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!