Senate Republican leaders return to Washington this week with just enough time to pass reconciliation and get home to see 4th of July fireworks. But Congress and the administration also have to deal with the fallout from the bombing of Iran. There is certainly a lot going on in DC! So, let’s get into it – welcome to the Week Ahead!
The Administration
The Centers for Medicare and Medicaid Services (CMS) has kicked off its own fireworks show by finalizing the 2025 Marketplace Integrity and Affordability Final Rule. The final rule largely retains the provisions of the proposed rule released in March, including shortening of the Affordable Care Act (ACA) open enrollment period and prohibiting ACA coverage for Deferred Action for Childhood Arrivals (DACA) recipients.
However, the rule also finalizes other parts of the proposal on a temporary basis, including several provisions strengthening income eligibility requirements. Why would CMS do that?
According to reports, by sunsetting some of the rule’s provisions, Congress could get “budget credit” if these provisions are included in the final reconciliation bill being debated in Congress. The Congressional Budget Office (CBO) previously estimated that many of these same provisions in the House-passed version of the reconciliation bill would save $101 billion over ten years.
The Senate draft did not include these provisions, but having an extra >$100 billion of “walking around money” could be very useful to Republican leaders either to reduce the overall cost of the bill or mitigate the need for savings from other controversial provisions like Medicaid provider taxes or state directed payments.
We expect CMS to finalize several other final rules over the next month, including rules setting Medicare payment rates for the coming year. These rules will set the stage for how Medicare reimburses different providers and services.
The Senate
Senate Republicans are feeling the heat, and it’s not just because of the temperature. Ever since the Senate Finance Committee released its reconciliation text on June 16, several Republican Senators have raised concerns about those provisions. For example, there are concerns about proposed reductions in the use of provider taxes to 3.5% by 2031 for Medicaid expansion states, as well as an annual 10% reduction in state directed payments until they match Medicare rates. This group includes Sens. Josh Hawley (R-MO), Jim Justice (R-WV), Lisa Murkowski (R-AK), and Susan Collins (R-ME). When you add in Senators such as Sens. Ron Johnson (R-WI) and Rand Paul (R-KY), who have raised concerns about the bill’s impact on the deficit, you are up to six Senators with major concerns over the current draft. Remember, Republicans can only afford three no votes and still pass the reconciliation bill. That’s certainly enough to make Senate Republican leadership sweat.
That said, conversations are continuing to address these Medicaid concerns. For example, Sen. Hawley has been pitching a return to the House-passed moratorium on new provider taxes and changes to state directed payments with additional guarantees that existing rates would be grandfathered in. Additionally, there have been discussions about creating a fund to help rural hospitals survive any changes to provider taxes or state directed payments. Something will need to be done to ensure the bill doesn’t burn up on the Senate floor.
In non-reconciliation news, the Senate Committee on Health, Education, Labor, and Pensions (HELP) is scheduled to consider the nomination of Dr. Susan Monarez to be the Director of the Centers for Disease Control and Prevention (CDC) on June 25. Expect this hearing to feature fiery remarks about the removal and replacement of the entire CDC’s Advisory Committee on Immunization Practices (ACIP) by Health and Human Services Sec. Kennedy.
Other Health Care Hearings
- June 25: Senate Aging Committee hearing on sports medicine’s role in older Americans’ health
- June 25: Senate VA Committee hearing on the Veterans Crisis Line
The House
House Speaker Mike Johnson (R-LA) is prepared to cancel the House’s upcoming recess if it means there is a chance that the reconciliation bill could be sent to President Trump’s desk before July 4th. But even with additional time, navigating the various factions within the House GOP caucus will be more difficult than leaving the National Mall after the fireworks end. That’s because, in addition to addressing concerns from members about Medicaid or the deficit, the Speaker also has to find a way to address concerns from House Republicans on the SALT Caucus.
The Senate reconciliation bill’s dropping of the SALT deduction cap from $40,000 to $10,000 is an insult to the SALT Caucus GOP members. Senate Republican leaders say their amount is a placeholder amount for negotiations, but it’s hard to see how that number makes GOP SALT Caucus members excited to come to the table.
Meanwhile, the House Budget Committee will be wading into the debate over Medicaid work requirements at a June 25 hearing. While not specifically mentioning Medicaid in the announcement, we expect Republicans to use the hearing as a platform to argue in support of provisions of the reconciliation bill that implement work requirements for certain individuals enrolled in Medicaid and the Supplemental Nutrition Assistance Program. Expect Democrats to use their time to highlight what they argue will be the detrimental effects of such policies on beneficiaries, although they have yet to name a witness for the hearing.
Other Health Hearings
- June 23: House Appropriations Committee continued markup of FY 26 Ag-FDA bill
- June 24: House Energy and Commerce Health Subcommittee hearing on FY 26 HHS budget
- June 25: House Ways and Means Health Subcommittee hearing on digital health
There You Have It
June 20 marked the Summer Solstice and First Day of Summer for the Northern hemisphere, otherwise known as the longest day of the year. How did you make use of the extra daylight? Let us know. Make it a great week!