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In collaboration with:
July 2, 2025
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Spotlight
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On July 1, the Senate voted 51-50, with Vice President Vance casting the tie-breaking vote, to pass H.R. 1, the so-called “One Big Beautiful Bill Act,” with several changes. All Republicans voted for the bill except Sen. Thom Tillis (NC), Rand Paul (KY), and Susan Collins (ME); all Democrats opposed. The changes that were included in the Senate-passed version of the bill sends the bill back to the House of Representatives to either pass the Senate-passed bill or make additional changes before sending it back to the Senate. President Trump and Speaker Mike Johnson (R-LA) are still hoping to pass the bill by July 4.
The Senate-passed bill includes:
- An expansion of existing work requirements for SNAP to require individuals age 55-65 and parents or members of a household that are responsible for a dependent child between ages 8-14 to comply with work requirements.
- An increase in the state share of SNAP costs based on the state’s payment error rate, as well as an increase in the state’s share of administrative costs for the program.
- A restriction of SNAP, Medicaid, and Medicare eligibility for non-U.S. citizens.
- A reduction of state provider taxes used to fund the state portion of Medicaid.
- New work and “community engagement” requirements as a condition of Medicaid eligibility. The legislation includes several exceptions from work requirements for: Native Americans, individuals who are medically frail or are participating in a drug or alcohol addiction treatment program, pregnant and postpartum individuals, parents or guardians of a dependent child 13 years of age and under.
- Requirements for states to conduct eligibility redeterminations for Medicaid expansion individuals every six months.
- Cost sharing requirements for Medicaid expansion individuals beginning in October 2028. Cost sharing cannot exceed $35 and excludes services provided by Federally qualified health centers (FQHCs), certified community behavioral health clinics, or rural health clinics.
- $50 billion ($10 billion a year for fiscal years 2026-2030) to support rural health care providers, including rural hospitals, rural health clinics, FQHCs, certified community behavioral health clinics, and community mental health centers serving rural communities.
- A prohibition on Medicaid funding for Planned Parenthood clinics.
Notably, the Senate-passed version excludes changes to the excise tax on private foundations as well as a provision related to alleged "terrorist supporting" organizations that were both included in previous House versions of the reconciliation bill.
Recent estimates from the nonpartisan Congressional Budget Office (CBO) estimate the legislation will reduce Medicaid funding by nearly $1 trillion (which is higher than the House-passed amount), increase the number of uninsured people by about 12 million, reduce nutrition assistance funding by $186 billion, and increase the deficit by nearly $3.5 trillion over the 2025–2034 period.
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In a series of 6-3 rulings, the Supreme Court recently announced decisions in multiple high-profile matters impacting the scope of federal authority in health care, preventive services coverage, funding for gender affirming care and Planned Parenthood, and an Executive Order on birthright citizenship.
In Kennedy v. Braidwood Management, the Supreme Court upheld a provision of the Affordable Care Act (ACA) requiring insurers to cover preventive services, at no cost to patients, that are recommended by the U.S. Preventive Services Task Force (USPSTF). The decision affirmed that members of the USPSTF are constitutionally appointed by the Secretary of Health and Human Services (HHS) and do not require Congressional approval. While the ruling preserves access to free preventive care for over 150 million Americans, it also grants the HHS Secretary greater authority over the task force, raising questions about its future independence and the potential for political influence over what services are covered.
In Department of Homeland Security v. New York, the Supreme Court determined that federal judges exceeded their authority by issuing nationwide injunctions to block an executive order aimed at ending birthright citizenship for children of undocumented immigrants. While the Court did not rule on the constitutionality of the executive order itself, the decision lifts the nationwide blocks, allowing the policy to potentially take effect in 28 states that did not challenge it. The decision significantly narrows the power of lower courts to halt federal policies across the country and opens the door for a patchwork approach to birthright citizenship, depending on state-level legal challenges.
In United States v. Skrmetti, the Supreme Court upheld Tennessee’s 2023 law banning gender-affirming care for minors. The decision found that the Tennessee law does not violate the Equal Protection Clause of the 14th Amendment and effectively affirms the authority of states to restrict access to gender-affirming care for youth. The decision could influence similar laws in over two dozen states.
In Medina v. Planned Parenthood South Atlantic, the Supreme Court upheld South Carolina’s decision to prohibit Medicaid funding for any services provided at Planned Parenthood. The majority held that Medicaid recipients do not have a private right to sue under federal law to challenge a state’s decision to disqualify a provider. This decision is expected to influence other states to take similar actions.
