Congressional leaders release FY 2026 Labor-HHS minibus and health package. On January 20, 2026, congressional appropriators released the 2026 Consolidated Appropriations Act, working to ensure that government funding does not lapse at the end of the month.
Appropriations
The package includes the final four of the 12 annual appropriations bills for fiscal year (FY) 2026: Labor-HHS, Defense, Homeland Security, and Transportation-Housing-Urban Development. The Labor-HHS portion of the “minibus” strikes a balance between the differing Labor-HHS bills advanced by the House and Senate appropriations committees last year. It would provide more than $116 billion in discretionary funding for HHS, which is an increase of $210 million over FY 2025 and $33 billion more than the president’s budget request. Within HHS, the bill includes $48.7 billion for National Institutes of Health research, which is an increase of $4.3 billion over FY 2025. Republican and Democratic appropriators in the House and Republican and Democratic appropriators in the Senate have released summaries of the Labor-HHS portion of the minibus.
Health package
The healthcare provisions within the minibus package are similar but not identical to the bipartisan, bicameral December 2024 health agreement that was ultimately pulled from the year-end spending bill that year. Of note, the package does not address the expired Affordable Care Act (ACA) enhanced APTCs. Key policy provisions in the package include pharmacy benefit manager (PBM) reforms, expanded participation in the Medicare Diabetes Prevention Program, Medicare Advantage provider directory updates, a delay in cuts to Medicare reimbursement rates for certain lab services, pediatric research provisions, and reauthorization of mental health support programs for healthcare workers.
The package would also extend various expiring healthcare programs for periods ranging from one to five years. These so-called “extenders” are tied to the January 30, 2026, deadline for the remaining FY 2026 appropriations bills and must be addressed by Congress by the end of the month to avoid lapses. The package would extend the Medicare-dependent hospital program, the low-volume hospital payment adjustment, and the geographic practice cost index floor used in the calculation of Medicare Physician Fee Schedule payments through the end of calendar year (CY) 2026. It also would eliminate Medicaid disproportionate share hospital allotment reductions through FY 2027, extend current Medicare telehealth flexibilities through CY 2027, and extend the Acute Hospital Care at Home waiver program through FY 2030.
The Congressional Budget Office cost estimate for the minibus package can be found here.
Next steps
Lawmakers are racing to complete action on the remaining FY 2026 appropriations bills, along with the health extenders, before January 30, 2026, when all of these provisions expire. The House passed the minibus package by a vote of 341-88 on January 22, 2026, sending the measure to the Senate. The Senate returns from its recess next week, at which time it will have to complete action on the final minibus package, which is expected to be combined with the previous minibus package approved by the House on January 14, 2026 (Financial Services and State-Foreign Operations). Senate approval would complete the FY 2026 appropriations process, avoiding a government shutdown.
House holds hearings on healthcare affordability featuring health insurance executives. In both the Energy and Commerce Committee hearing and the Ways and Means Committee hearing, committee members spent time discussing the role the ACA and insurance practices have in affordability for patients. Republican committee members largely emphasized the need for greater insurer competition and transparency to understand and lower costs, while also endorsing policies like health savings accounts (HSAs) to address increasing healthcare costs. Many Democrat committee members instead advocated for an extension of the ACA enhanced APTCs, citing evidence that subsidies improve enrollment and affordability in the individual market. Committee members of both parties asked questions about vertical integration and consolidation in the industry, prior authorization practices in Medicare Advantage, and PBMs and group purchasing organizations, inquiring about the potential impact of these factors on rising healthcare costs.
House Judiciary Committee examines fraud in federal programs. The hearing featured testimony on fraud across several publicly funded programs in Minnesota. Republican committee members noted similar cases of fraud in Arizona and Ohio, and Reps. Kiley (R-CA) and Tiffany (R-WI) also raised concerns about issues of fraud in their states. Democratic committee members noted that previous removals of inspectors general reduced federal oversight capacity, and emphasized that Minnesota fraud cases had already been investigated and prosecuted under the Biden administration.
House Budget Committee addresses rising healthcare costs. During the hearing, Republican committee members emphasized the need for a free-market healthcare system with less government interference, promoted HSAs as a solution to lower healthcare costs, and underscored the importance of addressing fraud within Medicare and Medicaid. Democratic committee members highlighted the expired enhanced APTCs as a key factor contributing to rising healthcare costs. One witness stated that her health insurance costs doubled following the expiration of the APTCs and that coverage became less affordable for many Americans. Republicans countered that the ACA is structurally flawed and argued that continuing to subsidize what they described as a broken system would only drive costs higher.
The House is scheduled to be out of session next week, but the Senate will return to take up the final appropriations minibus for FY 2026, including the health policy and extenders package. The snowstorm taking aim at many states and the Washington, DC area late this weekend could complicate or delay the Senate’s return to session as the clock ticks down to the January 30 funding deadline.
