THIS WEEK’S DOSE
- Senate votes on dueling healthcare bills. Although neither bill passed, some moderate House Republicans continue to try to find a path forward on the expiring enhanced advanced premium tax credits (APTCs), with Speaker Johnson (R-LA) indicating they may get a House vote on enhanced APTCs when the House considers a larger healthcare package.
- House and Senate committees hold hearings on enhanced APTCs. Several subcommittees discussed how to address the forthcoming enhanced APTCs expiration.
- House Oversight Subcommittees hold joint hearing on technology and healthcare affordability. The Subcommittees on Economic Growth, Energy Policy, and Regulatory Affairs and on Health Care and Financial Services examined how innovative technologies can be used to lower healthcare costs.
- Senate HELP Committee examines organ procurement and transplantation network. The Senate Health, Education, Labor, and Pensions (HELP) Committee assessed ongoing issues and explored strategies for strengthening organ availability.
- President Trump issues AI EO. The executive order (EO) outlines the development of a minimally burdensome national artificial intelligence (AI) framework.
- CMS issues informational bulletin on Medicaid work requirements. The Centers for Medicare & Medicaid Services (CMS) guidance precedes a forthcoming interim final rule.
- CMS Innovation Center releases new lifestyle medicine model. The voluntary model will provide funds to organizations that deliver lifestyle medicine services to Medicare beneficiaries.
- CMS proposes updates to IOTA Model. If finalized, the changes would apply to the Increasing Organ Transplant Access (IOTA) Model’s second performance year.
- ACIP updates hepatitis B vaccination recommendations. The Advisory Committee on Immunization Practices (ACIP) loosened recommendations for the hepatitis B vaccination at birth.
- FDA takes action on testosterone replacement therapy for men. The US Food and Drug Administration (FDA) released a request for information and held an expert panel on the subject.
CONGRESS
Senate votes on dueling healthcare bills. The Senate voted on a proposal from each party to address healthcare costs and the expiring enhanced APTCs, but neither bill garnered the 60 votes necessary for advancement:
- Democrats put forth S. 3385, the Lower Health Care Costs Act, which includes a clean three-year extension of the enhanced APTCs. The bill failed in a 51 – 48 vote, with Sens. Murkowski (R-AK), Collins (R-ME), Hawley (R-MO), and Sullivan (R-AK) voting in favor with all Democrats. The Congressional Budget Office estimates that the extension would cost nearly $83 billion and would increase the number of people with health insurance by four million in 2028.
- Republicans coalesced around S. 3386, the Health Care Freedom for Patients Act of 2025. This bill, put forward by Sens. Crapo (R-ID) and Cassidy (R-LA), would not extend the enhanced APTCs beyond January 1, 2026, and would instead introduce new health savings accounts (HSAs) with federal government deposits of $1,000 or $1,500 for certain individuals buying insurance on the Affordable Care Act (ACA) Exchange. The bill would also tighten Medicaid and Children’s Health Insurance Program (CHIP) requirements for immigrants and prohibit Medicaid, CHIP, and ACA plans from covering gender-affirming care. The bill failed in a 51 – 48 vote mostly along party lines. Sen. Paul (R-KY) was the only Republican to vote against the bill.
Attention now turns to the House where a bipartisan group of House members led by Rep. Fitzpatrick (R-PA) introduced H.R. 6501, the Bipartisan Health Insurance Affordability Act, which would extend the enhanced APTCs for two years with antifraud reforms, and includes HSA expansions and pharmacy benefit manager (PBM) reform. On December 10, 2025, Rep. Fitzpatrick filed a discharge petition on the bill, and its supporters are working to achieve the 218 signatures needed to force a floor vote. Most of the Democratic Caucus would need to sign the discharge petition to achieve that threshold.
A second bipartisan group led by Reps. Gottheimer (D-NJ) and Kiggans (R-VA) (and which also includes Rep. Fitzpatrick) filed a discharge petition on H.R. 6575, the CommonGround for Affordable Health Care Act, which provides for a one-year extension of the enhanced APTCs with reforms, and includes broker fraud protections, PBM reforms, and a spelled-out congressional procedure designed to guarantee a vote on a longer-term ACA tax credit extension bill by July 2026.
Speaker Johnson has said that the House will vote next week on a to-be-determined Republican healthcare plan that will not include an enhanced APTC extension or funding for HSAs, as was included in S. 3386. The package could be revealed as soon as December 12, 2025. To assuage concerns of moderate House Republicans, Speaker Johnson may also permit an amendment vote on a temporary enhanced APTC extension as part of consideration of the larger bill.
