Health Policy Report – December 16, 2025

Congress Looks for Health Care Compromise After Failed Senate Vote
On December 11, the Senate rejected a Republican plan that would expand health savings accounts (HSAs) as a replacement for enhanced Obamacare subsidies set to expire on December 31. The plan, which was introduced by Senators Mike Crapo (R-ID) and Bill Cassidy, MD (R-LA), would have converted the value of funding for premium tax credits under the Affordable Care Act (ACA) into federal contributions to HSAs to lower out-of-pocket healthcare costs.

The enhanced Obamacare subsidy issue has been left unresolved after the government shutdown this fall. Some Republicans are open to an extension of enhanced tax credits on a temporary basis, while others have proposed redirecting funds into HSA accounts, as in the Crapo-Cassidy plan.

On Friday, December 12, House Republican leadership released a set of health policy proposals they are working to include in an upcoming health package, featuring CHOICE legislation to codify a Trump-era rule that expands employer options for providing health coverage.

Under the proposal, employers could provide tax-advantaged funds for employees to purchase individual health insurance instead of offering a traditional group plan.

The package also contains provisions to reform Pharmacy Benefit Manager (PBM) practices, primarily focused on transparency. However, it does not include broader measures such as a ban on spread pricing, many of which were dropped from the 2024 year-end package.

A vote on this package is expected Wednesday. Notably, it does not include an extension of ACA tax credits set to expire at year-end. This is also the last week Congress will be in Washington before the holiday recess, with lawmakers scheduled to return on Monday, January 5.

To read more, CLICK HERE.

Senators Wyden and Crapo Introduce PBM Legislation

On December 4, Senate Finance Committee Chairman Mike Crapo (R-ID) and Ranking Member Ron Wyden (D-OR) introduced the “PBM Price Transparency and Accountability Act,” which would increase transparency and oversight of pharmacy benefit managers (PBMs), companies that manage prescription drug benefits on behalf of health plans.

The legislation would delink PBM compensation from negotiated rebates and prevent PBMs from promoting more expensive drugs. If passed, the bill would also increase reporting requirements for PBMs and strengthen the requirement that plan sponsors contract with any willing pharmacy that fits specific standards, a provision intended to protect rural independent pharmacy.  

“Pharmacy benefit managers should not profit from overcharging patients for their prescriptions,” Crapo said in a statement. “This bipartisan legislation is a decisive step toward making the prescription drug market easier to navigate for both patients and pharmacies. These proposals form a strong foundation for additional efforts to promote pharmacy access, demystify drug pricing and reduce costs for both taxpayers and seniors.”

A similar package nearly advanced through Congress late last year as part of a broader appropriations bill, but it ultimately stalled following public opposition from Elon Musk. The latest Senate Finance Committee proposal could be incorporated into appropriations legislation either before the end of the year or early in the next session.

To learn more, CLICK HERE.

To read a statement from the Senate Finance Committee, CLICK HERE.

MedPAC Recommends 0.5% Pay Increase for Physicians

The Medicare Payment Advisory Commission (MedPAC) – which advises Congress on issues related to Medicare – recently recommended a 0.5% reimbursement increase in 2027 for physicians and other health professionals who treat Medicare patients. Members who are supportive of this draft recommendation claim that it “balances rising beneficiary costs with preserving access to physician services.”

However, other experts are critiquing the recommendation, arguing that MedPAC has still recommended an aggregate pay cut for physicians given the net update of -2.2% compared to last year’s net update of 3%.

MedPAC made their recommendation according to the commission’s 2025 survey, which indicated that Medicare’s current pay rates don’t seem to have negatively affected Medicare enrollees’ access to care. The survey found that 97% of beneficiaries reported that they were “very” or “somewhat” satisfied with their ability to find providers who accepted their insurance, compared with 93% of those ages 50 to 64 who had private insurance.

Commissioners also discussed site-neutral payments, which will be expanded to include drug administration services in 2026. They noted that clinic visits in on-campus hospital outpatient departments present another opportunity to implement site-neutral payments.

To learn more, CLICK HERE.

CMMI Debuts New ACCESS Model
The Centers for Medicare & Medicaid Innovation (CMMI) has debuted the Advancing Chronic Care with Scalable Solutions (ACCESS) model, which encourages the use of technology to treat chronic diseases.

The model is voluntary for Medicare Part B–enrolled organizations that are helping patients manage qualifying chronic conditions, including diabetes, hypertension, or chronic kidney disease. It aims to boost digital health, giving providers a straightforward payment pathway when they use telehealth, wearables and smartphone applications to treat Medicare members with chronic conditions.

The ACCESS model is set to run for 10 years. Providers must apply by April 1 to be considered for the model’s first performance period, which will begin July 1.

To read more, CLICK HERE.