Reconciliation Update – Senate Republicans expect to pass the budget reconciliation package containing President Donald Trump’s domestic policy agenda sometime on Monday. The chamber voted 51-49 on Saturday to start debate on the legislation. Sens. Rand Paul (R-Ky.) and Thom Tillis (R-N.C.) joined Democrats in opposition to advancing the bill. Following the vote, Democrats requested Senate clerks to read the 940-page bill out loud. The chamber then began the process of offering amendments with a maximum of 20 hours of debate. After debate concludes, the Senate will begin a marathon voting process known as ‘vote-a-rama’ in which votes will take place on filed amendments. Under the Senate reconciliation process, senators are allowed to offer an unlimited number of amendments and there is no limit on time for completing the votes. Hundreds of amendments are expected to be filed by both Democrats and Republicans.
Republicans adjusted the legislative text to comply with the chamber’s rules for reconciliation. The latest version of the Senate’s One Big Beautiful Bill Act was released early Saturday morning. The bill includes a one-year Medicare physician payment fix to increase provider reimbursements by 2.5% in 2026. The bill would lower the state provider tax safe harbor from 6% to 3.5%, delaying implementation of the phasedown until 2028, while providing for the creation of a $25 billion stabilization fund in response to concerns about the impact of Medicaid cuts on financially vulnerable hospitals. The package restores a House-passed provision to expand the Medicare drug price negotiation program’s exemption for orphan drugs to include treatments for multiple rare diseases. The bill does not fund Affordable Care Act cost-sharing reduction payments, which Senate Parliamentarian Elizabeth MacDonough ruled ineligible for the budget reconciliation process.
Republicans can only lose three votes in either chamber and still pass the bill along party lines. Assuming Senate passage, the House of Representatives is expected to return to session early this week to vote on the revised bill. Congressional Republicans and the White House aim to have the package signed into law by July 4.
Tillis Announces Decision to Not Run for Reelection – Sen. Thom Tillis (R-N.C.) announced on Sunday that he will not seek reelection in 2026. “The choice is between spending another six years navigating the political theatre and partisan gridlock in Washington or spending that time with the love of my life Susan, our two children, three beautiful grandchildren, and the rest of our extended family back home,” Tillis said in a statement. “It’s not a hard choice, and I will not be seeking re-election.” The two-term senator currently serves on the Finance, Veterans’ Affairs, and Judiciary committees.
ACIP Convenes First Meeting Since RFK Jr. Overhaul – The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) convened a two-day meeting last week. It was ACIP’s first meeting since U.S. Department of Health and Human Services Secretary Robert F. Kennedy Jr. fired all 17 members of the vaccine advisory panel and named a group of replacement members earlier this month. ACIP voted 5-2 to recommend Clesrovimab, a new monoclonal antibody for newborns and infants to protect against RSV, and voted 5-1 to recommend against flu vaccines containing the preservative thimerosal.
During the meeting, new ACIP Chair Martin Kulldorff announced plans for the committee to investigate the cumulative childhood and adolescent vaccine schedules. “In addition to studying and evaluating individual vaccines, it is important to evaluate the cumulative effect of the recommended vaccine schedule,” Kulldorff said. “This includes interaction effects between different vaccines, the total number of vaccines, cumulative amounts of vaccine ingredients and the relative timing of different vaccines.” ACIP will also establish a work group to examine immunizations that have not been studied in more than seven years.
The ACIP meeting proceeded as planned, despite a call from Senate Health, Education, Labor, and Pensions Committee Chair Bill Cassidy, MD for a delay. “Although the appointees to ACIP have scientific credentials, many do not have significant experience studying microbiology, epidemiology or immunology,” Sen. Cassidy posted on the social media platform X. He stated that the meeting should not proceed until ACIP is fully staffed with “more robust and balanced representation – as required by law – including those with more direct relevant expertise.”
