The clock keeps ticking toward September 30, and the stakes are particularly high given that Congress is out next week for the Rosh Hashanah holiday. This week, the stakes feel particularly high. All eyes are on Senate Minority Leader Chuck Schumer (D-NY) as he has taken a strong stance on what he wants for his support on must-pass government funding legislation. The central question: Will Congress find a path forward on critical health care provisions, or are we headed toward yet another shutdown showdown? So – let’s get into it, welcome to the Week Ahead!
The Administration
It’s politics and prose with the administration this week. On the political side, President Trump and Vice President Vance are expected to continue focusing on the brutal murder of political activist Charlie Kirk. Both will be attending Kirk’s funeral, and the President has announced he will honor Kirk with a posthumous Presidential Medal of Freedom. In addition to eulogizing the fallen leader, the President has taken to excoriating progressive politicians and organizations and has said he will launch investigations into “groups of interest” that may have fed into the torment that led to the assassination.
On the prose front, the Centers for Medicare and Medicaid Services are pouring through stakeholder comments to the calendar year payment rules, including hospital outpatient, physician fee schedule, home health, and end-stage renal disease. While CMS often includes policies that health care providers seek to tone down during the comment period, of particular focus is the home health rule that takes $1 billion in payments away from home health providers, according to the National Home Care Alliance.
In other exciting news, CMS released guidance on September 15 for states to submit their applications for the $50B Rural Health Transformation Program. This guidance provides states with the official roadmap for accessing a major new federal investment aimed at strengthening health care in rural areas.
The Senate
The Senate is bracing for a fierce battle over advanced premium tax credits (APTCs), a cornerstone of affordable health coverage for millions of Americans. Schumer is holding firm, insisting that any continuing resolution (CR) to keep the government open must include an extension of these subsidies.
Schumer, who faced intense backlash from his caucus after siding with Republicans on a funding measure in March, is determined not to repeat that mistake. He has already made it clear to reporters—no APTCs, no CR.
Republicans, meanwhile, are pushing for a “clean CR” that would extend all existing programs and funding, including health extenders such as Medicare add-on payments for rural hospitals, funding for community health centers, the Teaching Health Center Graduate Medical Education program, and delays to Disproportionate Share Hospital (DSH) cuts.
Under normal circumstances, compromise might be within reach. But with the political climate highly charged, APTCs looming large, and open enrollment around the corner, Schumer appears unlikely to back down. The result? A heightened risk of a government shutdown—one that could leave both APTCs and health extenders hanging in the balance.
Senate Hearings this Week
- September 17: Senate Committee on Aging Hearing on Drug Safety, Supply Chains, and Risk to Aging Americans
- September 17: Senate HELP Hearing on “Restoring Trust Through Radical Transparency: Reviewing Recent Events at the Centers for Disease Control and Prevention and Implications for Children’s Health”
- September 17: Senate Committee on Veterans’ Affairs Hearing on Strengthening Services for Veterans with Spinal Cord Injury and Disorder
The House
Over on the House side, the question is whether leadership will try to force the Senate’s hand by moving its own appropriations bill. Democratic Leader Hakeem Jeffries (D-NY) has remained tightly aligned with Schumer, keeping the focus squarely on APTCs.
At the same time, Congress is feeling pressure from stakeholders to avoid any lapse in health extenders. Hospitals, health centers, and other providers depend on predictable funding to plan services, retain staff, and keep doors open—especially in rural and underserved areas. A disruption, even a temporary one, could have real-world consequences for patients.
Word is that some time on September 15 we will see the text of a “clean” CR that would run through November 20 or 21. House Republican leaders were said to be close to putting the final touches on a CR. The CR is said to extend expiring health provisions through the length of the CR and not include the APTC extension the Democrats have been calling for. House Republicans are reportedly eyeing September 17 for a vote on the CR.
Later this week, attention will be on the Medicaid and CHIP Payment Access Commission (MACPAC) as they meet for the first time since Congress passed the One Big Beautiful Bill Act. The meeting will include a review of the legislation and start to explore the work and community engagement requirements in Medicaid.
House Hearings this Week
- September 16: House Ways and Means Hearing on “Virtue Signaling vs. Vital Services: Where Tax-Exempt Hospitals are Spending Your Tax Dollars”
- September 18: House Energy and Commerce Health Subcommittee Hearing on Legislation to Expand Seniors’ Access to Innovative Medical Care
There You Have It
September marks Healthy Aging Month—a perfect reminder to celebrate every stage of life and enjoy the fall season. Make it a great week!