The Week Ahead

All eyes are on the House, and not just for the UK’s King Charles III’s state visit. House Republicans are up to bat for consideration of a budget reconciliation resolution focused on immigration enforcement, and votes seem to be hard to find. So, let’s see what the week holds. Welcome to the Week Ahead!

The Administration

State Medicaid departments have been put on notice. The Centers for Medicare and Medicaid Services (CMS) sent letters to all 50 states on April 23 asking them to conduct a “swift revalidation” of high-risk providers. States have 10 business days from receiving the letter to notify CMS if they intend to carry out this revalidation and 30 days to deliver a broader revalidation strategy. Democratic leaders have accused the administration of targeting blue states in its war on fraud, but this action could show they are going after fraud wherever it exists. However, dramatically broadening the scope of its anti-fraud activities could cause CMS to make another error as the agency did in New York, where CMS miscalculated the number of residents receiving certain services.

Meanwhile, back in DC, Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. promised his agency would be bringing on 12,000 new employees during his recent marathon of congressional budget hearings. What will these employees be doing? We know from the hearings that RFK wants these new positions to focus on addressing chronic health challenges. We also know that the CMS budget justification document highlighted staffing for program integrity and technology positions as a priority. But after a year of reductions in force and staffing uncertainty, it’s hard to imagine that filling these positions will be easy.

The Senate

Senate Republican leaders are breathing a sigh of relief after passing a budget reconciliation resolution focused on immigration enforcement and avoiding efforts to amend the resolution to include other policy areas.  Still, Senators discussed some health care amendments, providing insight into what members might want to include in a reconciliation 3.0.

President Trump’s MFN deals have been discussed as a potential item for inclusion in a reconciliation package. Sen. Sanders (I-VT) offered an amendment to adopt Most-Favored-Nation (MFN) drug pricing, which was supported by Republican Sens. Susan Collins (ME), Josh Hawley (MO), and Dan Sullivan (AK).

Sen. Josh Hawley (R-MO) also introduced an amendment to extend a ban on Medicaid funding for Planned Parenthood.  While Sens. Lisa Murkowski (R-AK) and Susan Collins (R-ME) voted against the amendment, there is broad Republican support for this policy, boosting its chances for inclusion in a potential third reconciliation package.

Meanwhile, this week, Senate Democrats plan on releasing their health care plan, according to comments made by Minority Leader Chuck Schumer (D-NY) at the America Hospital Association annual meeting. The plan will focus on strengthening the Affordable Care Act, including reinstating premium subsidies; strengthening Medicare and Medicaid; lowering drug prices; investing in federal research; and reversing budget cuts. The plan gives us a window into how Senate Democratic candidates will talk about health care on the campaign trail and what Senate Democrats might do if they retake the majority in 2027.

Health Care Hearings This Week

• April 29: Senate Homeland Security Subcommittee on Investigations hearing on Biden-era COVID-19 policies
• April 29: Senate Veterans Affairs Committee legislative hearing

The House

All eyes are on the House, now that the Senate has passed its reconciliation resolution. Speaker of the House Mike Johnson (R-LA-4) will have his work cut out for him as he balances demands from moderate Republicans, who have felt burned by the One Big Beautiful Bill, with demands from conservatives who want the reconciliation bill to be broader than immigration enforcement funding. To ensure support from conservatives, House Republican leadership has made it clear they are willing to leave the door open for a third reconciliation package and are preparing to unveil a framework of what could be included in that package. With only 2 Republican votes to lose, Johnson is sure walking a perilous path. The first step in that path is the House Rules Committee meeting at 1pm on April 27.

In non-reconciliation news, health system CEOs are rounding out the House health care affordability hearings, as they appear before the Ways and Means Committee on April 28. The witness list includes representatives from HCA Healthcare, New York-Presbyterian – currently being sued by the Department of Justice for anticompetitive contracts, ECU Health, and CommonSpirit.

