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The Week Ahead

Stay informed with our weekly buzz about what’s going on in Washington, DC.

Week Ahead: Senate on Deck

Congress returns to Washington following weekend storms in the D.C. area. The forecast this week calls for potentially clearer skies and a busy week for both Congress and the White House. With that, let’s get into it. Welcome to the Week Ahead!  

The Administration 

Nearly a month after releasing its FY 26 skinny budget, the Department of Health and Human Services (HHS) has released its FY 26 Budget in Brief, which outlines a massive reorganization and shuttering of existing agencies to align with the administration’s “Make America Healthy Again” agenda. 

As hard as issuing a budget request is, the real work is just beginning. Sec. Kennedy will now need to defend the full budget request against attacks from critics who argue that the reorganization is nothing more than a cut in disguise. Along with explaining the potentially bogus science in the recently published MAHA Report and plans to start publishing scientific research in-house, Sec. Kennedy has his work cut out for him.  

The Senate 

Senate Republicans return to Washington with only 13 legislative days to pass their version of the “One Big Beautiful Bill Act” before the self-imposed July 4 deadline.  However, there are a lot of questions about how the Senate will move forward and what changes might be made to the bill. Some questions include: 

  • What will the Byrd Bath look like? The House-passed bill includes several provisions that may not pass the Senate’s Byrd Rule, which prohibits the inclusion of provisions unrelated to the federal budget. This could kill House provisions such as a moratorium on state regulations on artificial intelligence, a ban on courts enforcing certain injunctions, and language defunding Planned Parenthood.  
  • Will the Senate make changes to address concerns from fiscal hawks? The House bill would increase the debt limit by $4 trillion and extend borrowing authority beyond the 2026 midterms. That’s enough for Sen. Rand Paul (R-KY) to reject the bill. Additionally, Sen. Ron Johnson (R-WI) has called for more cuts if he is to support the bill. Other fiscal hawks may balk at the recent Congressional Budget Office estimate that the House bill’s tax changes would increase the deficit by $3.8 trillion.  
  • Will the Senate bump back Medicaid work requirements? To appease House Freedom Caucus members, the implementation date for Medicaid work requirements was moved forward from 2029 to 2026. However, concerns have been raised by some, including Sen. Lisa Murkowski (R-AK), that it will be challenging for some states, including hers, to meet the new timetable.  
  • Will the Senate remove Medicaid copays? Sen. Josh Hawley (R-MO) has criticized the House bill’s Medicaid copay provision as a “hidden tax on working poor people trying to get health care.” Other Republicans who supported Democratic amendments to protect Medicaid, like Murkowski and Sen. Susan Collins (R-ME), may share his concerns.  
  • Will the Senate change the Medicaid provider tax provision? The House bill prohibits states from putting in place new provider taxes and freezes existing provider taxes at current rates. However, some Republicans, such as Sen. Hawley, have expressed concerns about how that provision of the House bill will impact their states.  
  • Will we see committee markups? Initially, it sounded like the Senate might skip the committee process altogether. However, more recently, our intelligence from the Hill suggests committees such as the Senate Finance Committee might want to mark up the Senate bill. That opens the door for more proposed changes to the bill and slows things down for Republicans looking to get this bill passed.  
  • Will the SALT deduction be touched? House Republicans from high-tax states fought hard to increase the cap on how much their constituents can deduct from federal income taxes. Senate Republicans don’t have the same incentive to defend this provision, given that they generally represent lower-tax states.   

Senate Health Care Hearings  

  • June 4: Senate HELP hearing on reauthorization of the over-the-counter monograph drug user fee program  

The House  

The House Appropriations Committee is kicking off the markup process for FY 26. First up are subcommittee markups for the funding bills for the Department of Veterans Affairs and the Food and Drug Administration on June 5.  

Members of the House Appropriations Ag and FDA subcommittee won’t have much time to review the recently released FDA budget request before its June 5 markup. FDA highlights include:  

  • $3.2B in discretionary budget authority (11.4% decrease from FY 25). FDA justifies this by: 
  • Consolidating work to focus on core functions 
  • Reducing the number of full-time equivalents by 1,940 
  • $3.6B in user fees (4% increase over FY 25) 
  • $234.6M to support MAHA efforts related to chronic disease and food.  

If the past is any gauge, we expect Republican members of the subcommittee to praise FDA’s efforts to address chronic disease rates by improving food quality and safety, and Democratic members to criticize planned reductions in force and funding cuts as a threat to public health.  

Other House Health Care Hearings 

  • June 3: House Rules Committee meeting to consider  the SUPPORT for Patients and Communities Reauthorization Act  
  • June 5: House Appropriations Interior and Environment Subcommittee hearing on FY 26 Indian Health Service Budget Request 

There You Have It 

It’s graduation season, so we wanted to take a moment to say congratulations to the class of 2025. Make it a great week!  

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Week Ahead: Racing to Recess

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!  

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Week Ahead: Game Time

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!  

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Week Ahead: Reconciliation Waiting Game

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!  

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Week Ahead: Off to the Races!

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!

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