The Week Ahead

Congress granted President Trump’s wish, just in time for his 80^th birthday, by sending him the immigration enforcement reconciliation legislation he’s been asking for. Now, President Trump has a new wish, a third reconciliation package to include defense funding and the SAVE America Act. However, Congressional Republicans have differing views on the likelihood of making this wish come true. So, let’s get into it. Welcome to the Week Ahead!

The Administration

The grace period for hospital price transparency is over, according to a notice published on social media by the Department of Health and Human Services (HHS). According to the notice, HHS has sent warning letters  to over 500 hospitals for noncompliance with price transparency requirements since enforcement went into effect on April 1, 2026. The notice and warning letters make it clear that the administration is trying to show that they are making strides in improving health affordability. However, it’s not clear from the notice what additional steps will be taken by the administration to ensure compliance.

On June 8, the District of Massachusetts vacated the Trump administration’s $100,000 fee on new H-1B applications as an unlawful tax. The administration appealed this, and it has been temporarily stayed until a ruling by the U.S. Court of Appeals for the 1^st Circuit. That stay is conditioned on the administration filing a motion to stay no later than June 18, 2026. Whether this fee remains in place has implications for the health care workforce, as many foreign-born physicians, who often fill critical gaps in the health care system, rely on the H-1B visa pathway.

The Senate

Reconciliation 3.0 is off to a rocky start in the Senate as Republican leadership disagrees on whether it is possible at all. Senate Majority Leader John Thune (R-SD) shared that he remains open to the possibility, especially for additional military funding. On the other hand, Senate Appropriations Committee Chair Susan Collins (R-ME) and Senate Appropriations Defense Subcommittee Chair Mitch McConnell (R-KY) are more skeptical about 3.0, cautioning officials not to rely on a 3^rd package to supplement lower funding levels during the normal appropriations process.

In non-reconciliation news, the first stage of the Democratic health care working groups has concluded. The three groups, focused on long-term care, health insurance, and prescription drugs, finished holding their open office hours and will next move to releasing Requests for Information and position papers on their topics according to our conversations on the Hill. These working groups are important to watch for what Democratic leaders may be looking to do if they retake the Senate in November.

Health Care Hearings This Week

The Senate Health, Education, Labor and Pensions (HELP) Committee is scheduled to consider several health care bills on June 17, spanning from organ transplants and drug competition to reauthorizing public health programs, most of which have House companions. Surprisingly absent from the list is S. 4189, the INSULIN Act, which would cap the monthly cost of insulin at $35 for patients with commercial insurance and was reportedly going to be included But don’t count it out yet, bill sponsor Sen. Jeanne Shaheen (D-NH) recently announced that the legislation has reached the 60-vote threshold for passage.

Also on the docket for June 17, the Senate Aging Committee will be holding a hearing on China’s impact on seniors’ health, finances, and security with Commissioners from the U.S.-China Economic and Security Review Commission. The Committee has already held multiple hearings on the security of the pharmaceutical supply chain and the dangers of reliance on foreign countries, including China. Based on this, we expect the topic to come up again at the upcoming hearing.

The House

The House is out until after the Juneteenth holiday, but Republican conversations about Reconciliation 3.0 are still happening. Measures targeting fraud in public health programs are still being viewed as a pay for by some members. However, House Energy and Commerce Health Subcommittee Chair Morgan Griffith (R-VA-9) told reporters that health care systems “need to adjust to the changes we’ve already made.” And then there are concerns from moderates and those in tight races about doing anything that could be seen as limiting access to benefits so close to the November midterms.

There You Have It

It was an exciting weekend for sports fans, as the NBA Finals and the Stanley Cup finals crowned their winners. Here at Chamber Hill Strategies, we have strong opinions about which games we preferred to tune in to. So, have you been watching hockey, basketball, or both? Let us know. Make it a great week!

The summer sprint is on, as lawmakers stream back from the Memorial Day recess. Senate Republican leaders are searching for a way to pass the immigration-enforcement funding reconciliation bill after bolting before recess over concerns about the “anti-weaponization” fund. At the same time, calls for a third reconciliation package to address issues such as affordability and health care show no signs of fading. Meanwhile, the administration is down to the wire on its long-awaited guidance on Medicaid work requirements. So with that, let’s get into it. Welcome to the Week Ahead! 

