Congress Debates Healthcare Affordability, CMS Proposes 2027 Medicare Policy Updates

Congress is currently grappling with healthcare affordability issues, focusing on the impending December 31, 2025 expiration of enhanced advance premium tax credits (APTCs). A Senate floor vote on extending these credits is anticipated on December 11, although partisan divisions persist, with Democrats advocating for a clean three-year extension and Republicans divided between extending credits with modifications or pursuing alternative cost-reduction measures such as health savings accounts and price transparency initiatives. In parallel, the House Ways and Means Oversight Subcommittee has spotlighted the need for systemic reform within organ procurement organizations (OPOs), emphasizing enhanced oversight, accountability, and data transparency to safeguard patient interests against alleged fraud and misuse of federal funds. During a Senate Aging Committee hearing, bipartisan support emerged for reauthorizing the Older Americans Act and shifting resources toward home- and community-based services to facilitate aging in place. The committee also discussed ancillary solutions like caregiver tax credits and community partnerships. Legislative advancements include the introduction of bipartisan pharmacy benefit manager (PBM) reform legislation aimed at curbing drug costs through delinking PBM compensation from negotiated rebates, augmenting transparency in federal prescription drug programs, and ensuring accurate Medicaid pharmacy payments. Concurrently, the Centers for Medicare & Medicaid Services (CMS) proposed 2027 policy updates for Medicare Advantage (MA) and Part D programs, including a call for public comments by January 26, 2026. CMS announced negotiated maximum fair prices for 15 Part D drugs under the 2027 Medicare Drug Price Negotiation Program, projecting substantial Medicare savings. Regulatory shifts include CMS revoking previous minimum staffing mandates for long-term care facilities, restoring prior staffing requirements while soliciting public input with changes effective around February 2026. CMS's Innovation Center unveiled the ACCESS model, a decade-long voluntary initiative to promote technology-supported care aligned with Medicare Part B, targeting chronic disease management through outcome-based payments and integrating FDA-authorized digital health devices under the complementary TEMPO pilot project. Additionally, the Department of Health and Human Services (HHS) disclosed a comprehensive AI strategy to unify AI adoption across its divisions through a centralized infrastructure focusing on ethical use, transparency, workforce enhancement, research, and operational improvement. Anticipated congressional sessions will address APTC extensions and healthcare cost reductions, with multiple committee hearings scheduled to examine technology's role, organ procurement networks, and the broader healthcare landscape. This confluence of legislative, regulatory, and technological developments signifies ongoing efforts to address cost containment, care delivery innovation, and regulatory oversight in the U.S. healthcare insurance ecosystem.