Weekly Spotlight: Health Policy at Midyear — A Constrained Congress, a Disrupted Senate, and a Busy Rule Cycle
Congress returns this week from its July 4 state work period into a narrow pre-recess window — roughly four weeks of session before the August 10 recess — and into a midterm election year in which nearly every health vote is refracted through November. The practical runway for legislation is short.
That runway narrowed further as the Senate absorbed two health-driven shocks in a single week. Sen. Lindsey Graham (R-S.C.) died suddenly at 71; the District of Columbia medical examiner’s preliminary findings cite an aortic dissection due to cardiovascular disease. Days earlier, former Republican leader Sen. Mitch McConnell (R-Ky.) broke a month of silence to attribute his long hospitalization to a fall and pneumonia. Both land on a chamber that has never built rules for member incapacity even as its membership ages — and both tighten the vote math for any health bill in the weeks ahead.
With the legislative path constrained, the action is at CMS. The CY2027 OPPS proposed rule is out, reviving the 340B payment fight and advancing site-neutral pay; the FY2027 IPPS rule, proposed in April, heads toward a final rule around the recess; and the CY2027 Physician Fee Schedule proposed rule is pending. Layered on top is CMS’s proposed TAVR National Coverage Determination overhaul, with comments due July 15 — the most consequential structural-heart coverage move of the year for Edwards and its peers.
The takeaway for readers: the near-term levers are regulatory — comment windows are open now on the OPPS rule and the TAVR NCD — while the legislative agenda (ACA subsidy-expiration fallout, Medicaid work requirements, drug pricing) is hardening into campaign material rather than floor action.
Centers for Medicare and Medicaid Services (CMS)
ACO REACH Posts Record Savings — With an Asterisk
CMS’s third annual evaluation of the ACO REACH model estimated nearly $1 billion in net Medicare savings in 2024, which the administration touts as the model’s strongest financial year as it prepares a successor model for next year. The same evaluation complicated the story: health-system-led standard ACOs raised Medicare spending 0.8% over the model’s first three years while ACOs built around independent physician practices cut spending by the same 0.8% — a roughly $285 million swing between the two groups — and independent reviewers questioned the gross-versus-net framing.
Source(s):
Becker’s Hospital Review
Fierce Healthcare
Inside Health Policy
Tags: #HOSPITAL #PAYER #PROVIDER
CMS Ends Fast-Track Review for 1115 Waiver Renewals
CMS rescinded the decade-old expedited “fast-track” review process for certain Medicaid Section 1115 demonstration renewals, adding procedural steps for states seeking to extend existing waivers. The change signals a more hands-on federal posture toward state Medicaid demonstrations.
Source(s):
Inside Health Policy
Tags: #PAYER #PATIENT
OB-GYN Pay Overhaul Signals Changes for Maternal Care
A major change to how OB-GYNs are paid is coming, with the potential to improve maternal-health outcomes but also to raise costs. The shift could reshape the economics of obstetric practice and access to maternity care.
Source(s):
Axios
Tags: #PROVIDER #PATIENT #PAYER
CMS Seeks Feedback on Standardizing Hospital Price-Transparency Data
CMS opened a request for feedback on standardizing hospital price-transparency data — a step toward more comparable, machine-readable pricing across hospitals and a potential building block for downstream transparency and benefit-design tools.
Source(s):
Inside Health Policy
Tags: #HOSPITAL #PAYER #PATIENT
Department of Health and Human Services (HHS)
HHS Moves to Create a COVID-19 Vaccine Injury Table
HHS Secretary Robert F. Kennedy Jr. is moving to create a formal “injury table” cataloging injuries attributed to COVID-19 vaccines and countermeasures, as part of a broader compensation overhaul. The step carries implications for manufacturer liability protections and for the federal government’s posture on vaccine safety and compensation.
Source(s):
STAT
The Hill
Fierce Pharma
Tags: #DRUG #PATIENT #PROVIDER
Preventive Services Task Force Blocked for a Fourth Time
The U.S. Preventive Services Task Force — the panel that determines which preventive services insurers must cover at no cost — had its meeting postponed for a fourth time amid a member shakeup, with HHS citing “unprecedented” membership nominations for the delay. RFK Jr. has now set his sights on remaking the panel after blocking it from meeting, declining to replace members whose terms expired, and firing members, raising fears about the future of no-cost preventive coverage under the ACA.
