The Week Ahead

Senate Republican leaders return to Washington this week with just enough time to pass reconciliation and get home to see 4th of July fireworks. But Congress and the administration also have to deal with the fallout from the bombing of Iran. There is certainly a lot going on in DC!  So, let’s get into it – welcome to the Week Ahead!  

The Administration  

The Centers for Medicare and Medicaid Services (CMS) has kicked off its own fireworks show by finalizing the 2025 Marketplace Integrity and Affordability Final Rule. The final rule largely retains the provisions of the proposed rule released in March, including shortening of the Affordable Care Act (ACA) open enrollment period and prohibiting ACA coverage for Deferred Action for Childhood Arrivals (DACA) recipients.  

However, the rule also finalizes other parts of the proposal on a temporary basis, including several provisions strengthening income eligibility requirements. Why would CMS do that? 

According to reports, by sunsetting some of the rule’s provisions, Congress could get “budget credit” if these provisions are included in the final reconciliation bill being debated in Congress.  The Congressional Budget Office (CBO) previously estimated that many of these same provisions in the House-passed version of the reconciliation bill would save $101 billion over ten years.  

The Senate draft did not include these provisions, but having an extra >$100 billion of “walking around money” could be very useful to Republican leaders either to reduce the overall cost of the bill or mitigate the need for savings from other controversial provisions like Medicaid provider taxes or state directed payments.  

We expect CMS to finalize several other final rules over the next month, including rules setting Medicare payment rates for the coming year. These rules will set the stage for how Medicare reimburses different providers and services.  

The Senate 

Senate Republicans are feeling the heat, and it’s not just because of the temperature. Ever since the Senate Finance Committee released its reconciliation text on June 16, several Republican Senators have raised concerns about those provisions. For example, there are concerns about proposed reductions in the use of provider taxes to 3.5% by 2031 for Medicaid expansion states, as well as an annual 10% reduction in state directed payments until they match Medicare rates. This group includes Sens. Josh Hawley (R-MO), Jim Justice (R-WV), Lisa Murkowski (R-AK), and Susan Collins (R-ME). When you add in Senators such as Sens. Ron Johnson (R-WI) and Rand Paul (R-KY), who have raised concerns about the bill’s impact on the deficit, you are up to six Senators with major concerns over the current draft.  Remember, Republicans can only afford three no votes and still pass the reconciliation bill. That’s certainly enough to make Senate Republican leadership sweat.  

That said, conversations are continuing to address these Medicaid concerns. For example, Sen. Hawley has been pitching a return to the House-passed moratorium on new provider taxes and changes to state directed payments with additional guarantees that existing rates would be grandfathered in. Additionally, there have been discussions about creating a fund to help rural hospitals survive any changes to provider taxes or state directed payments. Something will need to be done to ensure the bill doesn’t burn up on the Senate floor.  

In non-reconciliation news, the Senate Committee on Health, Education, Labor, and Pensions (HELP) is scheduled to consider the nomination of Dr. Susan Monarez to be the Director of the Centers for Disease Control and Prevention (CDC) on June 25. Expect this hearing to feature fiery remarks about the removal and replacement of the entire CDC’s Advisory Committee on Immunization Practices (ACIP) by Health and Human Services Sec. Kennedy.  

Other Health Care Hearings  

• June 25: Senate Aging Committee hearing on sports medicine’s role in older Americans’ health  

• June 25: Senate VA Committee hearing on the Veterans Crisis Line  

The House 

House Speaker Mike Johnson (R-LA) is prepared to cancel the House’s upcoming recess if it means there is a chance that the reconciliation bill could be sent to President Trump’s desk before July 4th. But even with additional time, navigating the various factions within the House GOP caucus will be more difficult than leaving the National Mall after the fireworks end. That’s because, in addition to addressing concerns from members about Medicaid or the deficit, the Speaker also has to find a way to address concerns from House Republicans on the SALT Caucus.  

