Summary
This morning at 9:00 am, the Senate kicked-off its vote-a-rama for the One Big Beautiful Bill Act (updated text and CBO score as of June 28), where the Senators have filed close to 300 amendments to the bill, most of which are offered by Democrat Senators. Senate Finance Committee Ranking Member Wyden (D-OR) will offer a Motion to Commit to strike all Medicaid cuts from the Republican reconciliation bill and ensure the ultra-wealthy and big corporations pay their fair share in taxes, with many other Democrat amendments focused on these priorities.
It is expected that this process will likely conclude late tonight or early Tuesday morning, with the House set to hold its first floor vote on Wednesday. This will give House Speaker Johnson (R-LA) two days to get the bill to the President’s desk by the July 4th deadline. House Republicans can only afford to lose three Republican votes for the bill and the House Freedom Caucus has already expressed opposition to the Senate version, stating that it adds $1.3 trillion to the deficit
Byrd Bath Updates
Following the release of the updated text, the Senate Budget Committee Democrats detailed that the Senate Parliamentarian advised against the following Senate Finance Committee provisions that would be subject to a 60-vote threshold if there were to remain in the bill as currently drafted:
- Section 71101. Repealing Parts of the Rule Relating to Eligibility and Enrollment in Medicare Savings Programs;
- Section 71102. Repealing Parts of the Rule Relating to Eligibility and Enrollment for Medicaid and the Children’s Health Insurance Program (CHIP);
- Section 71113. Repealing Parts of the Nursing Home Staffing Regulations and Transparency Policies;
- Section 71124. Determination of FMAP for High-Poverty States;
- Section 71203. Expanding and clarifying the exclusion for orphan drugs under the drug price negotiation program; and
- Section 71204. Application of Cost-of-Living Adjustment to Non-Labor Related Portion for Hospital Outpatient Department Services Furnished in Alaska and Hawaii.
The announcement also explains that following provisions have been redrafted to address the Parliamentarians guidance and are no longer subject to a 60-vote threshold: Section 71117: Provider Taxes; Section 71201: Limiting Medicare coverage of certain individuals; and Section 71301: Permitting premium tax credits only for certain individuals. Finally, Section 71115: Defunding Planned Parenthood was still under consideration of the Parliamentarian.
MAHA State Update
Secretary of the Department of Health and Human Services (HHS) Robert F. Kennedy Jr. stopped in Louisiana and Oklahoma to celebrate state actions aligned with his Make America Healthy Again (MAHA) agenda.
- Oklahoma: On June 26th, Secretary Kennedy joined Governor Kevin Stitt (R) to launch the state’s initiative to Make Oklahoma Healthy Again. As a first action, the Governor signed a waiver to ban the purchase of soft drinks and candy in SNAP. Governor Stitt also signed an executive order to:
- Instruct the Department of Health to stop recommending that municipalities put fluoride in water;
- Direct the Departments of Corrections, Education, and Human Services to supply meals they serve with no artificial dyes or flavors; and
- Establish an Advisory Council to provide suggestions on promoting health.
- Louisiana: On June 27th, Secretary Kennedy joined Governor Jeff Landry (R) for the signing of a SNAP waiver to ban the purchase of soda and candy, a bill to allow purchase of ivermectin without a prescription, and the Louisiana “Maha bill” (SB 14), which:
- Restricts artificial food dyes and preservatives in school meals;
- Mandates that physicians and physician assistants complete continuing medical education in nutrition and metabolic health;
- Requires restaurants to disclose the use of seed oils; and
- Requires QR code labeling from food manufacturers alerting consumers to specific ingredients.
8 states, including Oklahoma and Louisiana, have signed waivers to restrict the purchase of junk food, candy, and/or soda with SNAP benefits.
Regulatory Update
The Office of Management and Budget is reviewing the following:
Medicare
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- Proposed CY 2026 payment updates for physicians, hospital outpatient departments and ambulatory surgical centers, home health agencies, and end-stage renal disease facilities. These proposed rules are typically published in June or July.
- Final FY 2026 payment updates to the hospital inpatient prospective payment system for acute care hospitals and long-term care hospitals. This final rule is typically published around August 1.
Medicaid
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- A final rule titled, “Medicaid Eligibility Changes Under the Affordable Care Act of 2010; Giving States Freedom to Use Immigration Information to Determine State Residency for Medicaid Eligibility.” The final rule is part of the Trump administration’s efforts to increase federal oversight on states using Federal Medicaid funding for the health care of undocumented immigrants.
- 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.”