Summary
With the government finally reopened, Congress is now bustling again across a variety of fronts. Most timely and at the top of the list are addressing the expiration of the enhanced premium tax credits (EPTCs) and completing the fiscal year (FY) 2026 appropriations process before the new January 30th deadline. More details on the EPTCs follow:
EPTC State of Play
On the Senate side, as part of the deal on reopening government, Senate Majority Leader John Thune (R-SD) promised a vote on the EPTCs by mid-December. Ahead of the vote, the Senate Finance Committee will convene a hearing on Wednesday that will likely feature opposing viewpoints on how to address the EPTCs from witnesses representing the American Action Forum, the Paragon Health Institute, and Urban Institute. Last week, the Paragon Institute released a newsletter commenting on President Trump’s preference to convert the subsides to a health savings account (HAS) and offered policy principles to reform the existing subsidies. Senate Health, Education, Labor, and Pensions (HELP) Committee Chair Bill Cassiy (R-LA) has also floated converting EPTCs to flexible savings accounts (FSAs). Meanwhile, Democrats remain focused on a clean extension of the existing EPTCs.
On the House side, while Speaker Mike Johnson (R-LA) has not made a similar commitment to hold a vote on the EPTCs, House Majority Whip Steve Scalise (R-LA) indicated that the House is working on building a coalition on the EPTCs topic, with the goal of moving legislation as quickly as possible. The House Committee chairs will also begin listening sessions this week with groups of Republican members on the EPTCs and broader health care policy. House members have also begun floating various approaches, including the Fix It Act, which would extend APTCs for wo years for individuals under six times the federal poverty level. Finally, last week, a bipartisan group of thirty-house members sent a letter to Senate leadership urging the Senate to include House members in bipartisan negotiations in lead up to the vote on the EPTC expiration to ensure that proposal can successfully pass both chambers.
Medicare Premiums
The Centers for Medicare & Medicaid Services (CMS) released 2026 Medicare cost-sharing updates on Friday, with notable increases across Parts A and B. The Part A inpatient deductible will rise to $1,736 (up $60 from 2025), while the standard Part B premium will increase to $202.90 (up $17.90), and the Part B deductible will climb to $283 (up $26). Premiums for individuals without premium-free Part A will increase to $565 (up $47), and the immunosuppressive drug premium will be $121.60 (up $11.20). All changes take effect January 1, 2026, and Medicare Open Enrollment for 2026 coverage runs through December 7, 2025.
Regulatory Update
The Office of Management and Budget (OMB) is currently reviewing the following:
- Medicare:
- CY 2027 Medicare Advantage/Part D Policy. Proposed CY 2027 policy and technical changes to Medicare Advantage, Medicare Prescription Drug Benefit, Medicare Cost Plan, and PACE
- Medicare Payment Rules. The CY 2026 Hospital Outpatient PPS final rule, the CY 2026 ESRD final rule, and the CY 2026 Home Health PPS final rule.
- 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.
- 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.”
- Gender-Affirming Care.
- 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.”