The Senate reconciliation bill’s dropping of the SALT deduction cap from $40,000 to $10,000 is an insult to the SALT Caucus GOP members. Senate Republican leaders say their amount is a placeholder amount for negotiations, but it’s hard to see how that number makes GOP SALT Caucus members excited to come to the table.  

Meanwhile, the House Budget Committee will be wading into the debate over Medicaid work requirements at a June 25 hearing. While not specifically mentioning Medicaid in the announcement, we expect Republicans to use the hearing as a platform to argue in support of provisions of the reconciliation bill that implement work requirements for certain individuals enrolled in Medicaid and the Supplemental Nutrition Assistance Program. Expect Democrats to use their time to highlight what they argue will be the detrimental effects of such policies on beneficiaries, although they have yet to name a witness for the hearing.  

Other Health Hearings  

• June 23: House Appropriations Committee continued markup of FY 26 Ag-FDA bill 

• June 24: House Energy and Commerce Health Subcommittee hearing on FY 26 HHS budget  

• June 25: House Ways and Means Health Subcommittee hearing on digital health 

There You Have It 

June 20 marked the Summer Solstice and First Day of Summer for the Northern hemisphere, otherwise known as the longest day of the year. How did you make use of the extra daylight? Let us know. Make it a great week!  

In what seems like a premiere of the Real Housewives of Pennsylvania Avenue, Elon Musk and President Trump are splitting faster than members of Congress heading to recess. As Musk and Trump throw shade at each other, the Senate’s ‘Big Beautiful Bill’ might need a big, beautiful rescue plan. Let’s get into it. Welcome to the Week Ahead!  

The Administration  

The deadline is this week for the Centers for Medicare and Medicaid Services (CMS) request for information on regulatory burden, and the administration is looking for respondents to dish on how to best reduce the red tape. Health care groups have no shortage of ideas, but like a VIP party, we probably won’t see the guest list except for those who decide to share that they were there. And remember, this is just an RFI, not a new rule or regulation. The administration can decide to take suggestions or leave them as it suits them.  

Meanwhile, Office of Management and Budget (OMB) Director Russell Vought, has told the House Appropriations Committee not to expect more details about the President’s budget request and to work with what they’ve got when it comes to the President’s budget for fiscal year 2026. But it’s already June, and before you know it, summer will be over, and the September 30 deadline to pass FY 26 funding bills will be here. We are already seeing some House Republican appropriators express concerns about the timeline. As summer drags on, that number of doubters could grow.   

The Senate 

Senate GOP leadership has one goal this week: get “pens down” on the Senate’s version of the One Big Beautiful Bill Act and start the next scene. But let’s be real—they’re still far from a finished product. And now what GOP leaders had hoped would be a steady march toward passage is a lot like a group dinner gone wrong. Some Committees are releasing legislative text, but no one agrees on the guest list, the menu, or the bill. 

Republicans are looking at changes to the health section, including  the possibility of adding changes to Medicare Advantage (MA) to help reduce the overall cost of the bill. Specifically,  the Senate is looking at dialing back coding intensity adjustments that could net significant savings. Other potential changes to the menu could include: 

• Pushing back the December 31, 2026 effective date for new Medicaid work requirements, The House Energy & Commerce Committee had set the effective date for January 1, 2029 in its version of the bill.  

• Giving states more time before they are required to conduct Medicaid eligibility checks every 6 months instead of the current every 12 months for the expansion population. Currently, that provision is set to go into effect for renewals scheduled on or after December 31, 2026.  

• Extending the effective date for ending the incentives for states to expand Medicaid coverage. That date is currently set for January 1, 2026. 

In addition to these considerations, the Senate could bend to pressure to weaken the House-passed bill’s prohibition on new provider taxes and its freeze on existing provider taxes. Senators from states with provider taxes in place have complained that these provisions leave a bitter aftertaste in their mouths.  

The trick will be making sure the menu remains appealing to diners in both the House and Senate, some of whom have very different tastes. The menu could get a little less salty if Senate Republicans decide to trim the current state and local tax (SALT) deduction. The House SALT Caucus is demanding respect and threatening to walk if their concerns are not addressed in the final cut.  

