Senate Passes Reconciliation Bill
The Senate passed the One Big Beautiful Bill Act in a 51-50 vote after a marathon voting session and a tie-breaking vote cast by Vice President JD Vance(R). There was an intense overnight “vote-a-rama” to alleviate Republican concerns with the legislation’s cuts to Medicaid and the Supplemental Nutritional Assistance Program (SNAP). Senate leadership struck a last-minute deal with Senator Lisa Murkowski (R-AK) by delaying SNAP work requirements for some states, securing her vote to pass the bill. Republican Senators Susan Collins (R-ME), Thom Tillis (R-NC), and Rand Paul (R-KY) voted against the reconciliation bill along with all Democrats. Other last-minute changes to healthcare provisions include bumping the rural hospital relief fund up to $50 billion to offset proposed Medicaid and provider tax cuts, dropping the gender-affirming care ban in Medicaid and CHIP, and the Federal Medical Assistance Percentage (FMAP) penalty for states using their own dollars to pay for some immigrants’ care. Still included in the bill passed by the Senate are annual reductions toward a 3.5% cap for state provider taxes and a 2.5% bump in Medicare payments to physicians for 2026. The bill will now move to the House for consideration, as House Republicans race to get the bill to President Trump for his signature by the self-imposed July 4th deadline. The reconciliation bill faces an uphill battle in the House as some Republican Representatives have already expressed concerns.
Supreme Court Votes to Uphold the US Preventive Services Task Force
The Supreme Court decided whether the USPSTF violates the U.S. Constitution Appointments Clause in Kennedy v. Braidwood Management, Inc., a case challenging the Affordable Care Act’s requirement for insurance providers to cover preventive services. The US Preventive Services Task Force (USPSTF) is an autonomous panel established by the federal government to make evidence-based recommendations for preventive services. The Affordable Care Act required that preventive services recommended by the task force be provided by health insurers and group health plans without the imposition of cost-sharing charges, like co-pays and deductibles, on patients.
The USPSTF comprises 16 members appointed by the Secretary of HHS. The legal challenge stems from the plaintiff’s claim that the USPSTF does not have the authority to set coverage requirements, as the Appointments Clause requires officers of the United States to be appointed by the President, not the HHS Secretary. Kennedy v. Braidwood Management, Inc. questioned whether the Task Force members were appointed in a manner consistent with the Appointments Clause. In a 6-3 decision, the Supreme Court voted to uphold the task force’s legitimacy. Justices Kavanaugh, Roberts, Sotomayor, Barrett, and Jackson voted in support of the task force while justices Thomas, Alito, and Gorsuch dissented. Justice Kavanaugh authored the majority opinion, writing that the Task Force members’ appointment, direction, and supervision by the Secretary of HHS are consistent with the Appointments Clause because the Secretary, in turn, answers to the president of the United States.
The task force being upheld maintains access to care for many preventive services. Individuals seeking care or medication for concerns like heart disease, lung cancer screenings, or HIV will continue to access to care, without the deterrent of copays, deductibles, or coinsurance.
Supreme Court Decision Allows States to Block Planned Parenthood from Receiving Medicaid Funding
The Supreme Court reached a decision in the case of Medina v. Planned Parenthood South Atlantic that allows for Medicaid funding to be restricted away from Planned Parenthood in South Carolina, as the organization provides abortion services in other states where abortion is legal. This funding restriction would reduce access for many Medicaid beneficiaries that use Planned Parenthood services besides abortion care, such as contraception services, STI testing, and cancer screenings.
The 6-3 decision found that while Medicaid law allows people to choose their own provider, it does not make it a right enforceable in court. With all three liberal Justices dissenting. The court’s ruling furthers the conservative goal of ensuring that federal healthcare dollars be prohibited from reimbursing services provided by Planned Parenthood. The National Partnership for Women & Families released a statement, outlining how the decision may threaten provider choice and women’s health care access for female Medicaid beneficiaries in South Carolina. Other advocates argue the law will allow states to reduce the size of the Medicaid provider network based on politicized health care issues including vaccination.
