The Week Ahead

The recent announcement that Washington, D.C. will host the 2027 NFL Draft has certainly excited local football fans. Republicans in Congress are hoping to score with two key committees taking up reconciliation. Meanwhile, Secretary Kennedy Jr takes the field for hearings on the FY 26 Department of Health and Human Services (HHS) budget request. So, with that, let’s get into it. Welcome to the Week Ahead! 

The Administration 

President Trump is looking at his playbook to address prescription drug affordability and availability. The President unveiled a proposal from his first administration, known as the “Most Favored Nation” policy, which would tie federal payments for prescription drugs to the lower costs paid in other countries. He has also forecasted tariffs targeting the pharmaceutical industry to address concerns about overreliance on foreign countries.  

These plays are not without risks. Expect the pharmaceutical industry to mount a strong defense against the “Most Favored Nation” policy, which stalled toward the end of the first Trump term. Additionally, the President could call an audible if the markets show little appetite for more tariffs.  

President Trump is also gauging the reception of his new pick for Surgeon General, Dr. Casey Means. There is already resistance to this pick based on Dr. Means’ views on subjects such as the cause of autism. However, the real issue may be the resistance from Laura Loomer, who was a prominent voice in calling for President Trump to reconsider his first pick for the position.  

The Senate  

The Senate Committees have not been in a hurry to schedule markups of the budget resolution, as we previously reported, and rumor has it the Senate may skip the committee process altogether. The Senate could go straight to the floor, taking up the House-passed bill and voting on it or amending it then and there.  

Also on our radar, Secretary Kennedy Jr is scheduled to appear before the Senate Health, Education, Labor, and Pensions Committee on May 14 for a hearing on the proposed FY 26 HHS budget request. Expect Republican and Democratic Senators to raise concerns about the proposed restructuring of HHS and its potential impact on various agencies and programs.  

Other Senate Health Care Hearings  

• May 13: Senate Judiciary Committee hearing on PBMs  

• May 14: Senate Indian Affairs Committee hearing on oversight of Indian Health programs  

The House  

The House Energy and Commerce Committee and the House Ways and Means Committee are each scheduled to hold their respective markups of reconciliation-related legislation starting May 13.  

Both E&C and W&M have released their respective texts. The legislation appears to be a deal struck between conservatives and moderates in the Republican Party on Medicaid.  

Health care provisions in the E&C legislation include: 

• Bumping up eligibility requirement determinations for the expansion population to every 6 months. 

• Setting a ceiling of $1M in the home equity limit when making determinations regarding long-term care eligibility. 

• Requiring verified citizenship or appropriate immigration status for Medicaid and the Children’s Health Insurance Program (CHIP). 

• Reducing the Federal Medical Assistance Percentage (FMAP) by 10% for states providing coverage to illegal immigrants. 

• Sunsetting the 5% temporary enhanced FMAP under the American Rescue Plan Act to states that opt to expand Medicaid. This provision would apply prospectively, not affecting states currently receiving an enhanced federal match under this authority.  

• Freezing states’ provider taxes in effect and prohibiting states from establishing new provider taxes.  

• Limiting state-directed payments for services from exceeding the total published Medicare payment rate. 

• Setting a requirement for able-bodied adults without dependents to work at least 80 hours per month, through community service, work program, educational program, or any combination of these options. 

• Requiring states to impose cost sharing on Medicaid expansion adults with incomes over 100 percent of the federal poverty level (FPL).  

• Expanding Exclusion for Orphan Drugs from the Drug Price Negotiation Program.  

• Delaying the Medicaid Disproportionate Share Hospital (DSH) reductions, currently $8 billion in reductions per year that are set to take effect for fiscal years 2026 through 2028, to instead take effect for fiscal years 2029 through 2031. This section also extends funding for Tennessee’s DSH program, which is set to expire at the end of this fiscal year, through fiscal year 2028. 

• Requiring pharmacy benefit managers (PBMs) in Medicare Part D to share information relating to business practices with Medicare Part D plan sponsors, including information relating to formulary and coverage decisions that benefit affiliated pharmacies. 

 And a “doc fix”: Notably, the mark includes language tying the Medicare physician fee schedule update in 2026 to a portion of the Medicare Economic Index.   