House Appropriators Advance FDA Spending Bill – The House Appropriations Committee voted to advance its fiscal year (FY) 2026 Agriculture-Rural Development-Food and Drug Administration (FDA) spending bill last week in a 35-27 party line vote. The appropriations measure would provide $6.8 billion in total funding for the FDA, including $3.2 billion in taxpayer funds and $3.6 billion in user fees paid by drug and device makers. This funding level is 4.2% lower than currently enacted levels and mirrors the President’s budget request. During the markup, the panel adopted an amendment by Rep. Debbie Wasserman Schultz (D-Fla.) directing the FDA to continue to fund the youth anti-tobacco “The Real Cost” campaign at current levels. The bill now awaits a vote on the House floor.
The House of Representatives passed its first FY 2026 spending bill on Wednesday. The chamber voted 218-206 to adopt the Military Construction-Veterans Affairs appropriations measure. Congress faces an October 1 deadline to pass the 12 annual appropriations bills or extend federal funding via a continuing resolution to avoid a government shutdown at the end of the current fiscal year.
Ed Workforce Committee Advances Association Health Plan Legislation – The House Committee on Education and the Workforce advanced the Association Health Plans Act (H.R. 2528) last week in a party line vote. The bill would codify a first-term Trump administration standard that was rescinded by the Biden administration which expanded the availability of association health plans. Association health plans are made up of small businesses that coalesce under a single plan, and are not required to adhere to the Affordable Care Act’s essential health benefit requirements.
Supreme Court Limits Nationwide Injunctions, Potentially Impacting Federal Health Policy Challenges – On June 27, 2025, the Supreme Court ruled in Trump v. CASA, Inc. to limit the ability of lower courts to issue nationwide injunctions (orders that block federal policies across the entire country). The decision comes as several states and advocacy groups are challenging NIH and HHS actions on scientific integrity policies, reproductive health access, and grant funding. In many of these cases, district courts had issued nationwide injunctions to block enforcement while legal challenges proceed. While the decision will not retroactively affect these injunctions, it is expected to affect future litigation outcomes against federal health agencies. Writing for the majority, Justice Amy Coney Barrett emphasized that federal courts may only grant relief to the actual parties before them in a given suit.
Supreme Court Rejects Constitutional Challenge to Preventive Services Task Force – In the case of Kennedy v. Braidwood Management, Inc., the Supreme Court upheld the structure of the U.S. Preventive Services Task Force (USPSTF), ruling that its members do not require presidential nomination or Senate confirmation. The plaintiffs had (i) argued that the task force was unconstitutional because its members were not appointed in accordance with the Appointments Clause and (ii) sought to invalidate the Affordable Care Act’s (ACA) preventive services mandate. Writing for the majority, Justice Brett Kavanaugh emphasized that USPSTF members are “inferior officers” who operate under the supervision and control of the HHS Secretary, maintaining a constitutionally sufficient chain of accountability. The ruling aligns with arguments advanced by both the Biden and Trump administrations, which had defended the Secretary’s supervisory authority over the task force. It also effectively preserves the ACA’s requirement for insurers to cover preventive services—such as HIV prevention drugs like PrEP—at no cost to patients. Justice Clarence Thomas dissented, arguing that Congress had not clearly authorized the Secretary to appoint such influential officials without Senate approval.
Supreme Court Blocks Medicaid Patients from Suing Over Provider Bans – On June 26, 2025, the Supreme Court ruled in Medina v. Planned Parenthood South Atlantic that Medicaid recipients do not have a right to sue when states exclude providers like Planned Parenthood from the program. The case was brought as a result of South Carolina’s 2018 decision to remove Planned Parenthood from its Medicaid program due to its provision of abortion services. The decision is expected to limit patients’ ability to challenge state efforts to restrict access to reproductive and other preventive healthcare services under Medicaid. In dissent, Justice Ketanji Brown Jackson noted that the ruling undermines legal protections for low-income patients.
