Senate Begins Work on Reconciliation. The Senate returned from its Memorial Day recess to begin consideration of HR 1, the One Big Beautiful Bill Act, the House-passed reconciliation package. Senate Majority Leader Thune (R-SD) aims to have a modified bill on the floor the week of June 23, 2025, with the goal of getting a final bill to President Trump’s desk by July 4, 2025. This week’s work occurred mostly behind the scenes. Senate committees of jurisdiction are not expected to hold markups; instead, committees of jurisdiction will release titles of the bill within their jurisdiction. The process started this week. The Senate Committee on Commerce, Science, and Transportation released its language that modifies the House’s artificial intelligence (AI) provisions, removing the 10-year state ban on AI regulation and amending funding language so that states would only be eligible for AI development grants if they do not enforce state laws regulating AI models. The Senate Finance Committee, with jurisdiction over Medicaid, taxes, and the Affordable Care Act (ACA), will likely be the last committee to release updated text. Majority Leader Thune noted that the Finance Committee title could be released as soon as next week.
Majority Leader Thune can lose no more than three Republicans to pass the bill. This week, more Republicans came out in opposition to certain Medicaid provisions, including the moratorium on provider taxes. Sens. Collins (R-ME), Murkowski (R-AK), Moran (R-KS), and Hawley (R-MO) are among those with concerns. On the conservative side, Sens. Paul (R-KY), Johnson (R-WI), Lee (R-UT), and Rick Scott (R-FL) continued to voice strong opposition unless the bill does more to cut federal spending and reduce the deficit. There has also been discussion about potentially including Medicare Advantage reforms to increase savings, although no explicit policies have been presented publicly. Senate passage will likely require a delicate balancing act, and afterward the bill must pass the House again. President Trump met this week with Senate Finance Committee Republicans, and Centers for Medicare & Medicaid Services (CMS) Administrator Oz is holding meetings in the Senate to hash out concerns and attempt to reach policies that can unite Republicans. The process to scrub the bill of provisions that don’t meet the Byrd rule is also ongoing. Republicans met with the Senate Parliamentarian this week, and Democrats likely will follow soon. (For a full explainer on the Byrd rule, read our +Insight).
On June 4, 2025, the Congressional Budget Office (CBO) released updated estimates for H.R. 1. CBO estimates that the bill would increase the deficit by $2.4 trillion. This figure is based on a $1.2 trillion reduction in federal spending offset by a $3.6 trillion decrease in revenue. CBO estimates that 10.9 million individuals would be uninsured in 2034. Of those, 7.8 million would lose Medicaid coverage, with others mainly losing coverage from changes to the ACA. CBO estimates that the ACA changes would result in gross benchmark premiums for ACA plans decreasing by an average of 12%. At the request of Senate Democrats, CBO released additional analysis that provides further details on health insurance loss and estimates that failure to extend the enhanced advance premium tax credits as part of H.R. 1 would lead to an additional 5.1 million Americans being uninsured in 2034.
White House Sends Congress $9.4 Billion Rescissions Package. The package asks for more than $9 billion of previously appropriated funding to be rescinded and is largely focused on foreign aid and the Corporation for Public Broadcasting. The package includes recissions of funding from health programs within the US Department of State and the US Agency for International Development (USAID). It requests rescission of $500 million in global health USAID funding that focuses on equity, family planning, and reproductive health within child and maternal health, HIV, and infectious disease activities. It also requests rescission of $400 million of President’s Emergency Plan for AIDS Relief (PEPFAR) funding. Congress has 45 days to act. Approval of the rescission package only requires a simple majority in the House, which will likely consider it next week. In the Senate, Appropriations Chair Collins (R-ME) has already stated concerns about PEPFAR cuts and noted her committee’s intention to examine the package.
