The Week Ahead

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.

 Is Bipartisanship Alive? 

While the One Big Beautiful Bill was ultra-partisan, Republicans and Democrats showed they could come together last week when they cleared a first-ever crypto bill.   With the House in this week and the Senate in this week and next, Congress has only a handful of workdays before they head back to their districts and states to connect with constituents.  Can health care policy be bipartisan too?  Let’s find out – welcome to the Week Ahead!  

The Administration  

Things seem a little unsettled over at the Department of Health and Human Services (HHS), with Secretary Robert F. Kennedy Jr. appointing Matt Buckham as acting chief of staff to replace Heather Flick Melanson, who lasted six months in the role.  Buckham is currently Kennedy’s White House liaison for HHS, overseeing recruitment of political appointees with the agency. 

Maybe it’s because there are so many pending lawsuits against HHS?  The administration is appealing a federal court order that blocked the from cutting $11 billion in public health grants. In April, 23 states and DC sued HHS for arbitrarily freezing funds meant for vaccine access, emergency preparedness, mental health and substance abuse programs, and infectious disease tracking. A federal judge in Rhode Island issued a preliminary injunction in May, halting the funding freeze.  

This case, Colorado v. Kennedy, is one of several challenges HHS is facing over federal health funding cuts. In Washington, DC, a separate court granted four municipalities a preliminary injunction over similar infectious disease grant cuts. Meanwhile, a federal judge in Massachusetts vacated Trump-era NIH funding reductions targeting research on gender and diversity, equity, and inclusion. 

The Senate 

Could MilCon-VA be a bellwether of a September shutdown?  The Senate is set to take a critical appropriations vote to fund military construction and the Department of Veterans Affairs, a vote which could offer important insight into the likelihood of a government shutdown at the end of September.  Although the bill advanced unanimously out of committee, a lack of support from Senate Democrats on the floor may indicate broader resistance to cooperating on appropriations.  Prior to passage of President Trump’s recissions request, Senate Minority Leader Chuck Schumer (D-NY) warned that it would “poison” any bipartisan goodwill needed to negotiate the 12 annual spending bills, which need 60 votes to pass the Senate.  Given the backlash Democrats faced from their political base for avoiding a shutdown earlier this year, they may be more willing to let it happen this time —especially in light of Sen. Schumer’s recent warnings. 

The House 

Medicare Advantage is back in the spotlight at a House Ways and Means joint subcommittee hearing on “lessons learned and future opportunities.”  Citing rapid growth and possible need for “targeted improvements,” the hearing could bring out bipartisan interest in addressing coding intensity adjustments, prior authorization, and utilization management.  The committee includes both strong supporters and vocal critics of MA. 

Policymakers are eyeing MA as a possible funding source to pay for health care provisions that are set to expire on September 30 such as telehealth flexibilities and community health center funding.  Given the potentially significant savings involved, physician groups have been hinting at using MA changes to offset the costs of a longer-term “doc fix” or broader physician payment reforms. 

CMS Administrator Mehmet Oz will meet with House Ways and Means Democrats and Republicans on July 23 to discuss agency priorities that fall within the Committee’s jurisdiction.   Certain to come up is the pending $50B rural health transformation fund which states are scrambling to understand how to use to offset expected payment cuts to health care providers from the One Big Beautiful Bill Act. 

Other House Health Care Hearings  

July 22:  House Energy and Commerce Oversight Subcommittee hearing on organ procurement 

There You Have It 

The annual Perseid meteor shower starts this week and will last through August 23.  Caused by Earth passing through the debris of the Swift-Tuttle comet, these meteors are particularly bright and quick.  Did you watch the Perseids when you were a kid?  Aren’t we all still kids at heart?  Let us know!  Make it a great week!  

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!