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On June 4, the House passed the SUPPORT Act (H.R. 2483), which reauthorizes multiple Substance Abuse and Mental Health Services Administration (SAMHSA) programs related to substance use disorders, by a 366–57 vote. Championed by House Energy and Commerce Committee Chair Brett Guthrie (R-KY), the bill reauthorizes programs intended to expand access to treatment and recovery services, support pregnant and postpartum women, enhance first responder access to naloxone, and bolster state prescription drug monitoring programs. Ranking Member Frank Pallone (D-NJ) criticized and opposed the legislation, pointing to President Trump’s budget request which eliminates SAMHSA and many programs reauthorized in the legislation. Reauthorization of these programs related to substance use disorders were also included in a proposed funding bill in December, which failed to pass following criticism from Elon Musk on unrelated provisions. Bipartisan members of the Senate Health, Education, Labor, and Pensions (HELP) Committee also introduced a reauthorization of the SUPPORT Act within the Senate, but have not yet announced a legislative markup. These programs generally have bipartisan support and the legislation could be passed this year, but the funding level for these programs will be decided through the separate appropriations process.
On June 18, bipartisan members of the Senate HELP Committee also introduced a bill to reauthorize the Older Americans Act programs. The Older Americans Act includes several grant programs for state, local, and Tribal grant recipients to support services for seniors, such as Meals on Wheels. The Older Americans Act also authorizes programs for caregiver supports, preventing and addressing elder abuse, and Aging and Disability Resource centers. The recently introduced legislation would reauthorize these programs through fiscal year 2030. While funding can be provided to these programs without being reauthorized, the bill reflects continued bipartisan support for these programs, even during a time of funding cuts. The committee has not yet announced when it may vote to advance the legislation.
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On June 23, HHS Secretary Robert F. Kennedy, Jr. and Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz announced that a group of health insurers have committed to take several steps to reduce the impact of prior authorization on patient access to care, and to increase transparency in the use of prior authorization.
The commitments made by the insurers include:
- Reducing the volume of medical services subject to prior authorization by January 1, 2026;
- Honoring existing authorizations for patients who have changed insurers for 90 days following a transition to a new insurer;
- Improving clarity of explanations for authorization decisions and instructions for pursuing appeals;
- Responding in real time to electronic prior authorization requests for 80 percent of requests by 2027; and
- Ensuring medical professionals review all clinical denials.
The group of insurers making these voluntary commitments included Aetna, Inc., AHIP, Blue Cross Blue Shield Association, CareFirst BlueCross BlueShield, Centene Corporation, The Cigna Group, Elevance Health, GuideWell, Highmark Health, Humana, Inc., Kaiser Permanente, and UnitedHealthcare. Prior authorizations have received significant criticism in recent years, and several Members of Congress have expressed interest in codifying restrictions on the use of prior authorizations.
On June 25-26, the Advisory Committee on Immunization Practices (ACIP), which makes recommendations on vaccines, met and voted in favor of only recommending flu shots that do not contain the preservative thimerosal. ACIP’s recommendations are important because they guide both clinical practice and insurance coverage, influencing what vaccines are covered under Medicaid, Medicare Part D, employer-sponsored coverage, and private insurance. The committee also voted to recommend flu vaccines for the 2025-26 flu season for people 6 months old and older. While the committee did not vote on the measles, mumps, rubella, and varicella (MMRV) vaccine, one member proposed a recommendation that if there a safe equally effective alternative, the MMRV vaccine should not be administered to children younger than 47 months. ACIP could vote on this recommendation at a later meeting. In the weeks prior to the scheduled meeting, Secretary Kennedy dismissed all 17 of the previous ACIP members and installed eight new members, many of whom are viewed as anti-vaccine or as vaccine-skeptics. Several members of Congress raised concerns about the changes to ACIP, saying the move broke a commitment that Secretary Kennedy made to Senator Bill Cassidy (R-LA) prior to his Senate-confirmation. ACIP recommendations impact insurance coverage for vaccines, as recommended vaccines must be covered by Medicare, Medicaid, and other insurance plans. If insurers decide not to provide vaccine coverage, individuals could be required to pay out-of-pocket for vaccines, which could be cost prohibitive for many individuals and families. Additionally, ACIP recommendations determine which vaccines should be offered under the federal Vaccines for Children Program, which provides vaccines for eligible children at no charge.
