Week in Washington

EPTC Update

The Senate Finance Committee held a hearing this week on the potential for an enhanced premium tax credit extension.  Axios reported that hope was dimming on an agreement that would allow for the enhanced subsidies to be extended for 2026. The Senate is scheduled to have a vote on extending the subsidies in mid-December.

Alternative Plans

Senate and House Republicans have discussed alternative plans to extended ePTCs. Most of these plans have centered using creating enhanced HSAs or FSAs instead of ePTCs or APTCs. The White House also raised the potential of creating a reconciliation bill to reconfigure the ACA (a reconciliation bill would allow Republicans to pass a bill without agreement from Democrats). It’s unclear the extent to which a specific plan will emerge.

Public Charge Rule

The Trump Administration released a proposed rule that would reimpose a public charge. The rule would penalize legal immigrants attempt at permanent citizenship if they use Medicaid, SNAP, ACA, or other public programs. The rule was imposed during the first Trump Administration although later rescinded by the Biden Administration. KFF previously estimated that the rule could reduce Medicaid enrollment by 2 to 4.7 million.

Commercial Trend Estimates

Mercer released its annual estimates of total health benefit costs per enrollee. Mercer estimates costs will increase 6.0% in 2025 and 6.7% in 2026. The 6.7% would be the highest increase in 15 years. Mercer said increasing prescription drug costs, specifically increased GLP-1 utilization was a key driver. 

Coming Attractions

A number of proposed regulations such as the Medicare Technical Rule, ACA Payment Notice, CMMI Demos, and Medicaid State Directed Payments have piled up at OMB. It is possible that December could be a very busy month for CMS regulation releases.