Other Health Care Hearings This Week:

• April 29: House Energy and Commerce Health Subcommittee hearing on regulation and oversight of food
• April 30: House Appropriations Interior Subcommittee hearing on the Indian Health Service

There You Have It

OpenAI has unveiled ChatGPT for Clinicians, designed to support clinical tasks like documentation and research. What are your thoughts about AI in health care? Let us know. Make it a great week!

Congress is back in town and has a lot on its plate. Members left for the 2-week scheduled work period without fully funding the Department of Homeland Security (DHS), and while they were away, President Trump released his Fiscal Year 2027 Budget Request, which his cabinet will now need to justify. So, let’s get into it. Welcome to the Week Ahead!

The Administration

Not wanting to be left out of the podcast trend, Health and Human Services (HHS) Secretary Robert F. Kennedy. Jr. has announced that the first episode of his podcast, aptly named “The Secretary Kennedy Podcast,” will premiere this week. Kennedy will host discussions with doctors, scientists, and HHS staff to begin “a new era of radical transparency in government.” The podcast will act as another tool for the administration to spread the message of the Make America Healthy Again (MAHA) movement ahead of the midterms, which is crucial as President Trump looks for wins to highlight.

Secretary Kennedy has also been busy working on his vaccine priorities through changes to the Advisory Committee on Immunization Practices (ACIP) charter. The changes are designed to expand the fields from which the Secretary of HHS can draw from when appointing ACIP members, including those who are knowledgeable in the field of “recovery from serious vaccine injuries.” The charter also adds several vaccine skeptic organizations to the list of organizations that supply non-voting liaison representatives to the Committee. Richard Hughes, an attorney who represented the groups that successfully halted Kennedy’s previous attempt to remake ACIP, commented that “the purposes (of the document) are likely two-fold — attempting to create the appearance of conformity to legal challenges while laying the groundwork for furthering an anti-vaccine agenda.”

The Senate

 As the House considers the DHS funding bill, minus funding for immigration and Customs Enforcement (ICE) and Customs and Border Protection (CBP), the Senate is looking at ways to maneuver ICE and CBP funding through. President Trump agreed with plans to move forward with a plan to finish DHS funding through reconciliation after meeting with Sens. John Barrasso (R-WY) and Lindsey Graham (R-SC), Chairman of the Senate Budget Committee, on April 10. Our conversations on the Hill support the idea that this second reconciliation bill would focus exclusively on ICE/CPB funding. This will certainly raise questions for the Senate parliamentarian, who will have to decide if the Senate can use reconciliation for funding normally passed through the annual appropriations process. Our conversations also indicate that a desire to keep this reconciliation bill focused on ICE and CBP could push any other potential items into a third reconciliation bill.

It is the last full week for Senators to submit appropriations requests for consideration by the Senate Appropriations Labor-HHS Subcommittee as the deadline for submission is April 21.

Health Care Hearings This Week

• April 16: Senate Budget Committee hearing to examine the Presidents FY27 budget proposal with Office of Management and Budget Director Vought
• April 16: Senate Health, Education, Labor, and Pensions hearing to examine lowering drug costs

The House

The House is kicking off consideration of the President’s Fiscal Year 2027 budget proposal and will be hosting multiple cabinet members throughout the week. HHS Secretary Kennedy, for his part, will appear before the House Appropriations Labor-HHS Subcommittee and the House Ways and Means Committee on April 16. Sec. Kennedy will be likely be facing questions about the large cuts to HHS, especially the National Institutes of Health. We also expect Democratic members to take advantage of the opportunity to hit the administration on everything from vaccines to Medicaid cuts.

Public health legislation will be the focus of a House Energy and Commerce Health Subcommittee hearing on April 15. Bills being discussed include reauthorizing funding for research related to areas including tick-borne diseases, school-based health centers, stem cell therapeutics, and others. The hearing will also cover legislation to expand services offered at community health centers, require HHS publication of physical fitness recommendations, and establish rules related to the regulation of general wellness products. This hearing is the first step in moving these bills through committee and onto the floor. Those bills that pass and that are bipartisan would be likely targets for inclusion in a potential health care package later in the year.

