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!
