In Depth Analysis

Every year, the administration releases the president’s budget, which requests funding from Congress for the upcoming fiscal year (FY). The president’s budget is a nonbinding document and funding levels reflected in appropriations bills do not always align with funding levels in the president’s budget request. However, the president’s budget has traditionally been an opportunity for the administration to lay out its priorities and state publicly what programs and activities it wants to invest in, and which it wants to cut. Thus, it can be viewed as a guide map to how the administration wants departments, like the US Department of Health and Human Services (HHS), to be structured and funded.

On May 22, 2025, the US House of Representatives passed its reconciliation package, now known as H.R. 1, One Big Beautiful Bill Act, by a 215 – 214 – 1 vote, advancing an agenda that extends and builds on tax cuts enacted in President Trump’s first term.

The bill contains several policies including Medicaid provisions that would alter enrollee eligibility and how states finance their share of Medicaid funds, Medicare physician payment, Affordable Care Act Marketplace enrollee eligibility and benefits, and more. The bill now moves to the Senate, which is expected to make changes to key provisions.

Read on for a comprehensive summary of the health-related provisions in the reconciliation package.

This +Insight outlines key changes CMS is proposing, particularly related to episode pricing, quality measurement, and trend factor calculations.

The Centers for Medicare & Medicaid Services (CMS) recently finalized the 2026 Medicare Advantage (MA) and Part D Payment Rates and Policies, including a net 5.06% increase in payments to MA plans before accounting for coding trends. The overall increase reflects an average county benchmark growth rate of 9.04% along with continued phase-in of changes to the MA risk model and rebasing of county benchmark amounts. The updates and changes to payment policies are important for plans in preparing offerings and bids for 2026, as well as providers and others who do business with MA plans or are thinking about engaging with MA.

On April 11, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2026 Inpatient Prospective Payment System (IPPS) proposed rule. The rule would update Medicare payment policies and quality reporting programs relevant for inpatient hospital services.