Upcoming Congressional Hearings and Markups
House Appropriations subcommittee markup of Fiscal Year 2026 Labor, Health and Human Services, Education, and Related Agencies Bill; 5:00 pm.; July 21
House Appropriations full committee markup of Fiscal Year 2026 Labor, Health and Human Services, Education, and Related Agencies Bill; 10:00 am.; July 24
Recently Introduced Health Legislation
H.R.4063 — To amend title 38, United States Code, to ensure that veterans in each of the 48 contiguous States are able to receive services in at least one full-service hospital of the Veterans Health Administration in the State or receive comparable services provided by contract in the State; Sponsor: Pappas, Chris [Rep.-D-NH-1]; Committees: House – Veterans’ Affairs
H.R.4056 — To amend title XVIII of the Social Security Act to permit a private cause of action for damages in the case of a group health plan which fails to provide for primary payment or appropriate reimbursement; Sponsor: Bilirakis, Gus M. [Rep.-R-FL-12]; Committees: House – Ways and Means; Energy and Commerce
H.R.4055 — To amend title XVIII of the Social Security Act to provide coverage and payment under such title for certain treatments for dialysis-related amyloidosis, and for other purposes; Sponsor: Babin, Brian [Rep.-R-TX-36]; Committees: House – Energy and Commerce; Ways and Means
H.Res.524 — Expressing support for the designation of June 19, 2025, as “World Sickle Cell Awareness Day” in order to increase public awareness across the United States and global community about sickle cell disease and the continued need for empirical research, early detection screenings, novel effective treatments leading to a cure, and preventative care programs with respect to complications from sickle cell anemia and conditions relating to sickle cell disease; Sponsor: Davis, Danny K. [Rep.-D-IL-7]; Committees: House – Energy and Commerce
H.Res.523 — Expressing support for the designation of June 21, 2025, as National ASK (Asking Saves Kids) Day to promote children’s health and secure storage of guns in the home; Sponsor: Crow, Jason [Rep.-D-CO-6]; Committees: House – Energy and Commerce
S.2145 —A bill to amend title 38, United States Code, and the Social Security Act to permit recovery from the Department of Veterans Affairs of costs from Medicare Advantage and Medicare prescription drug plans and to modify the authority for recovery by the United States of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities, and for other purposes; Sponsor: Warren, Elizabeth [Sen.-D-MA]; Committees: Senate – Veterans’ Affairs
H.Res.531 — Recognizing the contributions of academic medicine and observing Academic Medicine Week from June 23 through 27, 2025; Sponsor: Castor, Kathy [Rep.-D-FL-14]; Committees: House – Energy and Commerce
H.Res.532 — Supporting the designation of “Brain and Spine Metastasis Awareness Month”; Sponsor: Foushee, Valerie P. [Rep.-D-NC-4]; Committees: House – Energy and Commerce
H.R.4074 — To direct the Secretary of Health and Human Services to issue guidance on coverage under the Medicaid program under title XIX of the Social Security Act of certain pelvic health services furnished during the postpartum period, and for other purposes; Sponsor: Bacon, Don [Rep.-R-NE-2]; Committees: House – Energy and Commerce
H.R.4077 —To amend title 38, United States Code, and the Social Security Act to permit recovery from the Department of Veterans Affairs of costs from Medicare Advantage and Medicare prescription drug plans and to modify the authority for recovery by the United States of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities, and for other purposes; Sponsor: Doggett, Lloyd [Rep.-D-TX-37]; Committees: House – Veterans’ Affairs; Ways and Means; Energy and Commerce
H.R.4084 — To amend the Public Health Service Act to establish certain duties for pharmacies to ensure provision of Food and Drug Administration-approved contraception and medication related to contraception, and for other purposes; Sponsor: Kelly, Robin L. [Rep.-D-IL-2]; Committees: House – Energy and Commerce
H.R.4086 — To authorize the Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration, to award grants for providing evidence-based caregiver skills training to family caregivers of children with autism spectrum disorder or other developmental disabilities or delays, and for other purposes; Sponsor: Min, Dave [Rep.-D-CA-47]; Committees: House – Energy and Commerce
S.Res.299 — A resolution expressing support for the designation of July 2025 as “National Sarcoma Awareness Month;” Sponsor: Johnson, Ron [Sen.-R-WI]; Submitted in the Senate, considered, and agreed to without amendment and with a preamble by Unanimous Consent.
