IHPP - Impact Weekly, December 8, 2025

Summary

With two legislative weeks to go before the end of the year, the fate of the enhanced premium tax credits remains unclear. The Senate is likely to vote on a clean three-year extension on Thursday, pursuant to Senate Majority Leader John Thune’s (R-SD) promise to Democrat when reopening the government, but the unified Republican alternative option has yet to emerge. So far, Republican Senators are considering Senate HELP Chair Bill Cassidy’s option to expand health savings accounts (HSAs) and Sen. Rick Scott’s More Affordable Care Act, which would create HSA-style accounts, while Sens. Bernie Moreno and Susan Collins are working on a new proposal that would extend the EPTCs for two year with income caps and other modifications. However, it is unclear whether Senate Republicans will find compromise before the end of the year.

On the House side, the National Defense Authorization Act (NDAA) is the main focus of the week, but Speaker Mike Johnson (R-LA) also indicated that leadership is planning on releasing a health care framework early this week for caucus consideration. This could reflect a variety of proposals that are floating around the House, including reforms that go beyond the EPTCs. This could reflect the CommonGround 2025 framework for a one-year extension, provisions similar to Sen. Scott’s HSA-style accounts, or something else entirely.

Open Enrollment Snapshot

On Friday, the Centers for Medicare and Medicaid Services (CMS) released a snapshot of the Marketplace 2026 open enrollment period. Since open enrollment began on November 1^st, 950,000 new consumers have signed up for a plan, a decrease from 988,000 new consumers in the December snapshot from 2024. However, because of the coverage gains last year, there are also 4.8 million returning consumers for 2026, an increase from 4.4 million returning consumers at this point last year. Enrollment changes due to the increase in premiums from the expiration of EPTCs will become clearer as consumers begin to shop and enrollees begin to pay premiums in January

Regulatory Update

The Office of Management and Budget (OMB) is currently reviewing the following rules:

The OMB is currently reviewing the following:

• ACA Marketplace: The HHS Notice of Benefit and Payment Parameters for 2027 proposed rule
• Medicare:
  • Procurement of Domestic PPE. An advance notice of proposed rulemaking that would detail program incentives and requirements for Medicare providers and suppliers to invest and phase-in the procurement of American made personal protective equipment (PPE) and essential medicine to secure our nation’s health and safety.
  • *NEW* MA and Part D: Advance Notice of Methodological Changes for Calendar Year (CY) 2027 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies

• Medicaid:
  • Gender-Affirming Care.
    • A proposed rule titled, “Medicaid Program; Prohibition on Federal Medicaid Funding for Sex Trait Modification Procedures Furnished to Children and Youth.”
    • A proposed rule titled, “Medicare and Medicaid Programs; Hospital Condition of Participation: Limiting Participation Based on the Performance of Sex Trait Modification Procedures on Children.”
  • State Directed Payments. A proposed rule titled, “Medicaid Managed Care-State Directed Payments.” The proposed rule appears intended to advance a presidential memorandum released on June 6, which directs HHS to “eliminate waste, fraud, and abuse in Medicaid, including by ensuring Medicaid payments rates are not higher than Medicare, to the extent permitted by applicable law.”
  • Medicaid Tax Waivers. A proposed rule titled, “Preserving Medicaid Funding for Vulnerable Populations – Closing a Health Care-Related Tax Loophole.”

• Prescription Drugs:
  • A proposed rule titled, “Improving Transparency into Pharmacy Benefit Manager Fee Disclosure” and a proposed rule addressing Transparency in Coverage requirements.
  • CMMI Drug Pricing Models. A proposed rule for a Global Benchmark for Efficient Drug Pricing (GLOBE) Model and a proposed rule for Guarding U.S. Medicare Against Rising Drug Costs (GUARD) Model

• Nutrition:
  • Head Start. A notice from the Administration for Children and Families titled, “Publish Request for Information: Nutrition Services in Head Start Programs

• Immigration:
  • Unaccompanied Children. An interim final rule titled, “Unaccompanied Children Program Foundational Rule; Update to Include Proof of Identity and Income Verification Standards.”