Reconciliation in the Senate

Congress is back from recess this week and the focus is on the Senate’s consideration of the House-passed reconciliation bill. Much of this work will be done behind the scenes, for example ensuring that provisions are consistent with the Byrd Rule. Senate Republicans must strike a delicate balance because they only have a three-vote margin, so they will need to come to near-full consensus to pass the bill, while also maintaining enough of the original provisions for it to get through the House again. And they are still trying to get a finished product to the President’s desk by July 4.

We are still waiting for an official, complete score from the Congressional Budget Office (CBO), but expect it to be released in the next few days. The CBO score will include the interactive effects of the various policies, including updated figures for the deficit and anticipated coverage losses, both of which are likely to be higher than earlier estimates.

Senators Collins (R-ME), Hawley (R-MO), Justice (R-WV), Moran (R-KS), and Murkowski (R-AK) have spoken out against the effects of various Medicaid provisions in the bill. In contrast, Senators Johnson (R-WI), Paul (R-KY), Lee (R-UT) and Rick Scott (R-FL) have spoken out against the bill not doing enough to cut future deficits. We’ll see if the updated CBO analysis brings out more concerns from additional senators.

Senate Democrats are united in opposition to the bill. Over the weekend, Senate Minority Leader Schumer (D-NY) sent an open letter to Senate Democrats outlining their opposition – with concerns about the Medicaid and ACA changes being front and center.

While that is the focus in the Senate, the House will be in session beginning on Tuesday and is scheduled to consider the H.R. 2483, the SUPPORT for Patients and Communities Reauthorization Act of 2025 in the full House. This bill has always been bipartisan, but it has faced Democratic opposition as it moved through the Energy and Commerce Committee this year because of the broader cuts impacting mental health and substance use disorder services being pursued by the Trump Administration.

The fiscal year (FY) 2026 appropriations process also begins this week. Last Friday, the Administration released the budget in brief and additional information to fill out their “skinny budget” submission, but many details are still missing. The Committee on Appropriations Subcommittee on Agriculture, Rural Development, Food and Drug Administration, and Related Agencies hold a hearing on Thursday. The major health health-related considerations will not happen until later in July when the Subcommittee on Labor, Health and Human Services, Education, and Related Agencies is scheduled to meet.

The U.S. Department of Health and Human Services (HHS) budget highlights include:

• $95 billion for HHS, a $31 billion, or 25% decrease from FY 2025 levels.
• $14 billion in budget authority for the new Administration of a Healthy America (AHA), which HHS estimates to be a $6 billion cut compared to the current funding levels for all the programs that will be transferred to AHA. The Budget in Brief includes an overview of all the programs from the Health Resources and Services Administration, the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration, and the Office of the Assistant Secretary for Health that will now be included in AHA, but many details are still missing.
• $3.1 billion in budget authority for the Food and Drug Administration, a $409 million cut compared to FY 2025 levels.
• $4.1 billion in budget authority for the Centers for Disease Control and Prevention, a $550 million cut compared to FY 2025 levels.
• $27.5 billion in budget authority for the National Institutes of Health, a $17 billion cut compared to FY 2025 levels.
• $3.5 billion in budget authority for the Centers for Medicare & Medicaid Services, a $673 million cut compared to FY 2025 levels.

Today’s Podcast

In this week’s Healthcare Preview, Debbie Curtis joins Maddie News to discuss forthcoming CBO scores and what the Senate margin means for ongoing reconciliation discussions.