The Week Ahead

As we approach the one-year anniversary of President Trump taking office for the second time, we have just as many questions about what the next 3 years will look like as we did on day one.  President Trump has already achieved one of his personal goals – a Nobel Peace prize – when Venezuelan opposition leader Maria Corina Machado gifted her Peace Prize medal during a White House visit. What else could President Trump check off from his bucket list? Let’s find out –welcome to the Week Ahead!

The Administration

President Trump released his Great Healthcare Plan which calls for lowering prescription drug prices and insurance premiums, and increasing transparency in health care costs and insurance benefits. The lack of details in the fact sheet creates more questions than it answers, but it’s clear the plan targets pharmacy benefit managers (PBMs) and health insurance companies, calling out those entities for deceptive practices and for accepting subsidies that the administration argues raise the cost of health insurance. Pharmaceutical companies are also under a microscope, with calls to codify most-favored-nation (MFN) pricing agreements and increase access to over-the-counter drugs. Many of the specific proposals in the plan, such as codifying MFN deals and PBM reform will require Congress to act. As we’ve seen, getting this Congress to act on health care is not easy, but getting the White House involvement is a necessary first step to unify the Republican majorities in both chambers.

The White House has promoted Farnoosh Faezi-Marian to Chief of the Health and Human Services (HHS) Branch at Office of Management and Budget (OMB). Faezi-Marian previously serviced as a Program Examiner at OMB, where she worked on budget development and execution for the Administration for Strategic Preparedness and Response. The promotion now has her leading the OMB office that is responsible for examining budget requests and making funding recommendations for HHS agencies so she will be an important voice in developing the President’s upcoming budget request to Congress for HHS.

The Senate

The Senate has left town without reaching an agreement on an extension of the enhanced advance premium tax credits (APTCs). The Open Enrollment period has already closed for most states, but a handful have deadlines to sign up for coverage through the end of January, which provides external pressure to reach an agreement. Senate Majority Leader Thune (R-SD) also previously told Punchbowl News that a deal would need to come together by the end of January, creating internal political pressure to move things along. Sen. Susan Collins (R-ME) who has been involved with negotiations on a bipartisan agreement has said negotiations will continue over the recess, but Leader Thune has cast doubt on the talks saying, “it doesn’t look like they’re close.”

The House

With the House scheduled to be out of session next week, it’s crunch time to pass the six remaining  appropriations bills to avoid at least a partial government shutdown on January 30. Although reports indicate neither side wants another shutdown, the remaining bills are some of the trickiest. These include Labor-HHS, Defense, and Homeland Security. The House has been working to pass appropriations bills in the form of minibus packages, and we expect that to continue. However, the controversy over ICE involved shootings in Minneapolis has made many believe that Homeland Security funding may need to be passed through a continuing resolution (CR).

Adding to the frenzy, over a dozen health care extenders, including telehealth flexibilities, community health center funding, and more, are set to expire at the end of the month. These have often been tied to government funding bills, but the possibility of a minibus for most and a CR for the Homeland Security bill raises questions as to whether the House has the stomach to authorize a longer-term extension for health care extenders or if they will keep kicking the can down the road. Extending funding for a year or two could provide stability for crucial health programs but would require more discussion than a shorter-term funding decision.

The House Budget Committee is holding a hearing on Health Care Costs that will feature witnesses from the Foundation for Research on Equal Opportunity and the Council for Affordable Health Coverage, both of whom might as well have offices in the Capitol Building for how often they’ve appeared in the last 4 months. But while there has been a lot of testimony, we have not seen any legislation as a result.

 Other Health Care Hearings This Week

• January 22: House Energy and Commerce Health Subcommittee hearing on health insurance affordability
• January 22: House Ways and Means Committee hearing with health insurance CEOs

There You Have It

With the NFL and College football playoffs happening, we’re seeing the season end for teams week after week. Are you prepared for the post-football seasonal depression? Let us know. Make it a great week!

Lawmakers have returned to Washington, still trying to make sense of the surprising raid that led to the capture of Venezuelan President Nicolás Maduro and his wife. Meanwhile, House Speaker Mike Johnson (R-LA) has a New Year’s Eve resolution to show voters House Republicans are serious about lowering health care costs after the expiration of enhanced ACA premium tax credits (APTCs). As with all New Year’s resolutions, it’s easier said than done. It’s going to be a crazy year, so let’s get back into it. Welcome to the Week Ahead!  

