What Does the Agreement to Reopen the Federal Government Mean for Health Policy Interests?

At a Glance

• Supporters of many health care policies have been eagerly seeking a pathway since the bipartisan bill crafted in mid-December 2024 was slimmed down to a package that consisted only of “extenders” of those provisions — such as Medicare coverage of telehealth visits and continued delay of Medicaid Disproportionate Share Hospital payments — which otherwise would have sunset.
• Other than bills to fund the government or address the Affordable Care Act subsidies, the menu of legislative vehicles for health policies becomes fairly thin. Another question would be whether there is enough momentum around one or more of the policies that fell out in December 2024 — such as pharmacy benefit manager reform — to drive a larger package.

As Congress and the White House appear headed toward an agreement to resolve the nearly seven-week federal government shutdown, what are the implications for scores of health care bills? Many health care policies have largely been in a state of limbo since the bipartisan December 2024 legislative package came undone following sharp criticism by then-Trump advisor Elon Musk.

The core of the agreement currently moving through Congress is a continuing resolution (CR) to fund the government through January 30, 2026, along with enactment of three bills to fund portions of the government — including the Food and Drug Administration (FDA) — for the full fiscal year through September 2026. This bill also includes several health care policies that have been tied to the CR’s deadline and that have been expired since October 1 — such as Medicare telehealth authorities, the delay of Medicaid disproportionate share (DSH) cuts and several other “extenders” — and which will now be tied to the new January 30 date. It also includes a five-year reauthorization of FDA’s Over-the-Counter Monograph Drug User Fee Program (known as OMUFA), which expired September 30.

The second component of the agreement — and the one of high relevance to those seeking any vehicle for health care legislation — is the agreement for the Senate to vote on legislation pertaining to the enhanced Affordable Care Act (ACA) premium subsidies that, absent congressional action, will expire at the end of December. Many congressional Republicans are reluctant to extend these further, arguing they were originally intended to address a COVID-19 pandemic-era economic need that no longer exists, with some working to develop an alternative set of proposals. But premium price increases coupled with concerns about backlash on provisions of the One Big, Beautiful Bill Act (H.R. 1) — particularly for members who are politically endangered — could drive a potential compromise, and several congressional Republicans have been publicly urging such an approach.

Within this landscape are the authors and supporters of many health care bills who have been eagerly seeking a pathway since the bipartisan bill crafted in mid-December 2024 was slimmed down to a package that consisted only of extenders that otherwise would have sunset.

Non-extender provisions that were pulled out of that package included a suite of carefully negotiated pharmacy benefit manager (PBM) reforms, legislation to facilitate out-of-state care for children in Medicaid and the Children’s Health Insurance Program (CHIP) who need to receive care outside of their home state, additional telehealth policies, a reauthorization of the nation’s pandemic preparedness law, a reauthorization of FDA’s rare disease priority review voucher (PRV) and measures to expand and strengthen price transparency in health care.

Complicating the landscape further are additional bills seeking a path forward. Aside from some policies that managed to be included in the One Big, Beautiful Bill reconciliation package and the reauthorization of the Substance Use Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, which has cleared Congress but still awaits the president’s signature, the year has brought little progress on bipartisan health care legislation, creating a backlog of bills eager for a legislative vehicle.

So, what opportunities may lie ahead?

With federal funding looking to be addressed through the end of January 2026, a must-pass December spending bill would be removed from the potential options list.

And while we expect a Senate vote on ACA subsidies, a threshold question is whether or not a critical mass of Republicans, especially in the House, would back such an agreement. A bill combining a more limited extension of the enhanced subsidies to address Republican calls for reform in addition to policies the party has traditionally favored to address health care access rather than the ACA is interesting to contemplate, though the political math forward remains in doubt. The politics of the issue over the coming weeks, especially as we move deeper into the open enrollment period — along with the all-important signals from the White House — will heavily influence this outcome.

Should such an agreement come together, the next question would be whether or not it could be significant enough to serve as a larger vehicle for other health care policies to ride upon. The price tag of such a measure along with what’s in and what’s out will be important indicators, particularly given concerns many in the House Republican caucus have about acting on large year-end bills, spending or otherwise.

Other than bills to fund the government or address the ACA subsidies, the menu of legislative vehicles for health policies becomes fairly thin. The annual National Defense Authorization Act (NDAA) would be another “must-pass” bill, but tacking nondefense health measures onto the NDAA is historically challenging.

Another question would be whether there is enough momentum around one or more of the policies that fell out in December 2024 — such as PBM reform — to drive a larger package. Congress hasn’t had much success lately in advancing bills not attached to a must-pass vehicle, but stakeholders should continue pursuing all avenues, particularly as sponsors of these bills are eager to see their work result in a victory.

Barring these scenarios, attention will then shift to what develops come January 2026, such as an omnibus FY 26 bill or smaller “minibuses,” which may present the last-best opportunity for movement until the 2026 post-election lame duck session.