Will we see a markup?  With all the Republican talk of using regular order, so far, the negotiations on tax and health care have been only within their own party.  Senate Minority Leader Chuck Shumer (D-NY) and Finance Ranking Member Ron Wyden (D-OR) sent a letter demanding a markup, which suggests Finance may not have one. Democrats are ready to host the reunion and get the drama out in the open.  

As for the rest of the Senate cast, they’re trying to act calm and collective, but the group chat is full of shade. Negotiations are happening behind closed doors, but the energy is “we’re not far apart” one minute and “we’re done here” the next. 

And don’t forget the guest stars. Several fly-ins are happening this week, including key Medicaid constituencies such as nursing homes and children’s hospitals. They’re storming the Hill like Housewives entering a new season—scripted talking points, matching outfits, and a deep fear of being left out of the final edit. 

Senate Health Hearings 

• June 4: Senate Appropriations Labor-HHS Subcommittee hearing on FY 26 NIH Budget Request 

The House 

Over in the House, things are a little quieter—but not without drama. The Energy and Commerce Health Subcommittee is having a hearing on domestic manufacturing and the health care product supply chain on June 11. The hearing is expected to provide a high-level overview of a broad range of supply chain concerns, and explore the underlying background and contributing factors that have led to current disruptions—emphasizing a deeper understanding of the “what” and the “why” behind these issues. Expected topics include drug shortages, tariffs, international reference pricing, inspections of foreign drug manufacturing sites, and more.  While we don’t expect the majority to push a proposal or fix it at the hearing, we do expect members to offer plenty of ideas.  

Meanwhile, the House is watching the Senate with the same energy as a reunion special audience—waiting to see who flips, who cries, and whether groups such as the Freedom Caucus or SALT Caucus will throw the whole thing off track.  Everyone’s whispering about it like it’s a secret affair we’re all pretending not to know about.  

Additionally, a rescissions package that bill is causing slashes funding to HIV/AIDS programs like PEPFAR is expected on the floor this week. This will cause an uproar among public health groups, as well as both Republican and Democratic representatives who have been supportive of the program.  

The reintroduction of the Improving Access to Medicare Coverage Act is likely this week. This bipartisan bill would count patients’ time spent under observation status in a hospital towards the three-day stay required for Medicare coverage of care in a skilled nursing facility. CMS had waived the requirement during the COVID-19 public health emergency (PHE), but with the PHE in the rearview mirror, supporters are hoping lessons learned from the PHE will help draw new interest and a willingness to explore including the legislation in a must-pass health care package this Congress. 

Other Health Hearings This Week  

• June 10: House Appropriations Committee MILCON-VA Subcommittee Markup of FY 26 Allocations 

• June 11: House VA Oversight Subcommittee Legislative Hearing on H.R. 3482 Veterans Community Care Scheduling Improvement Act and H.R. 3494, VA Hospital Inventory Management System Authorization Act 

• June 12: House VA Health Subcommittee Legislative Hearing on H.R. 785, The Representing Our Seniors at VA Act of 2025; H.R. 2068, The Veterans Patient Advocacy Act; H.R. 2605, The Service Dogs Assisting Veterans (SAVES) Act; H.R. 3400, The Territorial Response and Access to Veterans’ Essential Lifecare (TRAVEL) Act of 2025; H.R. 3643, The VA Data Transparency and Trust Act; H.R. 1404, The CHAMPVA Children’s Care Protection Act of 2025; and H.R. 2148, The Veteran Caregiver Reeducation, Reemployment, and Retirement Act 

There you Have it 

A reminder that Father’s Day is June 15! Chamber Hill Strategies wishes all the Dads out there a very Happy Father’s Day. 

It’s crunch time in the House of Representatives, as Republican leadership has just a few days to pass their reconciliation bill before their self-imposed Memorial Day recess. It’s been a wild May here so far here in DC – so let’s get into it.  Welcome to the Week Ahead!  