Given that next week is the last week Congress will be in session for 2025, even if this House is successful in moving forward an amendment next week, what happens next will likely roll into 2026.
House and Senate committees hold hearings on enhanced APTCs.
- House Judiciary Subcommittees on Oversight and on the Administrative State, Regulatory Reform, and Antitrust. In the hearing, Republicans expressed concerns about findings from a recent US Government Accountability Office report and argued that the ACA’s structure enables significant fraud, waste, and abuse that may increase costs for taxpayers and premiums for families. Democrats underscored the immediate need to extend the enhanced APTCs to avoid severe premium increases for US families and coverage loss. They contended that centering the hearing on fraud misrepresented the core issue of affordability. Some Republicans on the committee acknowledged that, in the short term, APTCs must be extended to avoid immediate harm to families while broader reforms are debated.
- Senate Homeland Security and Governmental Affairs Investigations Subcommittee. During the hearing, Democrats acknowledged that the ACA isn’t perfect but urged Congress to extend the enhanced APTCs. Republicans noted that premium increases are due to the ACA’s design and stated that APTCs go to insurers and incentivize them to increase premiums. They discussed various solutions, including providing consumers with money for an HSA, making healthcare spending tax exempt, implementing high-risk pools, and reducing the federal match for the Medicaid expansion population. Witnesses shared their personal experiences with the ACA and suggested a variety of ways to improve the healthcare system, including extending the enhanced APTCs, implementing high-risk pools, and reforming Medicaid.
House Oversight Subcommittees hold joint hearing on technology and healthcare affordability. During the hearing held by the Subcommittee on Economic Growth, Energy Policy, and Regulatory Affairs and the Subcommittee on Health Care and Financial Services, members from both parties acknowledged rising healthcare costs as a major concern but differed sharply on how to address it. Republicans argued that the ACA failed to lower premiums and control costs, calling for alternative policies that promote competition, transparency, and innovation. Democrats highlighted the need to extend the enhanced APTCs before people lose affordable coverage starting January 1, 2026. Some witnesses discussed policies to improve affordability and efficiency, including cost-smoothing strategies, reforms to Medicare’s coverage with evidence development program, pricing transparency, and use of AI to reduce waste and improve care quality. Others stressed that technology cannot replace comprehensive coverage and urged Congress to address corporate price gouging and consolidation.
Senate HELP Committee examines organ procurement and transplantation network. Republicans emphasized the importance of restoring public trust in the organ procurement system by increasing transparency, breaking up monopoly contractors, and improving accountability. They also raised concerns about ethical issues, geographic disparities, and discrimination against patients with disabilities. Democrats focused on equity and patient protections, highlighting disparities in access for minority and vulnerable populations. They stressed the importance of continuous health coverage and vaccination policies to prevent long-term risks to the transplant network. Witnesses emphasized the need for modernization, stronger oversight, and reforms to improve transparency, accountability, and patient safety while addressing disparities and ensuring ethical practices in organ procurement.
ADMINISTRATION
President Trump issues AI EO. The EO directs the Administration to work with Congress to develop a national AI standard and discusses a framework to prohibit State laws that conflict with the administration’s AI policy, which is “to sustain and enhance the United States’ global AI dominance through a minimally burdensome national policy framework for AI.” Key provisions include:
- Within 30 days, the attorney general will establish the AI Litigation Task Force, which will challenge state laws that are deemed to violate the regulation of interstate commerce, are pre-empted by Federal law and/or regulation, or are unlawful for other reasons.
- Within 90 days, the Department of Commerce will undertake an evaluation of existing state AI laws that conflict with the AI policy and refer them to the task force.
- The Department of Commerce secretary must issue guidance clarifying that states that have AI laws identified in the evaluation are no longer eligible for the Broadband Equity Access and Deployment grant program. Other agencies will also review their grant programs to see if the same requirement can be added.
- Within 90 days, the Federal Communications Commission chair will determine if a federal reporting disclosure standard for AI models that preempts state AI laws is necessary.
- The Federal Trade Commission (FTC) chair will issue a policy statement on the application of FTC’s prohibition on unfair and deceptive acts or practices.
- The special advisor for AI and crypto and the assistant to the president for science and technology will jointly develop a legislative proposal to establish a federal AI regulatory framework.
