and Sen. Jon Fetterman (D-PA), who supports an enhanced APTC extension, but has shown a willingness to break with his party when it comes to strategy on how to get that done.

Meanwhile, Senators have made progress on another health care issue that has long garnered bipartisan support: pharmacy benefit manager (PBM) reform.  Senate Finance Committee Chair Mike Crapo (R-ID) and Ranking Member Ron Wyden (D-OR) introduced legislation to address concerns about certain PBM practices that have been criticized for driving up prescription drug costs and limiting transparency. Our conversations on the Hill support the idea that this bill, or similar PBM reform legislation, could pass along with larger legislation, such as legislation that will be needed to continue government funding beyond January 30, 2026.

Other Health Care Hearings

• December 11: Senate HELP hearing on the Future of the U.S. Organ Procurement and Transplantation Network

The House

If you were to just listen to House Republican and Democratic leadership, you’d think negotiations over the extension of the enhanced APTCs were as frozen as a pond in winter. But beneath the surface, there are signs of a breakthrough. Most notably, a group of 35 bipartisan representatives, led by Reps. Jen Kiggans (R-VA) and Josh Gottheimer (D-NJ), introduced a health care framework outlining a two-year plan to extend the enhanced APTCs, phase them out for certain enrollees, and institute reforms to address fraud concerns. This framework also calls for PBM reforms and lists other health care policies as potential reforms to pursue, including boosting the Medicare Physician Fee Schedule and health care price transparency requirements.

But if negotiations are like a frozen pond, don’t expect to go swimming just yet. House Majority Leader Steve Scalise (R-LA) has said the Kiggans-Gottheimer framework is “not been a part of the package we’re discussing.” Additionally, both Speaker Mike Johnson (R-LA) and Leader Scalise have been hinting that their conference is close to unveiling its own health care reform legislation. This could be as soon as this week (if you ask Speaker Johnson), but certainly within the next few weeks, according to Leader Scalise.

There You Have It

Washington celebrated a couple of annual traditions with the lighting of the Capitol Christmas tree on December 2 and the lighting of the National Christmas tree on December 4. Are decorations up at your house? Let us know. Make it a great week!

After a whirlwind of votes and a stroke of a pen, the longest federal government shutdown in history has come to an end. However, the deal to reopen the government is only in effect for a few weeks and advance premium tax credits (APTCs) expiration is looming.  With only a few more days before leaving town again for Thanksgiving, can lawmakers make progress on their stalled agenda? There’s only one way to find out, so let’s get into it. Welcome back to the Week Ahead!

The Administration  

President Trump weighed in on the health care debate on Truth Social (where else!?), saying that Republicans in Congress should redirect the APTCs from the insurance companies directly to the people. The post offered no details on how exactly that would work, but one idea coming from Republican lawmakers and conservative think tanks, such as the Paragon Institute, would be to put the funding for APTC credits into health savings accounts (HSAs) for individual enrollees to use. Another option that has been suggested is to provide the APTC credits to enrollees through flexible spending accounts (FSAs). Beefing up HSAs and FSAs is not a new idea in Republican circles, but the President’s call to action doesn’t mean Republicans are ready to sub in HSAs for APTCs.

The debate over APTCs is not the only issue on the administration’s health care policy plate. There are also the 29 regulatory actions from the Department of Health and Human Services (HHS) currently at the Office of Management and Budget (OMB). These include the final rules for calendar year 2026 (CY 26) End-Stage Renal Disease Prospective Payment System (PPS), Hospital Outpatient PPS, and Home Health PPS. These rules go into effect January 1, and the Centers for Medicare and Medicaid Services (CMS) has already lost valuable time due to the shutdown.

The Senate  

The Senate has been in session throughout the shutdown, working on the continuing resolution (CR), which ultimately led to the reopening of the federal government. Now, after a short break, it’s right back to work for the upper chamber as Senate Majority Leader John Thune (R-SD) promised a vote “in mid-December” on APTCs to get enough Democratic votes to pass the CR. In addition to APTICs, there has also been discussion of a concurrent vote on a Republican health care “reform” bill. This may include reallocating funding for APTCs to HSAs or FSAs for enrollees to use. There have also been discussions about a proposal to extend the APTCs with reforms such as an income cap, guardrails to prevent improper payments, and stricter eligibility/oversight measures.

All of these discussions will come to a head when the Senate Finance Committee meets for a hearing on November 19 regarding the rising cost of health care. This will be an opportunity for Senators on the Committee that oversees APTCs to discuss the future of the subsidies. It’s a battle royale for health policy wonks when the conservative American Action Forum (AAF) and the Paragon Institute and the progressive Urban Institute square off on the idea of redirecting ACA subsidies to tax-free accounts. It’s especially interesting since AAF recently published a piece expressing concerns about the idea of redirecting APTCs to tax-free accounts. We expect Democratic members of the committee to generally emphasize the importance of extending the APTCs, but it will be important to monitor any signs that Democratic members are open to any reforms.

Other Health Care Hearings This Week

• November 19: Senate Finance Committee executive session to vote on the nomination of Thomas Bell to be the Inspector General of HHS

• November 19: Senate Aging Committee hearing on restoring trust in medicines

The House 

The House returned on November 13 after being out of session since the end of September, and the chamber faces a daunting to-do list. The House is reportedly going to consider legislation requiring the Department of Justice (DOJ) to release information related to the Jeffrey Epstein investigation on November 18. House Speaker Mike Johnson (R-LA) has also indicated he plans to bring forward a bill to repeal provisions of the recently passed CR that would allow for Senate offices to sue the federal government for unauthorized disclosure of Senate data.

Even with all this going on, House appropriators are also feeling pressure to make progress on FY 26 funding bills for those that were not included in the CR. According to our conversations with House Appropriations Committee staff, the Defense appropriations bill is rumored to be up next for consideration, and the plan would be to pair it with other appropriations bills. This lines up with conversations on the Senate side about advancing a minibus of appropriations bills, including for Defense. The Senate has yet to advance its version of the Defense appropriations bill, but our conversations on the hill indicate that it could be considered as soon as the week of November 17 or the week after Thanksgiving.

House Republicans will also face continued questioning about what they plan to do on APTCs. Speaker Johnson has not indicated that he would take up a bill to extend the enhanced ACA tax credits, but he may face political pressure, especially from House GOP members who are defending vulnerable seats in the 2026 midterm elections. On the other hand, bringing up a vote on extending the enhanced ACA tax credits could be divisive, since it would be something many members of his caucus would oppose, and he would need Democratic support to pass it.

 House Health Care Hearings this Week  

• November 18: House Energy and Commerce Oversight Subcommittee hearing on AI chatbots

• November 19: House Ways and Means Health Subcommittee hearing on preventing and treating chronic diseases

There You Have It  

Congratulations to the Washington Spirit, which will play in its second consecutive National Women’s Soccer League Championship game, and its fourth in club history, on November 22. Do you have a favorite fall sport? Let us know. 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.