The Administration  

The much-anticipated Rural Health Transformation Program awards are out and the White House is wasting no time touting the initial funding with newspaper clippings from all 50 states.  In addition to expected public events on how the funding is advancing the Make America Healthy Again agenda, be on the lookout for the first annual CMS Rural Health Summit in March during the 2026 CMS Quality Conference. 

States and stakeholders are also eagerly awaiting clarifications from the Centers for Medicare and Medicaid Services (CMS) on Medicaid work requirements that are expected to be finalized in June 2026. The qualifying activities, and more importantly, the exemptions to work requirements, will drastically shape who will be eligible for services.  

CMS has also entered the annual Medicare Advantage policy and payment cycle. The agency issued the Contract Year 2027 MA and Part D policy and technical changes proposed rule on November 25, 2025, with comments due January 26, 2026.  The proposed Advance Notice is still pending at the Office of Management and Budget.   

The Senate  

Despite failing to pass either GOP and Democratic health care bill before the break, Senators continued bipartisan talks over the holidays. These talks have involved Sens. Bernie Moreno (R-OH), Susan Collins (R-ME), and Jeanne Shaheen (D-NH), among others. Notably, Sens. Moreno and Collins have been pushing for a proposed two-year extension of the tax credits, along with measures to address concerns about fraudulent activity in the ACA marketplace.   

These bipartisan talks are important to watch, as the real challenge is taking up a measure that can meet the Senate’s 60-vote threshold.  While the House will be taking up a three-year, clean extension of the enhanced APTCs in January, that bill is DOA in the Senate.  There have been discussions, however, that the House bill could be used as a vehicle for a bipartisan package in the Senate. 

There’s also that pesky upcoming government funding deadline – January 30 – that will require attention. This has major implications for health care extenders, such as the Medicare telehealth flexibilities and funding for community health centers, which are tied to the soon-to-expire government funding. Congressional GOP appropriators in the House and Senate did reach an agreement on topline funding over the holidays, causing Senate Majority Leader Thune (R-SD) to suggest he may not continue pursuing the five-bill minibus he has been trying to move.  

The real question remains as to each side’s stomach for another government shutdown with precious little time left before the deadline for members of Congress to work out their differences.  Nothing has really changed since the previous shutdown, though maintaining government funding during an active period of foreign policy could change the dynamic. 

The House 

Speaker Johnson intends to make health care a focus in 2026 for his conference, and he believes that a partisan reconciliation package could be used to advance those policies.  While Speaker Johnson would rather talk about expanding health savings accounts and association health plans, he can’t escape the divisive issue in his conference on what to do with the expired APTCs.  We expect Democrats to continue attacking moderate and vulnerable Republican members about their failure to address health care costs – a fact that will ensure these GOP members continue to press for legislation on APTCs. 

Meanwhile, a three-year APTC extension will be put to a vote, reportedly as soon as January 9, thanks to a discharge petition brought by House Democratic leadership that has gained the support of four moderate House Republicans.  

The House Energy and Commerce Health Subcommittee is wasting no time by jumping right back into health care policy with a legislative hearing on 10 proposals to support access to Medicare services, including clinical lab testing, quality reporting, supplemental oxygen and CMS’ new WISeR Model. 

There You Have It 

If you like college football, we can’t imagine you were disappointed with the games in the College Football Playoff series – unless, of course, your team lost.  This week’s games will be awesome!  Do you think Indiana can keep it going?  Let us know. Make it a great week!  

As a polar vortex threatens the Northeast and Midwest with cold temperatures, lawmakers looking to extend the expiring enhanced advance premium tax credits (APTCs) are feeling the heat. With only eight days left before Congress is set to leave for the holiday recess, advocates are hoping for a cooling of relations between party leadership to avoid a blue Christmas. So, let’s get into it. Welcome to the Week Ahead!

The Administration

It’s all about moving forward at the Department of Health and Human Services (HHS) these days.  HHS announced its major AI strategy, “OneHHS” where all divisions will work together on a Department-wide AI infrastructure to boost internal operations, research, and public health.  But that isn’t the only collab HHS is working on.