Other Health Care Hearings This Week

• April 14: House Ways and Means Health Subcommittee field hearing on modernized health care in practice
• April 17: House Education and Workforce Committee hearing on HHS Policies and Priorities

There You Have It

Congratulations to the Artemis II crew for successfully completing their mission around the moon, the first trip towards the moon for humans in over 50 years, and for setting a new record for farthest distance ever traveled from Earth. Did you watch the splashdown? Let us know. Make it a great week!

President Trump recently shared his top legislative priority: send the voter ID bill called the SAVE America Act to his desk or nothing else will get signed. That’s a tall order, right now, but let’s see what happens. With that, welcome to the Week Ahead!

The Administration

The Centers for Medicare and Medicaid Services will be busy this week, as they host their Quality Conference and work with states behind the scenes on their rural health transformation plans. Reports on implementation have been quiet as each state works with its legislature to approve its funding.

The clock is running out on the Centers for Disease Control and Prevention’s (CDC) lack of permanent leadership. Dr. Jay Bhattacharya, the National Institutes of Health Director, has been filling in, but his ability to exercise the “exclusive powers” of that office expires on March 26, per the timeline set out in the Administrative Procedures Act.

If the President decides to leave the position vacant, the authority to make decisions on things like the vaccine schedule would go to Health and Human Services Secretary Robert F. Kennedy, Jr., while someone like Dr. Bhattacharya could continue to perform “non-exclusive” duties. Was this the plan all along?

The Senate

Pay attention to the Senate floor on the SAVE America Act even as health care may be embroiled in the voter ID debate. Senate Majority Leader Thune (R-SD) promised a full discussion but using a sequence of votes and debate that avoids the “talking filibuster.” Expect some health care-related amendments, including one requested by the President to add language prohibiting gender transition procedures for minors. Could this new method of debate-amendment-vote become a new norm in the upper chamber? We will see.

We have also hit the one-month mark for the Department of Homeland Security (DHS) shutdown. While there is still no end in sight, the Senate Homeland Security Committee is holding a hearing on the nomination of Sen. Markwayne Mullin (R-OK) on March 18, advancing the confirmation process.

Senate Health, Education, Labor, and Pensions Committee Chairman Bill Cassidy (R-LA) recently laid out his health care priorities, including codifying some of President Trump’s most-favored-nation pricing policies as well as price transparency. The decision to focus on areas of agreement with the President may be strategic, as he faces Trump-endorsed Rep. Julia Letlow (R-LA-5) in a primary on May 15.

Health Care Hearings This Week

• March 19: Senate HELP Committee Member Day hearing

The House

While the Senate is distracted by voter IDs, House committees are focusing on health.

Health affordability hearings are back as the House Energy and Commerce Health Subcommittee hears from health care providers on March 18.  On the docket will be the American Hospital Association (AHA) and could also include representatives from groups such as the American Medical Association (AMA). We expect the Committee to focus on issues such as the impacts of consolidation in the health sector and concerns about price transparency.

Continuing its work on fraud, waste, and abuse from February, the House Energy and Commerce Oversight Subcommittee will examine the role of CMS in preventing and detecting fraud in federal programs. The Committee will focus on vulnerable programs, using technology to stop fraud, and the role of states in preventing Medicaid fraud.

NIH Director Dr. Jay Bhattacharya will be back on Capitol Hill on March 17, this time in front of the House Appropriations Labor-HHS Subcommittee for an oversight hearing.

Not to be left out of the health care discussion, the House Ways and Means Health Subcommittee will examine current challenges in kidney disease care and how prevention and treatment options can improve the lives of patients.

Looking ahead, hospitals will take center stage in April, as the House Ways and Means Committee continues its own health affordability series with a focus on the impact of consolidation.

Other Health Care Hearings This Week

• March 18: China Select Committee hearing on the drug supply chain
• March 18: House VA Committee hearing on health care legislation

There You Have It

Did you catch the MAHAspital sketch on Saturday Night Live, spoofing Sec. RFK, Jr?  What did you think? Let us know. Make it a great week!