As expected, Democrats are panning the legislation as cuts to benefits and enrollment. Immense pressure from President Trump will make voting against the markup in either committee difficult for any Republican. So, we expect party line votes on the bills – at least until the floor.  

While most of the attention at Ways and Means is on taxes, there is a provision which limits Medicare coverage for non-citizens. There were intense discussions about including the Trump administration’s ACA marketplace integrity rule, but that was not included in the mark, for now.  

Expect the markups to take multiple days; don’t expect to see all CBO scores yet as provisions keep shifting and it takes CBO more time than you think to score these policies. 

Health Care Hearings in the House 

• May 14: House Appropriations Labor, HHS Subcommittee hearing on the FY 26 HHS budget request 

• May 14: House Judiciary Antitrust Subcommittee  hearing on the medical residency antitrust exemption  

There You Have It 

The week of May 11 is National Hospital Week. We celebrate and extend our gratitude to health systems and hospital staff for their unwavering dedication to patient care and access. Make it a great week!  

Congress is back in town, and the race is on to meet House Speaker Mike Johnson’s ambitious goal of passing a budget reconciliation bill by Memorial Day. Meanwhile, the Trump administration is busy with plans to change civil service classification and restructure the Department of Health and Human Services. So, with that, let’s get into it. Welcome to the Week Ahead!

The Administration 

The Treasury Department is expected this week to provide an estimate of when the X Day will occur – the day on which the federal government will have exhausted its ability to pay its bills. This date is expected to be sometime in the summer or early fall of 2025.

Remember, Republican leaders in Congress included raising the debt ceiling in the reconciliation bill they are trying to pass. An earlier X Day means an earlier deadline for when Congress would need to raise the debt ceiling.

The Trump administration is also dealing with the fallout of a leaked copy of the proposed fiscal year 2026 (FY 26) budget for HHS to the Washington Post. Health care advocacy groups are concerned about the proposed $80B in cuts to discretionary spending, plans to eliminate funding for several agencies and programs, and the restructuring of several parts of the department into a new “Administration for a Healthy America.” The official budget is expected in May, and the president’s proposed budget is just that, a proposal that Congress can change or even ignore.

Proposed cuts to spending and reorganizing federal agencies are nothing new for an administration’s budget proposals. However, these proposals hit differently coming from an administration that has not been shy about exerting executive branch authority to move forward with its agenda. Case in point: the Trump administration plans to move forward with a plan to reclassify civil servants to make it easier for them to be removed.

The Senate 

We don’t have dates yet for the Senate committee markups for their budget reconciliation legislation, but they are under pressure to get a reconciliation bill passed by Memorial Day. We are paying particular attention to the Senate Committee on Health, Education, Labor, and Pensions (HELP), as this committee has been instructed to find at least $1 billion in savings over ten years.

Senate Hearings 

• April 29: Senate Veterans’ Affairs Committee hearing on veterans’ mental health
• April 30: Senate Appropriations Committee hearing on biomedical research

The House 

The House Committees on Armed Services, Education and Workforce, and Homeland Security will kick off the reconciliation markup process on April 29. House Energy and Commerce Committee is still working to find $880B in savings including what and how much Medicaid spending will be cut.

Based on conversations with the Hill, Republican leadership thinks it can get to $500B over ten years by addressing “waste, fraud, and abuse” within the Medicaid program, according to previous work from the Government Accountability Office.

Other potential sources of savings within the Medicaid program that have been mentioned include work requirements, changes to provider taxes, and penalties on states that provide care for undocumented immigrants. Republicans are saying other non-Medicaid policies, such as cuts to Medicare Advantage plans and policies to address Medicare reimbursement for physicians, are unlikely for reconciliation but could come later in the year.

House Hearings 

• April 29: House Education & Workforce Committee markup of reconciliation directives and H. Res. 344, a resolution directing President Trump and HHS Sec. Kennedy to provide documents related to the elimination of the Administration for Community Living
• April 29: House Energy and Commerce Committee markup of 6 health care bills (not reconciliation)
• April 29: House Veterans’ Affairs Health Subcommittee hearing on reforming state veterans homes
• April 30: House Veterans’ Affairs Oversight and Investigations Subcommittee hearing on the VA’s mental health policies
• April 30: House Education & Workforce HELP Subcommittee hearing on ERISA

There You Have It 

If you need a break from betting on the likelihood that Congress will pass a reconciliation bill by Memorial Day, the 151st Kentucky Derby takes place on May 3. Do you have plans to watch? Make it a great week!