S.Res.300 — A resolution designating June 15, 2025, as “World Elder Abuse Awareness Day” and the month of June 2025 as “Elder Abuse Awareness Month;” Sponsor: Grassley, Chuck [Sen.-R-IA]; Submitted in the Senate, considered, and agreed to without amendment and with a preamble by Unanimous Consent.
S.2149 – A bill to expand access to health insurance coverage for immigrants and their families by removing legal and policy barriers to health insurance coverage, and for other purposes; Sponsor: Booker, Cory A. [Sen.-D-NJ]; Committees: Senate – Finance
S.2150 — A bill to protect a person’s ability to determine whether to continue or end a pregnancy, and to protect a health care provider’s ability to provide abortion services; Sponsor: Baldwin, Tammy [Sen.-D-WI]; Committees: Senate – Judiciary
H.Res.542 — Expressing support for the designation of the month of June 2025 as “National Post-Traumatic Stress Awareness Month” and June 27, 2025, as “National Post-Traumatic Stress Awareness Day”; Sponsor: Peters, Scott H. [Rep.-D-CA-50]; Committees: House – Armed Services; Veterans’ Affairs
H.R.4093 — To amend title XVIII of the Social Security Act to require the Secretary of Health and Human Services to publish information on expenditures under the Medicare program, and for other purposes; Sponsor: Bean, Aaron [Rep.-R-FL-4]; Committees: House – Ways and Means; Energy and Commerce
H.R.4101 — To amend the Employee Retirement Income Security Act of 1974 to require a group health plan (or health insurance coverage offered in connection with such a plan) to provide for cost-sharing for oral anticancer drugs on terms no less favorable than the cost-sharing provided for anticancer medications administered by a health care provider; Sponsor: Grothman, Glenn [Rep.-R-WI-6]; Committees: House – Education and Workforce
H.R.4104 — To expand access to health insurance coverage for immigrants and their families by removing legal and policy barriers to health insurance coverage, and for other purposes; Sponsor: Jayapal, Pramila [Rep.-D-WA-7]; Committees: House – Energy and Commerce; Ways and Means
H.R.4114 — To amend title 38, United States Code, to automatically enroll eligible veterans in the patient enrollment system of Department of Veterans Affairs, and for other purposes; Sponsor: Takano, Mark [Rep.-D-CA-39]; Committees: House – Veterans’ Affairs
H.Res.544 — Supporting the designation of the month of June 2025, as “National Men’s Health Month”; Sponsor: Carter, Troy A. [Rep.-D-LA-2]; Committees: House – Oversight and Government Reform
H.R.4121 — Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2026; Sponsor: Harris, Andy [Rep.-R-MD-1]; Committees: House – Appropriations
H.R.4122 —To permit nurse practitioners and physician assistants to furnish necessary services, appliances, and supplies to individuals receiving medical benefits for illnesses; Sponsor: Allen, Rick W. [Rep.-R-GA-12]; Committees: House – Judiciary; Education and Workforce
H.R.4132 — To provide for digital communication of prescribing information for drugs (including biological products), and for other purposes; Sponsor: Harshbarger, Diana [Rep.-R-TN-1]; Committees: House – Energy and Commerce
H.R.4139 — To amend title XVIII of the Social Security Act to provide for adjustments to the Medicare part D cost-sharing reductions for low-income individuals; Sponsor: McGarvey, Morgan [Rep.-D-KY-3]; Committees: House – Energy and Commerce; Ways and Means
H.R.4150 — To amend title XIX of the Social Security Act to provide a higher Federal matching rate for increased expenditures under Medicaid for maternal health care services; Sponsor: Williams, Nikema [Rep.-D-GA-5]; Committees: House – Energy and Commerce
S.2171 — A bill to amend title 38, United States Code, to prohibit smoking on the premises of any facility of the Veterans Health Administration, and for other purposes; Sponsor: Durbin, Richard J. [Sen.-D-IL]; Committees: Senate – Veterans’ Affairs
S.2169 — A bill to require the development of a comprehensive rural hospital cybersecurity workforce development strategy, and for other purposes; Sponsor: Hawley, Josh [Sen.-R-MO]; Committees: Senate – Health, Education, Labor, and Pensions
S.2167 —A bill to permit nurse practitioners and physician assistants to furnish necessary services, appliances, and supplies to individuals receiving medical benefits for illnesses; Sponsor: Hickenlooper, John W. [Sen.-D-CO]; Committees: Senate – Health, Education, Labor, and Pensions
S.2165 — A bill to amend chapter 44 of title 18, United States Code, to prohibit the distribution of 3D printer plans for the printing of firearms, and for other purposes; Sponsor: Markey, Edward J. [Sen.-D-MA]; Committees: Senate – Judiciary
S.Res.303 — A resolution expressing support for the designation of May 17, 2025, as “DIPG Pediatric Brain Cancer Awareness Day” to raise awareness of, and encourage research on, diffuse intrinsic pontine glioma tumors and pediatric cancers in general; Sponsor: Reed, Jack [Sen.-D-RI]; Submitted in the Senate, considered, and agreed to without amendment and with a preamble by Unanimous Consent.
