Summary
The House is in recess this week as the Senate continues to work on confirming President Trump’s cabinets nominees and potentially takes the next step towards moving a reconciliation package.
Nominations: This week the Senate is poised to confirm Kash Patel as FBI Director and Howard Lutnick as Secretary of Commerce. Meanwhile the Health, Education, Labor and Pensions (HELP) Committee will hold a markup to consider the nomination of Linda McMahon to be Secretary of Education and a hearing to examine the nomination of Lori Chavez-DeRemer to be Secretary of Labor. The Senate Homeland Security and Governmental Affairs Committee holds a hearing to examine the nominations of Troy Edgar to be Deputy Secretary of Homeland Security, and James Bishop to be Deputy Director of the Office of Management and Budget.
Budget Reconciliation: While not officially scheduled, many expect the Senate will bring their “skinny” budget resolution to the floor in the latter half of this week. Last week both the House and Senate Budget Committees (IHPP Senate and House Committee markup summaries) took the first step towards a budget reconciliation package by adopting their fiscal year (FY) 2025 Budget Resolution. The Senate Resolution is a $342 billion package will focus on securing the border ($175 billion), enhancing and revitalizing the nation’s military capacity ($150 billion), and facilitating energy independence by allowing offshore leases for oil drilling. According to Senate Budget Committee Chairman Lindsay Graham (R-SC), this package will cost $85.5 billion a year over four years and will be completely offset by reduced annual spending. The Budget Resolution includes instructions for the Senate Finance Committee and the Senate Health Education and Labor Committee (HELP) to find no less than $1 billion in funding over a 10-year period. A second reconciliation package is expected later in the year that will address extending the 2017 Trump tax cuts and will likely require much steeper spending cuts, with Medicaid, prescription drug pricing, and Enhanced Premium Tax Credits all on the table.
The House Budget Committee’s resolution proposes a sweeping fiscal plan that includes $4.5 trillion in tax cut extensions, $1.5 trillion in spending cuts, and lifting the statutory debt ceiling by $4 trillion (text/charts). Among the key provisions in the budget, substantial cuts are mandated across several committees. Notably, the Energy and Commerce Committee is tasked with finding at least $880 billion in savings, which could include cuts to Medicaid; the Agriculture Committee must reduce spending by at least $230 billion; and the Education and Workforce Committee is expected to slash $330 billion. It is expected the Budget Resolution will be brought to the House floor the week of February 24.
Regulatory Update
The Office of Management and Budget (OMB) is reviewing a new proposed rule titled, “Patient Protection and Affordable Care Act; Individual Health Insurance Market and Exchange Program Integrity (CMS-9884).” The proposed rule is likely focused on addressing fraud in Marketplace plans, which has been a primary concern for House Republicans and conservative think tanks, such as the Paragon Health Institute.
The proposed rule will likely reverse a number of Biden-era policies related to enrollment and eligibility for premium subsidies, which were promulgated through the annual notice of benefit and payment parameters (NBPP). Peter Nelson, the new head of Center for Consumer Information and Insurance Oversight (CCIIO), identified numerous Biden-era regulations in a report he wrote during his time at the Center of the American Experiment, a conservative think tank.
Given the timing of the proposed rule, it seems that the Trump Administration intends for its policies to be finalized and effective before the start of the 2026 Open Enrollment Period on November 1, 2025. Below, we highlight Biden-era policies specified in Nelson’s report that could be reversed in the proposed rule:
- Enrollment
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- Extension of the Open Enrollment Period from November 1 to December 15 to November 1 to January 15 (NBPP for 2022)
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- Earlier coverage effective dates for individuals who attest to a future loss of minimum essential coverage (NBPP for 2024)
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- Expansion of the timeframe to report a loss of Medicaid coverage to qualify for a Special Enrollment Period from 60 to 90 days (NBPP for 2024)
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- Changes to the re-enrollment hierarchy to allow Exchanges to direct re-enrollment for individuals who qualify for cost-sharing reductions (CSRs) to a CSR-qualified silver plan (NBPP for 2024)
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- Establishment of a monthly Special Enrollment Period for individuals with a household income at or below 150 percent of FPL (NBPP for 2025)
- Eligibility for Premium Subsidies
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- Requirement for Exchanges to wait to discontinue premium subsidies until a tax filer has failed to file taxes and reconcile premium subsidies for two consecutive years (NBPP for 2024)
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- Requirement for Exchanges to accept an applicant’s attestation of projected income without verification when there is no tax information (NBPP for 2024)
Under President Trump’s Executive Order on deregulation, CMS would be required to eliminate 10 existing regulations for every new regulation introduced. It remains unclear how this directive will be implemented, or which CMS regulations may be affected by the program integrity proposed rule.
The fiscal year (FY) 2026 Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System proposed rule has also arrived at OMB for review. By statute, the proposed rule must be published by April 1 annually.