CMS issues informational bulletin on Medicaid work requirements. Under the One Big Beautiful Bill Act (OBBBA), states must implement Medicaid work requirements for certain adult populations by January 1, 2027. CMS’s informational bulletin provides an overview of this new requirement in advance of the anticipated interim final rule. The bulletin largely reiterates the requirements and details from OBBBA, with a few clarifications:
- Good-faith exemptions. OBBBA allows CMS to provide states with good-faith exemptions to delay implementation of work requirements to no later than December 31, 2028. CMS anticipates that it will only approve good-faith exemptions for states that make meaningful efforts towards implementation and experience severe or unexpected issues that hinder their progress.
- Role of managed care organizations (MCOs). Under OBBBA, states are prohibited from using an MCO (or any contractor with a direct or indirect financial relationship with an MCO) to determine a beneficiary’s compliance with work requirements. The bulletin notes that OBBBA includes no other prohibitions on states delegating activities to MCOs to support successful implementation of work requirements. CMS indicated that it will issue further guidance on potential roles that MCOs can play.
- Examples of compliance at application and renewal. CMS provided additional detail and examples of how an individual would demonstrate compliance both at application and renewal. For example, if a state requires an applicant to demonstrate compliance for two consecutive months prior to application, an individual applying in January 2027 would need to demonstrate compliance in both November and December 2026. OBBBA states that during a renewal, individuals must show compliance for one or more months, as specified by a state, whether or not consecutive. The bulletin notes that for renewals, a state may not dictate the specific months during which an individual must demonstrate compliance, and if a state requires compliance for more than one month between renewals, it must permit, but may not require, individuals to demonstrate compliance in consecutive months.
CMS Innovation Center releases new lifestyle medicine model. The voluntary Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence (MAHA ELEVATE) Model seeks to establish an evidence base for the effectiveness of whole-person functional or lifestyle medicine approaches to address chronic disease. Similar to one of the first models that the Innovation Center ever tested, the Health Care Innovation Awards (HCIA), this model will fund cooperative agreements to selected awardees, rather than testing specific modifications to the Medicare or Medicaid programs. CMS has stated that interventions tested in MAHA ELEVATE will inform future original Medicare coverage determinations or potential future CMS Innovation Center models. This approach mirrors the pathway of the Medicare Diabetes Prevention Program Expanded Model, which was first tested under HCIA before being expanded nationwide in original Medicare and Medicare Advantage (MA). Key takeaways include:
- Design. CMS will provide about $100 million to fund three-year cooperative agreements for up to 30 proposals that promote health and prevention for original Medicare beneficiaries. The model will not include MA or alter benefits, coverage, or rights in original Medicare.
- Covered services. Funding can be used to cover whole-person care services that original Medicare does not cover. Critical areas of focus include nutrition, physical activity, sleep, stress management, harmful substance avoidance, and social connection. Three awards will be reserved for interventions that address dementia. Funding can also be used to cover costs of administration and data collection and reporting. Cooperative agreement funding cannot be used to cover food or services that can be billed to original Medicare.
- Timing. CMS will release a notice of funding opportunity in early 2026 for the first cohort, and the voluntary model will launch on September 1, 2026. The second cohort will begin in 2027.
CMS proposes updates to IOTA Model. The IOTA Model is a six-year mandatory Medicare payment model that aims to test whether performance-based incentive payments to or owed by participating kidney transplant hospitals increase access to kidney transplants for patients 18 and over with end-stage renal disease while preserving or enhancing the quality of care and reducing Medicare expenditures. Performance year one began July 1, 2025, and CMS issued a proposed rule with key revisions for performance year two (starting July 1, 2026) and beyond, including the following:
- Composite graft survival rate. For this measure, CMS proposes to add a risk-adjustment methodology, exclude multiorgan transplants, and update point allocation and scoring methodology.
- Payment. If the rule is finalized as proposed, downside payment would be due within 60 days of CMS demand, after which any remaining amount owed would be considered delinquent debt. CMS also proposes to expand extreme and uncontrollable circumstances flexibilities.
- Transparency requirements. CMS proposes to conduct an annual (versus one-time) review and post waitlist selection criteria; annually publish IOTA participant waitlist selection criteria and the proposed living donor selection criteria on the IOTA Model website; and clarify that the required review of acceptance criteria pertains to individual patient organ offer acceptance criteria, not organ offer filters or kidney transplant hospital level acceptance criteria. CMS also proposes to require IOTA participants to publicly post selection criteria for evaluating potential living donors for kidney transplant waitlist patients; semiannually notify Medicare waitlist beneficiaries of the number of, and reasons for, declined offers made on their behalf; and notify waitlisted Medicare beneficiaries and their care team anytime their waitlist status changes.