S.2189 — A bill to amend the Internal Revenue Code of 1986 to treat certain assisted reproduction expenses as medical expenses of the taxpayer; Sponsor: Schiff, Adam B. [Sen.-D-CA]; Committees: Senate – Finance
H.R.4165 — To amend the Public Health Service Act to provide for the inclusion of a biological attribution strategy, and an early warning strategy and implementation plan, in the National Health Security Strategy, and for other purposes; Sponsor: Crenshaw, Dan [Rep.-R-TX-2]; Committees: House – Energy and Commerce
H.R.4184 — To amend the Internal Revenue Code of 1986 to exclude from gross income certain compensation to clinical trial participants, and for other purposes; Sponsor: Kelly, Mike [Rep.-R-PA-16]; Committees: House – Ways and Means
H.R.4185 — To amend title XVIII of the Social Security Act to revise the definition of the term clinical social worker services; Sponsor: Kiggans, Jennifer A. [Rep.-R-VA-2]; Committees: House – Energy and Commerce; Ways and Means
H.R.4186 — To authorize the Secretary of Education, in coordination with the Secretary of Health and Human Services, to award grants to eligible entities to support the mental and behavioral health of elementary and secondary school students, and for other purposes; Sponsor: Krishnamoorthi, Raja [Rep.-D-IL-8]; Committees: House – Education and Workforce; Energy and Commerce
H.R.4191 — To improve coordination of Federal efforts to identify and mitigate health and national security risks through maintaining a list of essential medicines, conducting a risk assessment of essential medicine supply chains, and creating a monitoring system to map essential medicine supply chains using data analytics; Sponsor: Matsui, Doris O. [Rep.-D-CA-7]; Committees: House – Energy and Commerce
H.R.4203 — To amend the Internal Revenue Code of 1986 to allow certain wearable devices to be purchased using health savings accounts and other spending arrangements and reimbursement accounts; Sponsor: Schweikert, David [Rep.-R-AZ-1]; Committees: House – Ways and Means
H.R.4204 — To amend title XVIII of the Social Security Act to allow Medicare beneficiaries to choose their physical and occupational therapists, speech-language pathologists, audiologists, and chiropractors; Sponsor: Smucker, Lloyd [Rep.-R-PA-11]; Committees: House – Ways and Means; Energy and Commerce
H.R.4206 —To amend title XVIII of the Social Security Act to expand access to telehealth services, and for other purposes; Sponsor: Thompson, Mike [Rep.-D-CA-4]; Committees: House – Energy and Commerce; Ways and Means
H.R.4207 — To require any convention, agreement, or other international instrument on pandemic prevention, preparedness, and response reached by the World Health Assembly to be subject to Senate ratification; Sponsor: Tiffany, Thomas P. [Rep.-R-WI-7]; Committees: House – Foreign Affairs
H.R.4209– To amend titles XIX and XXI of the Social Security Act to prohibit Federal financial participation under Medicaid and CHIP for individuals without verified citizenship, nationality, or satisfactory immigration status; Sponsor: Van Drew, Jefferson [Rep.-R-NJ-2]; Committees: House – Energy and Commerce