The Week Ahead

While DC is still digging the city out of one of the worst winter storms of the last decade, Congress is in a storm of its own. The government entered a partial shutdown on January 31 after the Senate passed an amended minibus.  As we await House action, let’s get into it. Welcome to the Week Ahead!

The Administration

The anticipated launch of TrumpRx has gotten off to a rocky start. The platform, which will allow individuals to purchase prescription drugs at discounted rates, was supposed to launch on January 30, but is experiencing delays. While the administration has not given a reason, there has been speculation that deals with pharmaceutical companies are violating anti-kickback statute laws.

Department of Health and Human Services (HHS) Secretary Kennedy reportedly said that TrumpRx will launch “probably in the next 10 days,” indicating optimism that the holdup will be addressed quickly.

Meanwhile, changes to the Medicare Advantage (MA) program in the proposed Calendar Year 2027 MA and Part D Advance Notice are causing alarm among stakeholders.  Both AHIP and the Better Medicare Alliance hinted at possible benefits cuts should the rates be finalized as proposed.  The Association of Community Health Plans expressed concerns about the impact to safety net plans.  Even the American Hospital Association piled on, worrying that changes to the Star Ratings program could affect access to care.  With comments due February 25, proponents are scrambling to change the minds of CMS officials.

The Senate

As if the Senate heard us wondering, discussions on a potential enhanced advance premium tax credit (APTC) deal have renewed. Sen. Bernie Moreno (R-OH) reportedly shared legislative text on a compromise extension bill with 4 Democratic colleagues and is awaiting responses. But time has run out for the request by Senate Majority Leader Thune (R-SD) to have a bipartisan deal by the end of January.

Health Care Hearings This Week

• February 3: Senate Health, Education, Labor, and Pensions (HELP) hearing on modernizing the National Institutes of Health
• February 4: Senate Veterans’ Affairs Committee hearing on Veteran health and healing through adaptive sports

The House

Speaker Mike Johnson (R-LA-04) may have thought he had finished FY26 funding, but it is back on his to-do list.   With health care programs and health policy extenders taken care of in the Senate minibus, Johnson has to steer his caucus through a new vote strategy.

House Freedom Caucus members have previously stated that they will oppose a funding bill that does not include funding for the Department of Homeland Security. However, that was before President Trump endorsed the idea, and the Senate fell in line.  The House Rules Committee meets February 2 to set up floor debate and passage.

The House Energy and Commerce Oversight Subcommittee will hold a hearing on February 3 to examine Medicare and Medicaid fraud. The Subcommittee has recently been investigating allegations of Medicare home health and hospice payment fraud in Los Angeles County as well as Medicaid fraud in Minnesota, so this hearing will be a prime opportunity for the Subcommittee majority to highlight those actions. While the hearing is timely, remember that the Oversight Subcommittee is not responsible for writing policy related to Medicare and Medicaid fraud.  That’s up to the Health Subcommittee to determine any legislative activity in relation to the investigations.

There You Have It

We were on the edge of our seats watching the Grammys last night. Did your favorites win? Anyone you think got snubbed a la Bill Belichick? Let us know. Make it a great week!

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!