The Administration 

The Food and Drug Administration (FDA) is expected to unveil a new framework for vaccine regulation, which is making vaccine advocates nervous. Potential changes include requiring all vaccines to be tested against placebos and ending the use of the Vaccine Adverse Events Reporting System, which vaccine skeptics have long criticized as inadequate for addressing vaccine injury claims. Vaccine advocates are also raising concerns that Dr. Vinay Prasad, whom they count as a vaccine skeptic, will oversee this framework as the newly appointed director of the FDA’s Center for Biologics Evaluation and Research.  

The Centers for Medicare and Medicaid Innovation (CMMI) is also undergoing a makeover to align with the Make America Healthy Again (MAHA) agenda. In a blog post, CMMI Director Abe Sutton unveiled a three-pronged strategy to achieve this by promoting evidence-based prevention, empowering individual health choices, and driving choice and competition. While light on specifics, the announcement is a sign that the Trump administration still sees a place for CMMI despite longstanding Republican concerns about the Center’s value and return on investment.   

HHS is also rescinding guidance documents, including a 2001 guidance on opioids and a Biden administration guidance on buprenorphine for opioid addiction. Given how quickly the second Trump administration has moved on its deregulatory agenda, we expect more regulatory changes could be in the offing.  

The Senate  

As Americans prepare for Memorial Day cookouts, RFK Jr. is preparing for a different kind of grilling. The HHS Secretary will return to Capitol Hill on May 20 to testify before the Senate Appropriations Labor-HHS subcommittee about his department’s FY 26 budget request. This follows appearances by Secretary Kennedy before the House Appropriations Labor-HHS Subcommittee and the Senate Health, Education, Labor and Pensions (HELP) Committee. Much like the heated exchanges at last week’s hearings, we expect sparks to fly at the upcoming Senate subcommittee hearing, especially since Chair Susan Collins (R-ME) has already expressed concerns about HHS’s actions related to National Institutes of Health research and the impact of workforce reductions on implementing Alzheimer’s funding legislation.  

We could also see action on the Senate floor this week on two HHS nominations that advanced out of the Senate Finance Committee on May 15, James O’Neill to be Deputy Secretary and Gary Andres to be an Assistant Secretary. It’s important to remember, though, that Senate Democrats are not completely powerless to stall President Trump’s nominees, as Minority Leader Schumer’s (D-NY) recent hold on Department of Justice nominees shows.  

Other Senate Health Hearings  

• May 21, Senate Homeland Security Subcommittee on Investigations hearing on adverse events following COVID-19 vaccination 

• May 21, Senate VA Committee legislative hearing (includes bills related to health care) 

The House  

Following marathon markups at Energy and Commerce and Ways and Means, and a Sunday night reconvening of the House Budget Committee, the House Rules Committee is scheduled to meet on May 21 at 1 am to make any agreed-upon changes, and advance the bill to the House floor with just enough time to get it passed out of the chamber before Memorial Day recess.  

But that’s a lot easier said than done. For everything to go according to plan, the final bill must be acceptable to both conservative Republicans, who have been demanding further spending cuts, and moderate Republicans, who are wary of how the cuts will be perceived both politically and practically. And then, of course, you have the contingent of blue-state Republicans who must be satisfied that the bill provides a high enough state and local tax (SALT) deduction cap for their constituents.  

From what we are hearing both on and off Capitol Hill, there will be a move for the Rules Committee to consider amendments that would expedite the implementation of Medicaid work requirements, address concerns of the SALT caucus Republicans, and speed up the phasing out of energy tax credits, among other things. However, some House Conservatives are reviving the possibility of changes to the federal matching rate for Medicaid, but that would threaten moderate Republican support for the bill. It remains to be seen if Republican leadership can strike the right balance and send the big, beautiful bill to the Senate (where Republican Senators have also signaled their interest in changing the bill to their liking).  

Beyond all the markups, the House Oversight Committee is also scheduled to hold a subcommittee hearing on May 20 that will consider the impact of the Inflation Reduction Act’s prescription drug provisions.  

There You Have It 

As we approach Memorial Day, Chamber Hill Strategies pauses to thank the brave men and women of our armed forces who have made the ultimate sacrifice in defense of our freedoms. Make it a great week!