Turning heads, a new Center for Medicare and Medicaid Innovation model called ACCESS was announced, which will test expanded access to new technologies by offering outcome-based payment incentives to primary care clinicians.  Bolstering this model will be the Food and Drug Administration’s TEMPO pilot, which will evaluate a risk-based enforcement approach to new digital health devices.  Together, the two models will help the agencies understand the interaction between access, cost, and improved care.

Speaking of models, CMS teased a new Accountable Care Organization (ACO) model called LEAD to be released in December.  The 10-year model will use an updated financial benchmarking approach, risk arrangements, and wellness incentives.

But, wait, where is the administration on APTCs??  The future is now.

The Senate

The Senate is expected to consider legislation to extend the enhanced APTCs this week, fulfilling Senate Majority Leader John Thune’s promise to Democrats in exchange for their votes to reopen the government. Senate Democrats are planning on bringing forward a three-year clean extension of the subsidies – legislation that mirrors the bill House Democrats have been trying to get enough signatures for to force a House floor vote.

There has also been talk about Senate Republicans bringing a bill forward that would redirect enhanced APTC funding to health savings accounts (HSAs), but only for marketplace enrollees with bronze or catastrophic plans, since they are now eligible for HSAs under the One Big Beautiful Bill Act.   Then there is the latest float by Republican Senators Bernie Moreno (OH) and Susan Collins (ME) that  would eliminate zero-premium plans and cap income eligibility for APTCs.

However, Leader Thune has not yet announced plans to move forward on this bill. Based on our conversation, both bills would fail to reach the 60-vote threshold required to pass the Senate. And even if the Democratic bill passed the Senate, it would be DOA in the House.

It will also be important to watch what happens at the Senate Homeland Security and Governmental Affairs Investigations Subcommittee hearing entitled, “Defining Our Healthcare Problem and Principles We Should Follow to Solve It.” This hearing, scheduled for December 10, is likely to see some fireworks, as Sen. Ron Johnson (R-WI), an avid Affordable Care Act critic, chairs the subcommittee. We will also be watching for potential wild cards, such as Sen. Bernie Moreno (R-OH), who is working on a short-term enhanced APTC extension provided reforms are made, and Sen. Jon Fetterman (D-PA), who supports an enhanced APTC extension, but has shown a willingness to break with his party when it comes to strategy on how to get that done.

Meanwhile, Senators have made progress on another health care issue that has long garnered bipartisan support: pharmacy benefit manager (PBM) reform.  Senate Finance Committee Chair Mike Crapo (R-ID) and Ranking Member Ron Wyden (D-OR) introduced legislation to address concerns about certain PBM practices that have been criticized for driving up prescription drug costs and limiting transparency. Our conversations on the Hill support the idea that this bill, or similar PBM reform legislation, could pass along with larger legislation, such as legislation that will be needed to continue government funding beyond January 30, 2026.

Other Health Care Hearings

• December 11: Senate HELP hearing on the Future of the U.S. Organ Procurement and Transplantation Network

The House

If you were to just listen to House Republican and Democratic leadership, you’d think negotiations over the extension of the enhanced APTCs were as frozen as a pond in winter. But beneath the surface, there are signs of a breakthrough. Most notably, a group of 35 bipartisan representatives, led by Reps. Jen Kiggans (R-VA) and Josh Gottheimer (D-NJ), introduced a health care framework outlining a two-year plan to extend the enhanced APTCs, phase them out for certain enrollees, and institute reforms to address fraud concerns. This framework also calls for PBM reforms and lists other health care policies as potential reforms to pursue, including boosting the Medicare Physician Fee Schedule and health care price transparency requirements.

But if negotiations are like a frozen pond, don’t expect to go swimming just yet. House Majority Leader Steve Scalise (R-LA) has said the Kiggans-Gottheimer framework is “not been a part of the package we’re discussing.” Additionally, both Speaker Mike Johnson (R-LA) and Leader Scalise have been hinting that their conference is close to unveiling its own health care reform legislation. This could be as soon as this week (if you ask Speaker Johnson), but certainly within the next few weeks, according to Leader Scalise.

There You Have It

Washington celebrated a couple of annual traditions with the lighting of the Capitol Christmas tree on December 2 and the lighting of the National Christmas tree on December 4. Are decorations up at your house? Let us know. Make it a great week!