Week in Washington

Congress

House Republicans continue to debate various ideas around how to achieve savings in their reconciliation bill via reductions in spending for Medicaid. Ideas continue to be raised from capping provider taxes to per capita caps to increased eligibility checks to work requirements to revoking Biden era eligibility/enrollment regulations.

CBO

CBO released scores (budget/enrollment implications) for several of the potential ideas House Republicans are considering- specifically reducing expansion population matching rate, limiting state taxes on health care providers, cap on spending per enrollee, repealing Biden era eligibility/enrollment final rule.  The impacts of the options ranged in federal deficit reduction from 162 billion (repeal eligibility and enrollment rules) to 710 billion (FMAP reduction) and reduction in Medicare coverage from 2.3 million (repeal eligibility and enrollment rules) to 8.6 million (limit state taxes on providers).

CSRs

One potential policy being discussed for inclusion in upcoming legislation (either via the reconciliation bill or an appropriation bill) is to include CSR funding. CSR funding would be counted as a budget saver (as the funding would reduce the amount of APTCs/number of APTC enrollees) and therefore could be useful as part of the reconciliation.

CMS

CSR/Rate Filing – On Friday May 2, CMS released ACA guidance related to 2026 rate filings, The guidance relates to silver-loading/cost-share reduction (CSR) payments in anticipation of the potential CSR funding legislation.  You can read the two pieces of guidance, you can read them here and here. The guidance required (for states without effective) issuers to file a set of rates assuming CSR are funded and ePTC’s expire. It encouraged states with effective rates (i.e., not required) to do something similar. It also required all issuers regardless of the state to include certain information in their rate filings on CSRs such as their estimated 2024 CSR payments. 

Pharmaceuticals

Tariffs  – President Trump announced that he expected an announcement on tariffs to be released in the next two weeks. There is considerable uncertainty on the impact

Medicare Drug Executive Order – President Trump is expected to sign an executive order as early next week that would direct CMS to implement a policy of most favored nation. The US tends to pay more for drugs than other countries so such a policy would dramatically reduce the price of drugs. CMS could attempt to implement such a policy through a demonstration model or through drug negotiations that are part of the Inflation Reduction Act. This policy was attempted during the first Trump Administration although halted by a lawsuit.