Congress lacks consensus on addressing healthcare affordability. With the December 31, 2025, expiration date of the enhanced APTCs quickly approaching, discussions – both partisan and bipartisan – continued on Capitol Hill this week, although agreement on a path forward remains elusive. As part of the agreement to reopen the government last month, Senate Majority Leader Thune (R-SD) promised Democrats an APTC floor vote in December. This vote is expected to occur on December 11. On December 4, Senate Minority Leader Schumer (D-NY) announced that Democrats will offer a bill on the Senate floor at that time to provide a clean three-year extension of enhanced APTCs. That bill is unlikely to garner much, if any, Republican support. It is still unknown whether Senate Republicans plan to offer an alternative bill.
Partisan differences on APTCs were on display during this week’s Senate Health, Education, Labor, and Pensions (HELP) Committee hearing on healthcare affordability, with Democrats pressing for a straightforward extension of the enhanced APTCs and Republicans split on whether to extend the credits with revisions or focus on other measures to bring down health insurance costs, such as health savings accounts, price transparency efforts, and reforms to promote competition. Some Senate Republicans agreed that, in the short term, APTCs should be extended to avoid immediate harm to families while broader reforms are debated.
House Ways and Means Oversight Subcommittee examines organ procurement organizations. During the hearing, committee members agreed on the need for systemic reform, including stronger oversight, penalties for violations, and improved data transparency within organ procurement organizations (OPOs). Witnesses emphasized the urgent need for accountability within OPOs to prevent harm to patients and families. Republican committee members focused their questions on accountability and transparency within OPOs, highlighting allegations of fraud, misuse of federal funds, and unethical practices. Democrats on the committee stressed the importance of maintaining health insurance coverage for transplant patients, warning that cuts to Medicaid and failure to extend the enhanced APTCs would leave millions uninsured and jeopardize access to organ transplants.
Senate Aging Committee holds hearing on aging in place and community support. During the hearing, members on both sides of the aisle expressed support for reauthorizing the Older Americans Act and encouraging aging in place by shifting resources from institutions to home- and community-based services. Witnesses spoke to the importance of Older Americans Act programs in supporting older adults, individuals with disabilities, and their caregivers. Republican committee members expressed support for other solutions to aid caregivers and reduce senior loneliness, such as a multigenerational home caregiver tax credit and partnerships with community-based organizations. Democrats on the committee voiced concern about Medicaid cuts and recent administration actions, such as reductions in force in the Administration for Community Living and US Department of Education, and rulemaking related to travel accessibility and the direct care workforce.
Senate Finance Committee leaders introduce bipartisan pharmacy benefit manager reform legislation. Chair Crapo (R-ID) and Ranking Member Wyden (D-OR) introduced the Pharmacy Benefit Manager (PBM) Price Transparency and Accountability Act in an effort to increase transparency in federal prescription drug programs and lower drug prices for patients. The legislation would delink PBMs’ compensation from their negotiated rebates and increase PBM reporting requirements to Medicare Part D plan sponsors and HHS. It would also require retail community pharmacies to participate in the National Average Drug Acquisition Cost survey to ensure accurate Medicaid payments to pharmacies, and would mandate that PBMs pass Medicaid payments directly to pharmacies in order to ensure transparency in drug costs.
CMS releases MA and Part D proposed rule. The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule with policy and technical changes to the MA and Part D programs for 2027 and beyond. Key takeaways include:
Comments on the proposed rule are due by January 26, 2026. Read CMS’s fact sheet on the proposed rule here. You can also read our Regs & Eggs blog post on this topic.
CMS announces negotiated prices for 15 drugs selected for Medicare Part D. In a press release, CMS announced the agreed-upon maximum fair prices for 15 drugs selected for the 2027 Medicare Drug Price Negotiation Program. CMS estimated that about 5.3 million people with Medicare Part D coverage used these drugs in 2024 to treat a variety of conditions, such as cancer, type 2 diabetes, and asthma, and that these drugs accounted for about $42.5 billion in total gross covered prescription drug costs under Medicare Part D in 2024, or about 15%. Had these negotiated prices been in effect in 2024, net savings to the Medicare program would have approximately $12 billion, according to CMS.
The 15 Part D-covered drugs selected for 2027 will join the 10 Part D-covered drugs previously selected for negotiation, with those prices going into effect January 1, 2026. A fact sheet detailing the negotiated prices for the 15 selected drugs can be found here.
CMS repeals minimum staffing requirements for long-term care facilities. CMS issued an interim final rule effectively repealing the Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting final rule. Released by the Biden administration in 2024, the repealed rule established minimum staffing standards for long-term facilities. These standards would have required a registered nurse (RN) to be onsite 24 hours, seven days per week, and would have required each facility to provide a minimum of 0.55 RN, 2.45 nurse aide (NA), and 3.48 total nurse staffing hours per resident day, for a specified time period. The 2024 rule has been challenged in court, and the One Big Beautiful Bill Act prohibited CMS from implementing, administering, or enforcing the minimum staffing standards until September 30, 2034. Thus, the standards have never been enforced.
CMS will reinstate prior regulatory requirements, including the minimum statutory RN staffing requirement for long-term care facilities to use the services of an RN for at least eight consecutive hours a day, seven days a week, and to designate an RN to serve as the director of nursing on a full-time basis except when waived. CMS is accepting comments, but the changes are effective 60 days after the rule is published in the Federal Register (both the comment due date and the rule’s effective date are estimated to be February 1, 2026).
CMS Innovation Center announces new digital health model. The ACCESS model is a 10-year voluntary model designed to expand access to new technology-supported care options that help Medicare fee-for-service beneficiaries improve their health and prevent and manage chronic disease. Examples of technology-supported care that would be covered by this model include medication management, therapy and counseling, and the use or monitoring of US Food and Drug Administration (FDA)-authorized devices or software.
The ACCESS model will test outcome-aligned payments for care organizations enrolled in Medicare Part B and will include four clinical tracks focused on common chronic conditions:
During a December 4, 2025, live stream event, CMS officials announced that applications are expected to open in January 2026 and close in April 2026, with rolling admissions. The model is scheduled to begin in July 2026 and will run for 10 years. During the same event, FDA and CMS officials announced the TEMPO (Technology-Enabled Meaningful Patient Outcomes for digital health devices) pilot project, an FDA initiative that will help health device manufacturers offer their device inside of the ACCESS model with exemption from the FDA market access process. Applications for the TEMPO pilot are expected to open in early 2026.
FAQs on the ACCESS model can be found here.
HHS unveils AI strategy. HHS announced its AI action plan focused on integrating AI via a “OneHHS” approach in which all HHS divisions will use a collaborative department-wide AI infrastructure. The strategy focuses on five pillars:
The House and Senate are both scheduled to be in session next week, with votes on the expiring APTCs expected in the Senate. At the committee level, the House Committee on Oversight and Government Reform will hold a hearing on how technology can lower the cost of healthcare, and the Senate HELP Committee will hold a hearing to examine the US organ procurement and transplantation network. The Senate Committee on Homeland Security and Governmental Affairs Subcommittee on Investigations will also hold a hearing on healthcare. The House Judiciary Committee will continue the APTC discussion with a hearing on the topic.
