IHPP - Weekly, October 6, 2025

Summary

Today is day six of the government shutdown and both parties have not changed course on their shutdown strategy. Democrats want an “iron-clad” commitment to address health care, including extending the enhanced premium tax credits, and Republican will not negotiate on such an extension until Democrats support the continuing resolution (CR). The Senate is scheduled to vote for the fifth time on the House-passed CR and Republicans believe they will eventually secure the eight Democrat votes needed as pressure ramps up and funding for the Women Infants and Children (WIC) program runs out this week, and active-duty military will miss their first paycheck on October 15. So far, only Sens. John Fetterman (D-PA), Catherine Cortez Masto (D-NV) and Angus King (I-ME) have joined Republicans in voting yes on the CR.

However, Democrats feel that support may be swinging in their favor, as recent polls show that 78 percent of Americans expressed that Congress should extend the enhanced premium tax credits, and nearly 40 percent feel that President Trump and Republicans in Congress are to blame for the shutdown. Reports detail that the Trump Administration is beginning to prepare proposals on how to extend the enhanced premium tax credits, however these efforts may be delayed, as Congressional leadership has no agreement in sight on how to exit the shutdown.

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
  • CY 2026 Physician Fee Schedule. The final rule for the CY 2026 CY 2026 Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Medicare Part B
  • 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.”

• 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.”