While the men’s and women’s Final Four brackets are set, the Congressional budget is not at all locked up.  Senate Majority Leader Thune (R-SD) is preparing to vote this week on a budget they’ve been negotiating with the House, while Speaker Johnson (R-LA) is hoping to add two members to his razor-thin majority by winning special elections in Florida.  Will March Madness yield a “beautiful” budget in April??  Let’s see!  Welcome to the Week Ahead!  

The Administration 

We are eagerly awaiting the final Medicare Advantage (MA) and Part D technical changes and rate announcement rules, as well as the proposed rules for the fiscal year payment systems.  CMS Administrator-nominee Oz is waiting for his Senate floor vote, and he was not especially warm on MA during his confirmation hearing.  We know the final MA rule will look different than the proposed rule released during the previous administration, but how much different?  Will the rule come out on time – around April 7?   

And how will the continued DOGE-ing complicate rule-making and public input?  In case you were under a rock, you might have missed that the Department of Health and Human Services (HHS) announced plans to reduce its full-time workforce by 10,000 employees and consolidate the number of divisions from 28 to 15. The Department says this decision is about improving efficiency, saving taxpayer dollars, and better implementing the Trump administration’s focus on addressing chronic disease rates.  

The Senate  

The Senate aims to vote on the budget resolution this week they’ve been negotiating for the past few weeks with the House. While an agreement has yet to be shared publicly, rumors are the budget would set up a reconciliation bill that would require smaller cuts from Senate Committees (at least $3B) than from those in the House (at least $1.5T).  Notably, the resolution may call for at least $1 billion in cuts from the Senate Health, Education, Labor, and Pensions Committee, which has jurisdiction over many HHS agencies. 

Wait, what?  How can they do that?  Doesn’t the Senate and the House have to vote on the SAME budget?   

Yes, they do, but the House and Senate do not have mirrored committees, so the Senate is really only voting on policies within the Senate’s committee structure, and the House is only voting on policies in the House’s structure.   

The move here is essentially a way for Senators to delay making the tough decisions on policies like Medicaid, Medicare, and taxes later on in the process of budget reconciliation.  Senators can vote for the budget this week and still vote against the final reconciliation bill if it doesn’t pass muster (ala the Sen. John McCain-style moment in 2017). 

Senate Hearings This Week 

• April 3:  Senate Judiciary Committee meeting on April 3 on bills increasing transparency and promoting competition within the prescription drug industry  

The House 

The votes are tight – for everything in the House including the budget.  Even with Democratic vacancies following the deaths of Reps. Sylvester Turner (D-TX) and Raul Grijalva (D-AZ), President Trump still felt the need to withdraw Rep. Elise Stefanik’s (R-NY) nomination to be UN Ambassador to boost his chances for a budget win.  All eyes now turn to Florida, where Republicans hope to pick up two seats in special elections to replace former GOP Reps. Matt Gaetz and Michael Waltz on April 1. 

These should be easy pickups for the GOP, but special elections should never be taken for granted. Republicans are growing anxious that Josh Weil, the Democratic candidate in the race to replace Rep. Waltz in Florida’s 6th congressional district, could pull off an upset against Republican Randy Fine. These races could either give Republicans more breathing room on forthcoming budget votes or make their lives even more difficult. Even if Republicans win both seats, they can still afford only 3 defections to reach the required 217 votes to pass a budget resolution and ultimately reconciliation. 

House Hearings This Week  

• April 1: House Energy and Commerce Health Subcommittee hearing on the regulation of over-the-counter monograph drugs 

• April 1: House Energy and Commerce Oversight Subcommittee hearing on cybersecurity vulnerabilities in legacy medical devices 

• April 1: House Veterans’ Affairs Committee oversight hearing on modernizing VA health care 

• April 2: House Veterans’ Affairs Oversight Subcommittee hearing on the VA’s mental health policies  

• April 2: House Education and Workforce Health, Employment, Labor, and Pensions Subcommittee hearing on employer-based health insurance  

There You Have It 

Speaking of March Madness, how are everyone’s brackets looking? Is your team still in it?  Mixing hoops and vote-a-rama is a great way to watch the Senate floor.  Let’s make it a great week!