HHS continues to add political leadership:
- Jim O'Neill was sworn in as Deputy Secretary of Health and Human Services. O'Neill is returning to HHS having been the Principal Associate Deputy Secretary from 2007 to 2008. During this time at HHS, O'Neill worked on implementation of the FDA Amendments Act and the launch of the Office of the Assistant Secretary for Preparedness and Response. In his new role as Deputy Secretary, O’Neill will be a key decisionmaker on issues related to the Department’s management and regulatory processes. He is also expected to focus on issues related to utilization of AI and medical products innovation.
- Paula Stannard was appointed as Director of the Office for Civil Rights (OCR) at HHS. She will lead enforcement of federal civil rights, conscience, and health information privacy laws. Ms. Stannard previously served as Senior Counselor and Advisor to the HHS Secretaries Alex Azar and Tom Price. She also served in the General Counsel’s office during the George W. Bush Administration. Prior to joining OCR, Ms. Stannard was the Chief Legal Counsel for Montana’s Department of Public Health and Human Services. She is expected to focus on enforcement of Health Insurance Portability and Accountability Act (HIPAA) regulations and federal civil rights protections within HHS programs, particularly religious freedoms and individual rights.
- Mark Cruz, a member of the Klamath Tribes, officially joined HHS as a Senior Advisor for Indian Health. Cruz was the Deputy Assistant Secretary for Policy and Economic Development at the Department of Interior during the first Trump Administration. He also held senior roles, including Chief of Staff, for Representative Todd Rokita, a Republican from Indiana. In his role in Secretary Kennedy’s immediate office, he will advise on decisions related to tribal health as well as opportunities for agencies to improve the health of Native Americans.
On June 20, CMS finalized the 2025 Marketplace Integrity and Affordability Rule, which reverses several Affordable Care Act (ACA) Marketplaces policies instated by the Biden Administration, such as extended enrollment periods and the expansion of Marketplace eligibility to Deferred Action for Childhood Arrivals (DACA) recipients. CMS also finalized measures intended to strengthen income verification processes, modify eligibility redetermination procedures, and adopt pre-enrollment verification for Special Enrollment Periods (SEPs), while ending SEPs for individuals with projected household incomes at or below 150 percent of the federal poverty level. The nonpartisan Congressional Budget Office estimated the proposed rule, which would have been codified in the House-passed reconciliation bill, would increase the number of uninsured people by 1.8 million in 2034.
On June 18, the Medicare Trustees released the 2025 report, projecting that the Medicare Hospital Insurance Trust Fund will deplete its reserves in 2033, which is three years earlier than last year’s estimate. The Hospital Insurance Trust Fund pays for Medicare part A services, which are generally inpatient hospital services. The trustees estimate that once the fund’s reserves are depleted, continuing programmatic income will be sufficient to pay 89 percent of total scheduled benefits.
On June 11, CDC reportedly rehired more than 400 employees who were previously laid off as part of HHS’ workforce reduction effort in April. Employees are reportedly being rehired in the National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention; the National Center for Environmental Health; the National Center for Health Statistics; the Immediate Office of the Director; and the Global Health Center. Senator Tammy Baldwin (D-WI) responded to these reports, noting that the Trump Administration “recklessly fired the very experts who should have been on the ground helping communities address serious public health threats—like in Milwaukee, which is grappling with a lead poisoning crisis.” In Milwaukee, lead poisoning has forced closures of six Milwaukee Public Schools (MPS) and displaced 1,800 children. Senator Baldwin stated that MPS’ request for CDC support was denied due to reductions in force within CDC.
On June 17, SAMHSA announced that on July 17 the 988 Suicide & Crisis Lifeline will end the dedicated option – Option 3 – for LGBTQ+ youth when they contact 988. SAMHSA also issued several advisories in recent weeks to:
- provide information on best practices and recommendations for implementing and expanding treatment of opioid use disorder (OUD) with methadone in hospital settings;
- urge that methadone be available to incarcerated patients with OUD in every correctional facility and advising that offering only tapering doses is not sufficient; and
- provide information about medications, service delivery models, regulatory requirements, staff training, and cultural issues that may affect the uptake and integration of medications for OUD. The document suggests actions to ensure continuity of medications for residents returning to the community.
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