Senate HELP Committee Reviews Reauthorization of Over-the-Counter Monograph Drug User Fee Program. During the hearing, Democrats focused on how workforce reductions at the FDA will impact agency operations, while supporting the development of over-the-counter (OTC) drugs. Republicans advocated for a more streamlined and efficient transition from prescription drugs to OTC medications, emphasized the need for regulatory oversight of international facilities, and encouraged use of an online dashboard to track the FDA’s progress. Jacqueline Corrigan-Curay, MD, acting director of the FDA’s Center for Drug Evaluation and Research, expressed her commitment to working with Congress to streamline the transition from prescription drugs to OTC medications.
House Begins FY 2026 Appropriations Markups. The House Appropriations Committee began subcommittee markups this week to discuss spending bills for FY 2026. The Subcommittee on Agriculture, Rural Development, FDA, and Related Agencies held its markup, during which it advanced its bill to the full committee by a party line vote. During the markup, Republicans stated that the bill would help reduce the federal deficit, while Democrats criticized the bill for cutting funding for the FDA and the Supplemental Nutrition Assistance Program. The full schedule of subcommittee and full committee markups can be found here.
HHS Releases FY 2026 Budget in Brief. Late on May 30, 2025, HHS released its budget request for FY 2026, known as a budget in brief. Some agencies and divisions within HHS also released congressional justifications that provide more information on funding requests. Additional justifications from other agencies and divisions are said to be forthcoming. The budget in brief follows the earlier release of the “skinny” budget and provides more detail on HHS priorities, including the agency’s restructuring. The document only includes discretionary funding requests and does not include legislative proposals that would impact mandatory programs such as Medicare or Medicaid. Administration officials indicate that mandatory funding requests are unlikely to be released before reconciliation is complete.
Highlights for HHS discretionary funding requests include:
Read more in our +Insight.
CMS Rescinds 2022 EMTALA Abortion Guidance. The Biden administration released the HHS guidance in July 2022 in the wake of the US Supreme Court Dobbs decision that left regulation of abortion to the states. The now-rescinded guidance stated that EMTALA protects healthcare providers’ clinical judgement and any action they take to provide stabilizing care for emergency medical conditions, including ectopic pregnancy, complications of pregnancy loss, or preeclampsia. In a press release, CMS noted that it will continue to enforce EMTALA, including in emergency medical situations where the health of a pregnant woman or her unborn child are at risk, and indicated that the agency will rectify any legal confusion on this issue.
FDA Declines to Appeal Ruling on LDT Regulation. In late March 2025, the US District Court for the Eastern District of Texas struck down the regulation finalized in May 2024 under the Biden administration that gave the FDA the authority to regulate LDTs. The district court found that the rule violated the Loper Bright standard because the FDA exceeded its statutory authority. The FDA was given a 60-day window to appeal the decision, which it declined to do. Therefore, the final rule remains without force. Although the FDA did not issue a statement on its decision, it follows previous actions by the Trump administration to limit agencies’ regulatory power outside of statutory authority. Read more about the March court decision here.
It remains to be seen if the Trump administration will take a new approach to LDT regulation or if lawmakers will re-introduce the VALID Act, which received bipartisan support in previous session of Congress and would require the FDA to regulate LDTs and other in vitro diagnostics.
Fired HHS Employees File Class Action Lawsuit. In yet another challenge to the HHS reductions in force, seven former HHS employees filed a case in the US District Court for the District of Columbia. The lawsuit claims that the personnel files used to justify firings had errors and inaccuracies, which HHS Secretary Kennedy has attributed to siloed human resources departments across the agency. The lawsuit notes that most employees fired during the April 2025 reduction in force could be eligible for this class action.
Both chambers of Congress will be in session next week, with work on reconciliation expected to continue in the Senate. The Senate Appropriations Committee will discuss the NIH FY 2026 budget, and the House Energy and Commerce Health Subcommittee will examine US-made medicine and domestic supply chains. The House Committee on Appropriations will consider the Agriculture, Rural Development, FDA, and Related Agencies appropriations bill that advanced from the subcommittee this week.