Source(s):
Becker’s Hospital Review
The New York Times
Inside Health Policy
The Hill
Tags: #PAYER #PATIENT #PROVIDER
HHS Presses Ahead on SSRI “Deprescribing”
RFK Jr. is advancing an effort to help Americans stop taking antidepressants, with HHS officials meeting mental-health professionals in a private session to draft federal guidance on discontinuing SSRIs. A federal push around deprescribing would be an unusual intervention into day-to-day psychiatric practice.
Source(s):
STAT
Tags: #DRUG #PROVIDER #PATIENT
ARPA-H Commits $160M to Custom Gene Editing for Rare Diseases
ARPA-H announced it will spend up to $160 million through its THRIVE program to advance custom gene-editing treatments for rare diseases, backing seven teams pursuing conditions across different organ systems. It is one of the agency’s largest concrete bets to date and a signal that the rare-disease gene-editing pipeline is a federal priority.
Source(s):
Inside Health Policy
STAT
Tags: #DRUG #PATIENT
NIH Reshapes Its Research Enterprise
NIH marked several structural moves in one week — a data milestone for its flagship precision-medicine cohort, a new office to reduce animal use in research, and two center-director appointments — that together sketch the agency’s direction under current leadership.
- NIH’s All of Us Research Program is now the largest integrated genomics-health database, with data from more than 747,000 participants
- NIH launches a new office to advance human-based research and reduce animal use
- Dr. Raymond Jacobson selected as director of the NIH Center for Scientific Review
- NIH selects Dr. Steven Schiff as director of the Fogarty International Center
Tags: #PROVIDER
Heard on the Hill
Cassidy Sets CDC, ASPR Confirmation Hearings — With a Vaccine Flashpoint
Senate HELP Chair Bill Cassidy will hold confirmation hearings for the administration’s CDC and ASPR nominees, advancing key public-health leadership posts. One nominee for a key federal health role, Sean Kaufman, has a history of questioning vaccine safety — setting up a potential clash with Cassidy, a physician who has made vaccine confidence a signature issue.
Source(s):
Inside Health Policy
STAT
Tags: #PROVIDER #PATIENT
Notable Notes
Copay Assistance Meant for Patients Is Landing With Insurers
Copay-assistance dollars intended to defray patients’ out-of-pocket drug costs are increasingly retained by insurers through copay-accumulator and maximizer programs, leaving some patients exposed at the pharmacy counter despite manufacturer help.
Source(s):
KFF Health News
Tags: #PATIENT #DRUG #PAYER
America’s Small Businesses Are Giving Up on Health Insurance
STAT’s out-of-pocket series documents how rising premiums and cost-sharing are pushing small employers out of offering health coverage, with knock-on effects for workers who land in the individual market just as ACA subsidies lapse.
- America’s small businesses are giving up on health insurance
- For a Georgia entrepreneur, health coverage has never been affordable
- An insurance whistleblower says employers are not helpless bystanders
Tags: #PAYER #PATIENT #HOSPITAL
Structural Heart, in Brief
A busy week of transcatheter-valve and left-atrial-appendage evidence relevant to Edwards Lifesciences and its competitors, spanning new head-to-head device data, durability results, and redo-procedure findings.
- Topaz vs. Evoque: a head-to-head study of TRiCares’ Topaz and Edwards’ FDA-approved Evoque TTVR systems begins
- A new left-atrial-appendage-closure device is noninferior to Watchman at one year
- Redo TAVR with balloon-expandable (SAPIEN) valves is linked to positive outcomes
- TAVR matches surgical valve durability at seven years
- Cardiologists highlight early success with a leaflet-modification device for valve-in-valve TAVR
Tags: #DEVICE #PROVIDER
Medicaid Cuts Threaten Families of Medically Complex Children
As states absorb Medicaid funding cuts, family caregivers of medically complex children face financial ruin — illustrated by a Maryland family whose son, who has cerebral palsy, a feeding tube, and round-the-clock needs, lost state-provided nursing care after aging out at 22. The squeeze on Medicaid home- and community-based services and private-duty nursing is a direct threat to congenital-heart and other medically complex pediatric families, for whom these benefits are a lifeline.
Source(s):
STAT
Tags: #PATIENT #PROVIDER #PAYER