The Week Ahead

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!

After a whirlwind of votes and a stroke of a pen, the longest federal government shutdown in history has come to an end. However, the deal to reopen the government is only in effect for a few weeks and advance premium tax credits (APTCs) expiration is looming.  With only a few more days before leaving town again for Thanksgiving, can lawmakers make progress on their stalled agenda? There’s only one way to find out, so let’s get into it. Welcome back to the Week Ahead!

The Administration  

President Trump weighed in on the health care debate on Truth Social (where else!?), saying that Republicans in Congress should redirect the APTCs from the insurance companies directly to the people. The post offered no details on how exactly that would work, but one idea coming from Republican lawmakers and conservative think tanks, such as the Paragon Institute, would be to put the funding for APTC credits into health savings accounts (HSAs) for individual enrollees to use. Another option that has been suggested is to provide the APTC credits to enrollees through flexible spending accounts (FSAs). Beefing up HSAs and FSAs is not a new idea in Republican circles, but the President’s call to action doesn’t mean Republicans are ready to sub in HSAs for APTCs.

The debate over APTCs is not the only issue on the administration’s health care policy plate. There are also the 29 regulatory actions from the Department of Health and Human Services (HHS) currently at the Office of Management and Budget (OMB). These include the final rules for calendar year 2026 (CY 26) End-Stage Renal Disease Prospective Payment System (PPS), Hospital Outpatient PPS, and Home Health PPS. These rules go into effect January 1, and the Centers for Medicare and Medicaid Services (CMS) has already lost valuable time due to the shutdown.

The Senate  

The Senate has been in session throughout the shutdown, working on the continuing resolution (CR), which ultimately led to the reopening of the federal government. Now, after a short break, it’s right back to work for the upper chamber as Senate Majority Leader John Thune (R-SD) promised a vote “in mid-December” on APTCs to get enough Democratic votes to pass the CR. In addition to APTICs, there has also been discussion of a concurrent vote on a Republican health care “reform” bill. This may include reallocating funding for APTCs to HSAs or FSAs for enrollees to use. There have also been discussions about a proposal to extend the APTCs with reforms such as an income cap, guardrails to prevent improper payments, and stricter eligibility/oversight measures.

All of these discussions will come to a head when the Senate Finance Committee meets for a hearing on November 19 regarding the rising cost of health care. This will be an opportunity for Senators on the Committee that oversees APTCs to discuss the future of the subsidies. It’s a battle royale for health policy wonks when the conservative American Action Forum (AAF) and the Paragon Institute and the progressive Urban Institute square off on the idea of redirecting ACA subsidies to tax-free accounts. It’s especially interesting since AAF recently published a piece expressing concerns about the idea of redirecting APTCs to tax-free accounts. We expect Democratic members of the committee to generally emphasize the importance of extending the APTCs, but it will be important to monitor any signs that Democratic members are open to any reforms.

Other Health Care Hearings This Week

• November 19: Senate Finance Committee executive session to vote on the nomination of Thomas Bell to be the Inspector General of HHS

• November 19: Senate Aging Committee hearing on restoring trust in medicines

The House 

The House returned on November 13 after being out of session since the end of September, and the chamber faces a daunting to-do list. The House is reportedly going to consider legislation requiring the Department of Justice (DOJ) to release information related to the Jeffrey Epstein investigation on November 18. House Speaker Mike Johnson (R-LA) has also indicated he plans to bring forward a bill to repeal provisions of the recently passed CR that would allow for Senate offices to sue the federal government for unauthorized disclosure of Senate data.

Even with all this going on, House appropriators are also feeling pressure to make progress on FY 26 funding bills for those that were not included in the CR. According to our conversations with House Appropriations Committee staff, the Defense appropriations bill is rumored to be up next for consideration, and the plan would be to pair it with other appropriations bills. This lines up with conversations on the Senate side about advancing a minibus of appropriations bills, including for Defense. The Senate has yet to advance its version of the Defense appropriations bill, but our conversations on the hill indicate that it could be considered as soon as the week of November 17 or the week after Thanksgiving.

House Republicans will also face continued questioning about what they plan to do on APTCs. Speaker Johnson has not indicated that he would take up a bill to extend the enhanced ACA tax credits, but he may face political pressure, especially from House GOP members who are defending vulnerable seats in the 2026 midterm elections. On the other hand, bringing up a vote on extending the enhanced ACA tax credits could be divisive, since it would be something many members of his caucus would oppose, and he would need Democratic support to pass it.

 House Health Care Hearings this Week  

• November 18: House Energy and Commerce Oversight Subcommittee hearing on AI chatbots

• November 19: House Ways and Means Health Subcommittee hearing on preventing and treating chronic diseases

There You Have It  

Congratulations to the Washington Spirit, which will play in its second consecutive National Women’s Soccer League Championship game, and its fourth in club history, on November 22. Do you have a favorite fall sport? Let us know. Make it a great week!