CDC Vaccine Advisory Panel Holds First Meeting with New Members
Earlier this month, HHS Secretary RFK Jr. fired all 17 members of the Advisory Committee on Immunization Practices (ACIP) panel. He subsequently announced eight replacement members, with one resigning prior to this week’s meeting. This week, the new seven member vaccine panel met for two days at the CDC headquarters in Atlanta. Despite HHS spokesperson Andrew Nixon describing the new board members as, “respected experts” who “deliver recommendations rooted in data and medical integrity”, several of the new members have extensive histories of promoting vaccine skepticism.
The panel voted to stop recommending flu vaccines with the preservative thimerosal. Despite scientists and public health agencies studying thimerosal in vaccines for years without finding evidence of any harm, the removal of thimerosal in vaccines, especially for children, has been a long-time goal of Secretary Kennedy. The Secretary wrote a book in 2014 expressing his belief that thimerosal causes autism and should be banned. The panel is also expected to recommend against the use of the MMRV vaccine at their next meeting. MMRV is a combination shot administered to children under four that provides protection against measles and chickenpox. The CDC currently recommends that the first shots for measles, mumps, rubella, and varicella be administered separately for children under two.
The CDC director typically endorses recommendations before they are official. Since there is currently no CDC director or acting director, Secretary Kennedy will likely endorse these recommendations. These changes and future decisions could set the stage for significant alterations to the current childhood vaccine schedule.
Vaccine Integrity Project Emerges as an Alternative to Overturned ACIP
The Vaccine Integrity Project (VIP), a University of Minnesota Center for Infectious Disease Research and Policy (CIDRAP) initiative comprised of leading public health and policy experts, has garnered support from a broad coalition of insurers, state health officials, pharmaceutical manufacturers, pharmacists, and major medical associations.
This move comes in response to Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. complete remake of the Advisory Committee on Immunization Practices (ACIP) on June 11. America’s Health Insurance Plans (AHIP), American Academy of Pediatrics (AAP), American Medical Association (AMA), and other large stakeholders criticized Secretary Kennedy’s abrupt firing of longstanding experts and appointing those who have conflicts of interest and espoused anti-vaccine sentiments. The shift has sparked concerns about disruptions in insurance coverage, vaccine access, and public trust in immunization guidance.
VIP, whose board includes former ACIP officials, aims to offer an alternative ecosystem for vaccine guidance that can serve both public and private organizations. It has committed to developing independent, evidence-based vaccine guidelines, supporting insurance coverage continuity, countering misinformation, and ensuring vaccine availability outside federal oversight.
RFK Jr. Questioned About HHS Restructuring During FY26 Budget Hearing
Today, June 24th, the House Energy & Commerce Committee held a hearing to discuss the proposed budget for Fiscal Year 2026; however, members of both parties chose to focus on Secretary Robert F. Kennedy Jr.’s actions within the Department of Health and Human Services (HHS) since his confirmation. Debate over the politicization of science was prominent, with Democrats accusing Secretary Kennedy of increasing public mistrust.
Secretary Kennedy opened by reiterating the Make America Healthy Again (MAHA) priorities, arguing that “throwing money at the agency” during the Biden administration had failed to improve outcomes and reaffirmed commitments to “radical transparency, gold standard science, and evidence-based medicine.” Furthermore, he framed the changes to the budget as simply “restricting Medicaid growth” rather than cutting program features.
Some Republicans, led by Chairman Brett Guthrie (R-KY-02), supported these cuts as a method to reduce waste, fraud, and abuse. They also aligned with Secretary Kennedy’s focus on utilizing emerging technology to increase efficiency. Democrats, led by Ranking Member Frank Pallone (D-NJ-06), criticized funding and job cuts to HHS programs, citing examples such as the Substance Abuse and Mental Health Services Administration (SAMHSA), Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP), and National Institute of Health (NIH) research. They also criticized the lack of transparency and divestment by those with whom Secretary Kennedy works closely, especially following the abrupt dismissal of the ACIP after claims of conflicting interests. Ultimately, members of both parties used the hearing as an opportunity to voice their support for or criticism of Secretary Kennedy’s changes to HHS, shifting the focus away from the intended discussion of the FY26 budget.
