Summary
It is day 20 of the government shutdown and a compromise to reopen the government remains out of sight. The Senate will convene its eleventh vote on the House-approved continuing resolution tonight, which will fail, and will vote later this week on a bill to pay federal workers, including the military, who have been working without pay, which is also likely to fail. With the Affordable Care Act (ACA) marketplace open enrollment beginning on November 1, Congress is running out of time to address the enhanced premium tax credit expiration. This deadline will either increase pressure on Republicans to come to a compromise with Democrats on an extension, or present an off-ramp for Democrats to reopen the government, as the impact of the premium tax credit expiration will already be experienced by millions of Americans at the hand of Republicans.
Additionally, it was reported on Friday that Republicans are now considering a year-end health care package that would include an extension of the enhanced premium tax credits, along with other Republican-favored health care provisions, such as pharmacy benefit manager (PBM) reform, adding Health Savings Account options, and providing additional flexibility for employer-sponsored health plans. However, House Majority Leader Steve Scalise expressed that he would not vote for an extension of the enhanced premium tax credits.
Regulatory Update
The Office of Management and Budget (OMB) completed reviewing the following:
- Medicaid and Immigration Status. 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.
OMB is also 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 Physician Fee Schedule final rule, the CY 2026 Hospital Outpatient PPS final rule, and the CY 2026 ESRD 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.”