We remember learning in school that an apple a day keeps the doctor away, but we don’t remember learning in civics class that health care would be so political! The politics of health and health care are dominating DC this week – and honestly we love it! Let’s get into it – welcome to the Week Ahead!
The Administration
While we expected vaccine policy to dominate HHS Secretary Robert F. Kennedy Jr.’s appearance before the Senate Finance Committee on September 4, we weren’t necessarily expecting the announcement coming of the State of Florida on working to end vaccine requirements for children in school. Vax politics seem to just be getting started with red and blue states moving forward with their own mandates.
One thing that brings red and blue states together is rural health. States are eagerly awaiting the funding notice of the Rural Health Transformation Fund – the $50 billion initiative aimed at spurring innovation and strengthening rural health care. Congress gifted this opportunity to the administration in the Big, Beautiful Bill, but they seem to be downplaying its potential political benefit in red and purple states with large rural areas. So far.
The Senate
With government funding running out on September 30, the Senate is focused on negotiating a continuing resolution (CR) to fund the government for a short period of time, and Republicans will need Democratic support to avoid a shutdown. Conversations are revolving around a short-term extension into November or December.
Senate Majority Leader Chuck Schumer (D-NY) faces a critical test. After facing backlash from within his own party in the last round of negotiations to fund the government, he may be willing to risk a shutdown to gain leverage. The Trump administration’s pocket rescission package has already heightened tensions, increasing the likelihood of a standoff. Schumer’s price for supporting the CR could be securing an extension of the advanced premium tax credits (APTCs, more on that later) or including language to restrict consideration of another rescissions package.
Congress could theoretically include language in a CR to block consideration of a future rescission package, but doing so would be procedurally difficult and politically risky. Such a move would require adding a “rider” to the CR, which is often controversial because appropriations bills are meant to fund the government, not legislate policy. Riders also face hurdles under House and Senate rules, potential challenges under the Impoundment Control Act of 1974, and even constitutional disputes over separation of powers.
Don’t forget – we haven’t – that all those health care extenders also expire on September 30. A likely scenario is that the policies get extended for the same amount of time as the CR. Been there, done that before.
Senate Health Hearings
- September 9: Senate Homeland Security & Government Affairs Permanent Subcommittee on Investigations Hearing on “How the Corruption of Science has Impacted Public Perception and Policies Regarding Vaccines”
The House
A bipartisan bill to extend the APTCs was introduced in the House September 4, but its prospects for movement are unclear. The proposal is rumored to score upwards of $26 billion, a cost that could complicate efforts to secure broader support, especially at a time when lawmakers are divided over spending priorities and deficit concerns loom large.
While stakeholders—including insurers, consumer groups, and state officials—and many House members are urging action in September, it is unclear at best if an APTC extension will move forward this month. To stand a chance, any legislative effort may need to be narrowly crafted to draw bipartisan backing and fit within the broader fiscal environment.
Delaying past September is problematic as health plans are legally required to finalize and publish their 2026 premium rates in October, and those rates depend heavily on whether APTCs are extended. Without clarity from Congress, insurers face a moving target, making it difficult to set prices and communicate accurate information to consumers.
If lawmakers fail to act in September, the issue could become entangled in larger, high-stakes negotiations over appropriations and how to keep the government funded into 2026. While there is bipartisan support for extending APTCs, the combination of cost, timing, and political dynamics makes the path forward highly uncertain—and stakeholders are growing more nervous by the day. That group includes vulnerable Republican House members thinking about their 2026 re-election bids.
House Health Hearings
- September 9: House Appropriations Subcommittee on Labor, HHS, Education and Related Agencies Full Markup
There You Have It
When it comes to the politics of health care, check out KFF’s Public Opinion tracking site. Currently trending is their research on who may or may not get the COVID-19 this fall and whether parents – including self-identified MAGA parents – agree with Florida’s move on vaccines for school entrance. Make it a great week!