CMS Temporarily Finalizes ACA Marketplace Integrity and Affordability Rule
On June 20, 2025, the Centers for Medicare & Medicaid Services (CMS) finalized the 2025 Marketplace Integrity and Affordability rule, implementing temporary policy changes for the Affordable Care Act marketplaces through 2026. Among the changes, CMS will repeal the rule that prohibits insurers from denying health coverage based on unpaid past-due premiums, require enrollees enrolled in a no-premium plan to pay at least $5, and allow exchanges to set their own open enrollment period within set parameters. CMS will also amend the definition of “lawfully present” to exclude Deferred Action for Childhood Arrivals (DACA) recipients from receiving benefits, remove the 60-day extension for resolving income inconsistencies, and tighten verification requirements for low-income individuals receiving subsidized coverage. Additionally, this rule will eliminate the year-round special enrollment period for individuals with incomes below 150 percent of the federal poverty line.
This final rule was published as Congress considers changes to the Affordable Care Act, Medicare, and Medicaid in budget reconciliation. While the House Energy & Commerce Committee included many of these policies in their draft language, the Senate Finance Committee’s version of the reconciliation bill omitted them. CMS may be temporarily finalizing several provisions in this rule so that Congress can permanently implement them in the budget reconciliation bill.
What’s on Tap
Over the weekend, Senate Republicans released the latest version of their reconciliation text after a series of last minute changes. GOP lawmakers were forced to revise the bill text after the Senate parliamentarian struck several provisions, arguing that they did not adhere to the strict guidelines of the Byrd rule. Following the release of the latest text, the Senate cleared a procedural hurdle that allows floor debate to begin by a vote of 51-49. Key GOP holdouts like Senators Murkowski (R-AK) and Hawley (R-MO) voted to advance the bill after weeks of voicing concerns around cuts to Medicaid and the Supplemental Nutrition Assistance Program (SNAP). The new text notably provides rural hospitals with a $25 billion stabilization fund – a substantial increase from the $15 billion previously floated by GOP leadership. Republicans in the upper chamber also expanded Medicare drug price negotiation for orphan drugs to include medicines that treat multiple rare diseases, in addition to a temporary, one-year, 2.5 percent bump in the Medicaid physician fee schedule for 2026.
Debate on the latest version of the bill began Sunday and stretched into the early hours of Monday morning before the chamber finally called a recess. Senators then headed back to the floor to begin a “vote-a-rama”, a process in which Senators from each side of the aisle can offer unlimited amendments that are germane to the reconciliation text. This process continued until the final vote (mentioned above). With their 53-seat majority, Republicans can afford in this process to lose three votes and still move the legislation back to the House for final passage – although Senators Tillis (R-NC) and Paul (R-KY) have already vowed to vote no on the bill in its current form. President Trump has said he expects the bill at his desk for his signature by the 4th of July, providing members of Congress only a few days to finalize the language in its entirety.
The Centers for Medicare and Medicaid Services (CMS), through its Innovation Center, announced a new model late last week aiming to ensure beneficiaries enrolled in traditional Medicare are safeguarded from fraud, waste and abuse. The Wasteful and Inappropriate Service Reduction (WISeR) Model will allow CMS to partner with companies to utilize innovative technologies to test ways to expedite prior authorization processes. More specifically, the WISeR Model will seek to leverage artificial intelligence (AI) in expediting prior authorizations for certain services that have been found as particularly vulnerable to fraud. Some of these services include skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy for knee osteoarthritis. Notably, the model excludes inpatient-only services and emergency services and will operate in assigned geographic regions that have clinical capacity and appropriate expertise to conduct medical reviews. The recent model announcement reflects this administration’s efforts to combat fraud and abuse throughout the federal government, and comes a week after HHS Kennedy and CMS Administrator Oz organized a pledge with the nation’s health insurers to streamline prior authorization processes.
Upcoming Events
- Senate: In session – June 30-July 6
- House: In session pending reconciliation vote.
- Relevant congressional activity is expected to resume following the passage of the reconciliation package after the fourth of July holiday.