Summary
Senate Republicans are working to meet President Trump’s July 4 deadline to deliver a budget reconciliation bill for his signature. The Senate Finance Committee is expected to release its legislative text today, including revisions to House-passed Medicaid provisions and other policy changes. However, some sections are anticipated to contain placeholders that will be updated at a later time. Prospects for significant policy changes remain limited, especially given the narrow margins in the House.
To meet the ambitious July 4 deadline, Senate floor action, including the vote-a-rama amendment process, would need to begin next week. The House would then need at least a week to pass the Senate’s bill given the 72-hour rule. The more pressing deadline is the “X-Date,” when the Treasury Department will exhaust cash reserves and extraordinary measures, requiring congressional action to raise the debt limit. Last week, the Congressional Budget Office slightly extended its estimate for when the debt limit must be raised, suggesting the “X-Date” range now falls between mid-August and the end of September (previously estimated to be in early August).
Senate Democrats continue to raise awareness about the negative impacts of the budget reconciliation bill, with a sharp focus on the projected losses in health insurance coverage. CBO estimates that if the House-passed policy changes to Medicaid and the Marketplace were enacted, 10.9 million more Americans would become uninsured. This is in addition to 5.1 million coverage losses already expected due to the expiration of enhanced ACA subsidies and changes in CMS’ Marketplace and Integrity proposed rule.
Last week, Senate Finance Committee Ranking Member Ron Wyden (D-OR) and a dozen Senate Democrats introduced 13 bills to strengthen and invest in Medicaid. These messaging bills are intended to highlight the differences between the Democratic and Republican approaches to Medicaid. Sen. Bernie Sanders (I-VT), Ranking Member of the Senate Committee on Health, Education, Labor, and Pensions issued a request for information to health care providers on the impacts of the reconciliation bill. Comments are due this Friday, June 20.
Meanwhile, the appropriations process is underway; however, a continuing resolution to avoid a government shutdown appears likely. The main question is how long a CR will last. In addition to addressing government funding, Congress will also need to act on a package of expiring health care extenders – including funding for community health centers and Medicare telehealth flexibilities, and other bipartisan policies.
In the House, appropriators are in the process of marking up fiscal year 2026 appropriations bill at both the committee and subcommittee levels. The House Appropriations Committee has begun considering the FY 2026 Agriculture, Rural Development, Food and Drug Administration bill. The text of the Labor, Health and Human Services, Education, and Related agencies bill has not yet been released.
The Senate is further behind in the appropriations process, with the Senate Appropriations Committee not expected to reach a topline agreement on FY 2026 spending until after budget reconciliation. Senate Appropriations Subcommittees are holding hearings to review the President’s FY 2026 budget request.
Regarding the recission package, which targets foreign aid – including PEPFAR – and public broadcasting, and was passed by the House last week, the Senate has not yet scheduled a vote. Notably, rescission bills are not subject to the 60-vote threshold and only require a simple majority. The White House is expected to send additional rescission packages over the next few weeks.
The Supreme Court is scheduled to release opinions on Thursday, which may include health care-related cases. Among them are Kennedy v. Braidwood Management, Inc., which challenges the constitutionality of the U.S. Preventive Services Task Force – an independent advisory body whose recommendations determine which preventive services most private health insurers must cover without cost-sharing – and United States. v. Skrmetti, which concerns a Tennessee law banning gender-affirming care for minors.