Congress nears deal that includes PBM reforms

Congress made good progress on negotiations over a health care package this holiday weekend, just not on the policy you’re probably thinking of.

An extension of the enhanced ACA premium tax credits is not part of the bipartisan, bicameral deal that, as of Monday evening, Congress was closing in on as part of HHS-funding legislation.

Instead, lawmakers are reviving the package of measures that Republicans and Democrats agreed to in late 2024 before Elon Musk and then President-elect Trump T-boned it. That deal included reforms to PBM business practices, hospital billing transparency measures, funding for public programs, an expansion of Medicare telehealth flexibilities, and drug patent reforms. The new legislative package is not identical to the past one, but it’s described as mostly mirroring it.

Democrats had tried to combine the ACA premium tax credits with the health care package. The Great Healthcare Plan that Trump released last week also does not include the ACA credits.

aca

True enrollment figures will take a while

ACA marketplan plan enrollment is down, but not by as much as might be expected. The true impact of the soaring cost of health insurance will likely not be clear until this summer.

Enrollment has fallen for the first time since the pandemic. As of this month, 22.8 million people have signed up for a plan for this year (though in some states people can still enroll). In 2025, 23.6 million people had enrolled by around the same time.

But those numbers only show how many people have chosen a plan, not how many have paid their premiums, according to Cynthia Cox, a senior vice president at KFF. Since the enhanced premium subsidies have been in place, nearly 90% of people kept the plans they chose, in part because many enrollees had no premium payments.

With the expiration of the enhanced credits, fewer enrollees now have zero-dollar premium plans, so a larger percentage might not keep the plans they’ve chosen.

“So, it’s likely we will see fewer people who selected a plan, or who were automatically renewed, pay their premium and start or keep their coverage in 2026,” Cox said.

The government has released final enrollment data at different times, but in the last couple of years it came out in late July.

food costs

Trump’s three-dollar meal deal

The question of affordability also is top of mind in the debate over the administration’s new dietary guidelines, Sarah Todd reports.

Sarah interviewed several nutritionists about the cost, in both terms of money and time, of eating right.

Sarah’s article opens with the question: How easy is it to make a healthy dinner for $3? Some Democrats ridiculed agriculture secretary Brooke Rollins for saying that Americans could make a meal that sticks to the guidelines for three dollars. So food economist William Masters challenged colleagues to design diets under the guidelines that are affordable, easy to make, and healthy.

This is how the dietary guidelines were done

A replacement committee had three months to develop dietary guidelines that typically would’ve taken years, according to a deeply reported article by Isabella Cueto.

Isa gives a behind-the-scenes account of an at-times improvised process on a tight deadline. Her article provides insights into how Kennedy’s HHS develops the scientific evidence on which its policies are based.

HHS spokesperson Emily Hilliard said the dietary guidelines are based on “rigorous scientific review and independent oversight” and that “it is absurd to suggest that anything other than gold-standard science guided our work.”

Isa reached out to all members of the committee, plus others, for this story. Read more.

research grants

OMB seeks more control

White House budgeters failed to impound NIH grants, and now they’re trying to gain more control over grant-making with a wonky policy, Anil Oza reports, with a little help from me.

The Office of Management and Budget wants Congress to fully fund multi-year grants the year they’re awarded, rather than annually, which is how they were handled before 2025. It might seem like a minor change, but it would result in fewer grants and make it easier for the White House to impound funds or advocate for decreases in the NIH’s budget, because those dollars would not be tied up in ongoing projects.

Read more about the pros and cons of multi-year grants.

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What we’re reading

Supreme Court agrees to review ‘skinny labeling’ and generic drug access, STAT
HHS gave a $1.6 million grant to a controversial vaccine study. These emails show how that happened, Rolling Stone
FDA delays reviews for two drugs in new voucher program, STAT
Trump encourages Rep. Julia Letlow to primary Sen. Bill Cassidy, NBC News

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