- Health equity. CMS proposes to remove the voluntary health equity plan requirement and all health-equity-related provisions.
CMS included requests for information (RFIs) about a future access to waitlist quality process measure, policies to address allocation out-of-sequence concerns, and the inclusion of MA beneficiaries in the model. Comments are due February 9, 2026.
ACIP updates hepatitis B vaccination recommendations. In an 8 – 3 vote, ACIP recommended individual-based decision-making for parents deciding whether to give the hepatitis B vaccine to infants born to women who test negative for the virus. ACIP suggested that for infants not receiving the birth dose, the initial dose be administered no earlier than two months of age. The Centers for Disease Control and Prevention (CDC) director has not yet adopted the recommendation, so the child and adolescent immunization schedule has not yet been updated to reflect this change. The change is not expected to impact insurance coverage.
The same day, President Trump released a memo directing the US Department of Health and Human Services (HHS) and CDC to review peer countries’ vaccine recommendations and update the US schedule to align with them.
FDA takes action on testosterone replacement therapy for men. FDA released an RFI on testosterone replacement therapy (TRT) for men to gather stakeholder perspectives on indications, dosing, route of administration, duration of treatment, and goals of treatment. Comments are due on February 9, 2026.
The same day, FDA held an expert panel to discuss TRT outcomes and some of the barriers men face when seeking treatment for low testosterone. Panelists presented studies to show that TRT is safe and does not increase risk for cardiovascular disease or prostate cancer, and many of them made the case that testosterone should no longer be classified as a Schedule III substance because the current scheduling leads to stigma.
QUICK HITS
- Senate will vote on resolution disapproving Richardson Waiver rescission. Sens. Murkowski, Collins, and Tillis (R-NC) joined all Democrats in support of a procedural motion to tee up a vote on a Congressional Review Act resolution that officially disapproves of the rescission of the Richardson Waiver. The Richardson Waiver directed government agencies to use the more formal rulemaking process for rules regarding “public property, loans, grants, benefits, or contracts.” The Senate floor vote is not yet scheduled.
- IRS implements OBBBA HSA changes. The Internal Revenue Service (IRS) issued guidance implementing OBBBA provisions related to the safe harbor for first-dollar coverage of certain telehealth services for individuals with HSA-eligible high-deductible health plans (HDHPs), bronze and catastrophic plans treated as HDHPs, and direct primary care service agreements.
- CMS releases Marketplace 2026 Open Enrollment Period Report. The report found that nearly 950,000 consumers who do not currently have healthcare coverage through plans in the individual market Marketplace have signed up for coverage in 2026 since the start of open enrollment on November 1, 2025.
- HHS investigates state health department for treatment of faith-based organizations. HHS is investigating the unnamed state health department because its licensing practices allegedly do not comply with federal conscience and equal treatment laws and regulations.
- USDA and HHS make MAHA announcements. In a press event, US Department of Agriculture (USDA) Secretary Collins, HHS Secretary Kennedy, and CMS Administrator Oz announced a new regenerative agriculture pilot program aligned with the Make America Healthy Again (MAHA) strategy and the approval of six new state waivers to remove unhealthy foods from the Supplemental Nutrition Assistance Program.
- House Ways and Means Committee advances home infusion bill. In a markup, the committee voted 41 – 0 to advance H.R. 4993, the Joe Fiandra Access to Home Infusion Act, which would expand Medicare coverage for external infusion pumps and non-self-administrable home infusion drugs.
- MACPAC holds December public meeting. The Medicaid and CHIP Payment and Access Commission (MACPAC) agenda includes sessions on children and youth with special healthcare needs transitions to adult coverage, implementing community engagement requirements, and ensuring accountability of Medicaid MCOs.
- CMS to hold Burden Reduction Conference. The conference, scheduled for February 25, 2026, will discuss ways to increase transparency, transform chronic care, and empower clinicians and patients through the use of AI.
NEXT WEEK’S DIAGNOSIS
Next week is scheduled to be Congress’ final week in session for the year. Several health-related hearings are scheduled:
- The House Energy and Commerce Oversight and Investigations Subcommittee will hold a hearing on AI and biotechnology.
- The House Veterans Affairs Technology Modernization Subcommittee will hold a hearing on electronic health record modernization.
- The Joint Economic Committee will hold a hearing on health outcomes and healthcare costs.
We will be monitoring the House closely to see whether Republicans advance a healthcare package.
