The Week Ahead

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!  

The markups of the House Energy and Commerce, Ways and Means, and Agriculture Committees have been delayed, but there’s still plenty to talk about with the President’s proposed “skinny budget” for fiscal year 2026. So, let’s get into it. Welcome to the Week Ahead!  

The Administration 

President Trump released his “skinny budget” for FY26 on May 2, outlining the White House’s discretionary budget requests. Continuing the theme of reducing government spending, the administration is requesting $33.3B less than was enacted last year for the Department of Health and Human Services (HHS), including cuts for the Health Resources and Services Administration, the Centers for Disease Control and Prevention, and the National Institutes of Health by eliminating and consolidating different programs. 

The “Make America Healthy Again” Commission, which is tasked with implementing HHS Sec. Kennedy’s agenda to tackle chronic disease through the promotion of healthy living and improving the nation’s food quality, has a $500M request. 

But as far as the federal budget process goes, “the president proposes, and Congress disposes.”  Congress will take these requests and consider them during their deliberations on appropriations, a process which is just getting under way.   

The administration is expected to release more details of their budget in the coming weeks.  Those details have been the subject of leaks in the last few weeks. Be on the lookout for the mandatory funding tables and HHS’ budget in brief, both of which highlight what the administration hopes to accomplish via regulation and legislation.   

The Senate  

The budget resolution calls on several Senate committees to submit recommendations to the Senate Budget Committee by May 9.  Based on our conversations with lawmakers, the committees are not hurrying to meet this nonbinding date.  

While the Senate HELP Committee could include health care provisions, they are expected to mirror their House counterpart (Education and Workforce) in focusing on reducing education and spending. And while not tasked with finding savings, the Senate Finance Committee could still wade into health care, whether on health care taxes, Medicaid, or Medicare, all of which would fall under Finance’s jurisdiction. 

Senate Health Care Hearings This Week 

• May 6: Senate Finance Committee nomination hearing to consider James O’Neil to be Deputy HHS Secretary and Gary Andres to be an Assistant Secretary of HHS 

• May 8: Senate HELP Committee nomination hearing for James O’Neil to be Deputy Secretary and Janette Nesheiwat to be Surgeon General  

The House 

House Speaker Mike Johnson (R-LA) continues to push aggressively for reconciliation legislation even as he has acknowledged the delayed target date of July 4 for getting a package to the President’s desk.  

During the listening sessions that House leadership and Energy and Commerce Chair Guthrie (R-KY) held with Republicans last week, the caucus fissures are starting to show.  A growing number of Republicans want a much lower savings target for Medicaid because of the large number of Medicaid enrollees in their district.  Other Republicans are pointing out the futility of making politically vulnerable House members take a vote on Medicaid changes that the Senate is unlikely to agree with.  Yet, some hardliners are pushing for even more spending reductions in Medicaid than what is on the table.   

The House Energy and Commerce bill is likely to include savings related to the Medicaid expansion population (expanded work requirements, bringing down the enhanced federal matching rate) and other policies that Republicans argue are about going after waste, fraud, and abuse (dropping of the provider tax safe harbor and targeting states that provide coverage to undocumented immigrants).  

It’s unlikely the bill will include changes to advanced premium tax credits, Medicare Advantage, or physician payments, with the thought being that there will be time to address those topics in health care legislation down the road.  

It’s important to remember that everything is still very much in flux. Recently, the White House threw another wrench in the plans by suggesting that the reconciliation package should include a “Most Favored Nation” policy to tie federal payments for prescription drugs to the lower costs paid in other countries. This could divide the GOP caucus, as some may see it as price controls.  

House Health Care Hearings This Week 

• May 5: House VA Tech Modernization Subcommittee hearing entitled “Improving Access to External VA Care through Enhanced Scheduling Technology” 

• May 6: House VA Committee markup of pending legislation, including legislation related to health care 

There You Have It 

Did you know that Anna Jarvis, the person who founded Mother’s Day in the US and around the world, tried unsuccessfully in the 1940s to cancel the legal holiday because she felt the day has succumbed to commercial and ideological distortion?  Make it a great week!