Top 5 U.S. Health Policy Priorities for Congress Post-Recess
As Congress reconvenes after the August recess, several key health policy issues are poised to influence the U.S. healthcare and insurance sectors in fiscal year 2026. The appropriations process for FY26 is progressing unevenly, with the House holding a partisan stance and the Senate advancing bills more bipartisanly. While several appropriations bills have been drafted and some passed, a complete FY26 budget deal is unlikely before September 30, increasing the possibility of a continuing resolution or even a government shutdown. Additionally, President Trump’s use of a "pocket rescission" to cut foreign aid may complicate these negotiations further. One motivator for eventual agreement is lawmakers' interest in securing earmarks and must-pass policies.
The Over-the-Counter (OTC) Monograph Drug User Fee Program, authorized in 2020, faces upcoming reauthorization as the current authorization expires on September 30. Both the House and Senate have approved respective versions of the reauthorization bill, though the Senate’s includes additional provisions affecting drug testing standards and guidance for prescription-to-nonprescription switches. Final legislative alignment is necessary to sustain the program beyond its expiration.
Drug pricing reforms continue to be a significant legislative focus amid ongoing policy activity. Recent drug pricing legislation, including reintroduced PBM reform bills and measures inspired by the "Most-Favored-Nation" executive order, reflect bipartisan interest but lack certainty for enactment this year. Key legislation like the Global Fairness in Drug Pricing Act and the Fair Prescription Drug Prices for Americans Act propose international reference pricing frameworks. Additionally, the Inflation Reduction Act's orphan drug provisions have been clarified recently, impacting Medicare drug price negotiations.
Congress is also approaching deadlines for several Medicare and Medicaid “health extenders,” temporary provisions vital to program continuity. These extenders require timely renewal to avoid disruptions for patients and providers, with potential extensions likely to coincide with government funding legislation or continuing resolutions. Public health program authorizations such as the SUPPORT Act and the Pandemic and All-Hazards Preparedness Act remain pending renewal.
Enhanced Advance Premium Tax Credits (eAPTCs) under the Affordable Care Act, extended by recent relief acts, are set to expire at the end of 2025. Their expiration could lead to increased uninsured rates, higher premiums, and greater uncompensated care costs for providers. Congressional divisions exist over whether and how to extend these credits, with cost concerns and coverage impacts central to the debate. Future discussions on these tax credits are expected to intensify as the expiration date approaches.
Overall, these legislative and regulatory activities underscore ongoing challenges in balancing budget priorities, public health needs, and insurance market stability. The outcomes will significantly affect federal health funding, drug policy, and insurance marketplace dynamics. Stakeholders should monitor these developments for potential impacts on compliance requirements, benefits design, and payer/provider relationships going forward.