The Administration 

All eyes are on the Centers for Medicare and Medicaid Services (CMS), which faces a June 1 statutory deadline to issue the interim final rule implementing H.R. 1’s Medicaid community engagement (a.k.a. work) requirements. States and stakeholders are watching closely as the interim final rule has made its way through the Office of Management and Budget (OMB) and is expected to be released imminently. It will fill critical gaps left by December’s preliminary guidance, including how to define and verify the medical frailty exemption. States are also eagerly awaiting this information as they have precious little runway to retool their systems before the January 1, 2027, implementation date. Once the interim rule lands, expect a wave of stakeholder reactions and plenty of midterm-year messaging on both sides. 

Turning now to the Food and Drug Administration (FDA), it’s been nearly a month since Marty Makary resigned under pressure, and Kyle Diamantas stepped in as acting commissioner. The White House has yet to finalize even a formal shortlist of potential permanent replacements. Additionally, the confirmation calendar for health nominees is already crowded, with the Senate still needing to act on President Trump’s nominees for director of the Centers for Disease Control and Prevention and Surgeon General. President Trump is also no stranger to leaving certain agencies with temporary leaders. All of this suggests Diamantas may be in for a longer stint as acting commissioner than initially reported.  

The Senate 

Senate Republican leaders already knew that passing the immigration-enforcement reconciliation package would be tricky. However, the vote math has gotten even trickier after incumbent Sen. John Cornyn (R-TX) was defeated by state Attorney General Ken Paxton in the May 26 GOP primary runoff. Cornyn joins Sen. Bill Cassidy (R-LA), who lost his own primary in May, on a growing roster of departing and lame-duck members with little incentive to fall in line with the President’s agenda, a dynamic that could complicate any party-line whip count. This is especially true since the Republican Conference also includes moderate members such as Sens. Susan Collins (R-ME) and Lisa Murkowski (R-AK), who have been willing to buck Republican leadership and President Trump on items they see as going too far. However, the core of the caucus is likely to gravitate back toward Trump, given the relative political safety proximity to POTUS provides through election cycles. This is one example of the challenges Senate Republican leadership is facing when it comes to moving reconciliation 2.0, let alone 3.0.  

At the Finance Committee, pharmacy benefit manager (PBM) reform may get a second act. February’s funding law already delivered a first tranche, including delinking pharmacy benefit manager pay from drug prices in Medicare Part D and new transparency and rebate pass-through rules for Part D and employer plans. Our conversations on the Hill suggest there may be interest in taking further action on PBM reform. One avenue they could explore is expanding PBM reforms to Medicaid plans. Given the limited time for legislating before the midterms, we would expect any additional PBM reforms to be included in a larger bipartisan legislative package, perhaps at the end of the year. 

Health Care Hearings This Week 

• June 3: Senate HELP Committee hearing on gender transition procedures on minors 
• June 3: Senate Homeland Security Permanent Subcommittee on Investigations hearing on the impacts of the COVID-19 vaccine 
• June 3: Senate Aging Committee hearing on the human cost of foreign drugs 

The House 

Both the Energy & Commerce (E&C) and Ways & Means (W&M) Committees have held a series of hearings on addressing health care affordability, and we’ve been told GOP leaders both want to keep working in this space.    

On the E&C side, we’re hearing of growing interest in addressing price transparency. This could take the form of legislation to strengthen price transparency requirements for insurers and providers, as President Trump called for in his “Great Healthcare Plan.”  

Over at W&M, legislation to increase the amount of information that not-for-profit hospitals have to report on their tax returns appears to still be alive after a discussion draft was released and then pulled from a recent markup of other legislation. The discussion draft would require non-profit hospitals to report on their spending on community benefits, charity care, advertising, quality improvement, non-clinical programming, and more. It’s important to note that any effort to increase the reporting requirements faces fierce resistance from the American Hospital Association, and we’ve been told that committee Democrats are also resisting the bill.  

Health Care Hearings This Week 

• June 2: House Rules Committee meeting of FY 27 FDA appropriations bill  
• June 3: House Oversight Committee hearing on examining HBCS fraud
• June 4: House Judiciary Subcommittee on Courts, Intellectual Property, Artificial Intelligence, and the Internet hearing on medicines and IP 
• June 5: House Appropriations Labor-HHS Subcommittee markup of the FY27 Labor-HHS appropriations bill 

There You Have It 

Summer is (unofficially) here! What summer plans are looking forward to? Let us know. Whatever’s on your agenda, make it a great week!

Congress is back after a short recess, and President Trump’s ballroom remodel has been paused yet again, and some congressional Republicans are worried that the $1 billion budget request for security related to the ballroom could get them into some hot water in the lead up to November midterms. But what is the status of Reconciliation 2.0? Let’s get into it. Welcome to the Week Ahead!

The Administration

The spotlight has shifted to the Food and Drug Administration (FDA), and Commissioner Marty Makary, as concerns mount about agency effectiveness under his leadership. The FDA recently rejected a drug that would treat melanoma from Replimune, citing insufficient data on the drug’s effectiveness due to the reliance on a single-arm trial design. Commissioner Makary will need to defend FDA decisions as he appears before the Senate Appropriations Ag-FDA Subcommittee on May 13 to testify about the FY 2027 (FY 27) FDA budget proposal. But he may not get the chance if President Trump follows through on his reported plans to fire Commissioner Makary…

Meanwhile, the Centers for Medicare & Medicaid Services (CMS) is hard at work developing the interim final rule on state implementation of the Big, Beautiful Bill’s community engagement requirements ahead of the June 1st, deadline. Nebraska recently became the first state to begin enforcement, but stakeholders are concerned about the effects on eligibility and enrollment. The Medicaid and CHIP Payment and Access Commission (MACPAC) has similar concerns about the requirements nationwide and voted to include a recommendation for CMS to develop a transparent monitoring and evaluation plan that will be included in its June 2026 report to Congress.

The newly formed Healthcare Advisory Committee (HAC) will have their first meeting on May 18. The committee was formed to advise the Secretary of Health and Human Services (HHS) and the CMS Administrator on programs and policies that can improve the US health care system. According to a press release announcing the Committee, HHS leadership intends for the Committee to focus on improving preventive care, reducing administrative burden with the health care system, and strengthening the sustainability of public health programs. The meeting will include public introduction of Committee members, the Committee vision, and establishment of Committee bylaws. Comments are due by 5pm on May 13 and can be submitted to hac@cms.hhs.gov.

The Senate

We’re on primary watch, as Sen. Bill Cassidy (R-LA) and Rep. Julia Letlow (R-LA-5) compete for the Republican spot on the November ballot. Sen. Cassidy chairs the Senate Health, Education, Labor, and Pensions (HELP) Committee and sits on the Senate Finance Committee, so a potential loss for him would have big implications for Senate health care committees in the 120^th Congress. Sen. Cassidy has pushed back against some of Health and Human Services Sec. Kennedy’s policies, most notably changes to the childhood vaccine schedule. He has also been called out by President Trump as a roadblock to the confirmation of President Trump’s nomination of Casey Means for US Surgeon General. On the other hand, Rep. Letlow has aligned herself closely with the make America healthy again (MAHA) movement, receiving endorsements from President Trump and the MAHA PAC.

If Sen. Cassidy loses the primary, he will still have another 7 months to exert his influence in the Senate. That might mean we see him become more outspoken about his disagreements on vaccines. Sen. Cassidy’s would also be able to exert influence over the confirmation process of Dr. Erica Swartz to lead the Centers for Disease Control and Prevention, Dr. Nicole Saphier to be Surgeon General, as well as a possible new nominee for FDA Commissioner.

Health Care Hearings This Week

• May 13: Senate Homeland Security Committee hearing on COVID-19 whistleblower testimony

The House

House Republicans are keeping their eyes on the prize: the promise of Reconciliation 3.0. House Republican leadership was able to keep the Reconciliation 2.0 package focused on immigration enforcement funding through assurances of a 3^rd package for other priorities, such as health care. House Republican leadership is committed to getting Reconciliation 2.0 on the President’s desk before his June 1 deadline. Meantime, House conservatives are working hard to keep the conversation about 3.0 afloat.

The House is kicking off floor consideration of FFY 27 appropriations legislation this week with the Military Construction-Veterans Affairs appropriations bill. The House Rules Committee is scheduled to meet on the bill on May 12 and floor consideration is expected later in the week. The bill includes funding for the Veterans Health Administration.

New health care legislation may be on the horizon, as our conversations on the Hill indicate that the House Ways and Means Committee is planning for a markup of anti-fraud legislation, including items related to health care. We are also hearing that the House Energy and Commerce Health Subcommittee is looking to take action in response to the recent series of hearing about health care affordability.

Health Care Hearings This Week

• May 14: House Veterans’ Affairs Committee markup of several Veteran health care bills

There You Have It

Did you know that Mother’s Day can be traced back to movements by women reformers to improve national public health and hygiene and now honors the role of mothers? What Mother’s Day traditions do you have? Let us know. Make it a great week!