Updated April 23, 2025

Federal

Federal Budget and Medicaid

Over the last seven weeks, Republicans in both chambers of Congress have been working to construct a budget blueprint for fiscal year 2026 – passing resolutions twice in that time period – to agree on an identical framework that now must work its way through the partisan process known as “budget reconciliation” to advance the final budget bill – which could take anywhere from one to several months.

Reconciliation is a process employed in Congress that allows a bill to advance through the Senate with only majority party votes (rather than the 2/3 majority normally required) and removes the opposition tactic normally employed through a filibuster. Republican members of Congress are seeking to enact President Trump’s legislative agenda, which is focused on extending expiring tax cuts and decreasing federal spending on non-defense programs. This will be a challenging task for Republicans, with narrow margins in the House and Senate. As PBS explained:

“The resolution adopted this week was only a first step that allows Republicans to draft legislation that they can push through Congress without Democratic support. Next, they begin crafting a final bill with enough spending cuts to satisfy those on the right while not jeopardizing the reelection prospects of more vulnerable lawmakers whose constituents rely on key safety net programs.”

Why does this matter to Health Centers?

As you may be aware, to achieve the goal of decreased federal spending noted above, Congress is finding themselves in the untenable position of trying to square conflicting demands to protect safety-net programs like Medicaid while cutting trillions of dollars from the federal budget; specifically, the House Energy and Commerce Committee, which oversees Medicaid, has been directed to reduce spending by $880 billion over 10 years. Complicating those efforts are twelve moderate Republican House members who sent a letter to their leadership stating they will not support a budget that cuts Medicaid benefits. It is important to understand that there is much deliberation to come on which spending cuts will be recommended and before any become finalized, they will need to be voted on by the whole Congress.

What can Health Centers do to mobilize and protect patients?

Concerns about changes to Medicaid through reconciliation are real for Health Centers, and in addition to leadership in Congress, many of our own Representatives and Senators are speaking out about the potential harms this could mean for Health Center patients and the destabilization of the health center model. The trickle-down impact to Oregon’s Medicaid – the Oregon Health Plan – is expected to be especially challenging as an expansion state with an uninsured rate under 5% – and over 1 million Oregonians on the Oregon Health Plan.

OPCA is working with NACHC, other PCAs, and state partners to ramp up our advocacy and ensure the health center story – and your patients’ stories – are heard and the impact on all who utilize Medicaid is understood. This not only includes national fly-in opportunities with NACHC (next one is May 13-14, register here and let OPCA know if you’re attending) and in-district meetings, health center tours, townhalls with Oregon’s delegation – it means engaging your staff and patients to share or “tell” their stories about why Medicaid matters. We know that many of you are building those campaigns internally, sharing posts from OPCA and NACHC, and working on all fronts to protect this benefit for patients and health centers. Oregon’s 6 Representatives and 2 Senators will be in their home districts May 26- 30. We know that a few are hosting roundtables and townhalls this week that you may have been invited to, and, as we heard at our recent Annual Conference, they may still have a few spots open for a health center tour- OPCA can help you get in touch with your representative and provide you with talking points, health center specific stats etc.

Stay tuned for updates from OPCA as we learn more about potential cuts that may be recommended, Congress’ reaction and analysis on impacts to Oregon’s Medicaid program as well as state leadership responses. Reach out to Danielle or our communications team with questions or support on stories and advocacy.

Resources at your fingertips (courtesy of NACHC):

  • Download the updated In-District Meeting Toolkit from NACHC; includes talking points on Medicaid.
  • Share Medicaid patient stories to demonstrate who will lose coverage if devastating cuts are made.
    • NACHC urges health centers to promote video or text-based story collection with outreach and enrollment navigators, and other staff that work closely with Medicaid patients. These testimonials will help strengthen our collective Medicaid advocacy efforts.
  • Collect and deliver postcards from your patients and board members.
  • Use a meeting request template to begin preparing for the next congressional in-district work period during the week of Memorial Day, May 24 through June 1.
  • Modern Medicaid Alliance Releases New Polling Data on Medicaid
    The Modern Medicaid Alliance (MMA) released new polling data on Medicaid. The polling highlights the program’s overall popularity, the favorability of specific parts of it, and the number of voters who have a personal or family connection to Medicaid. Click here for more information about the report.

For more information:

NACHC Blog on Budget Bill

Modern Medicaid Alliance Letter to Congress to Protect Medicaid

Welcoming the 119th Congress

At 11 a.m. ET on January 3, legislative business started with the closing of the 118th Congress. Just an hour later at noon the new Congress convened to elect a speaker. Many of you might be thinking back to January 2024 when it took days to elect a House Speaker, and some were thinking 2025 would turn out to be Groundhog Day.

And sure enough, the 119th Congress kicked off with drama. Speaker Mike Johnson faced an alarming revolt from conservative hardliners. Sound familiar? President-elect Donald Trump was lobbying on Johnson’s behalf and Rep. Marjorie Taylor Greene (R-GA), a Johnson critic was also backing him. In the end, Johnson won 218 – 215 with just one Republican, Rep. Thomas Massie (R-Ky.), voting for House Majority Whip Tom Emmer. This goes to show how narrow the GOP majority is.

Continuing Resolution Flat Funds Health Centers – Punts on PBM Reform

The American Relief Act extended health center mandatory funding for three months to March 14 at $4.26 billion. In the days leading up to December 20 (when the last continuing resolution (CR) was set to expire), we watched as the 1,547-page CR – which included an extension for CHCs’ mandatory funding for two years at $4.5 billion in FY25 and $4.6 billion in FY26, a 15 percent increase over the baseline at the start of the Congress – dwindled down to 116-pages and flat funded health centers.

Here are the details of the American Relief Act

  • Section 330 mandatory funding – Provides 3 months of flat-lined funding at the $4.26 annual rate
  • National Health Service Corps – Provides 3 months of funding (Jan. 1 – Mar 31, 2025) at an annual rate of $345 million, which is a slight increase over FY24.
  • Teaching Health Centers – Provides 3 months of funding (Jan. 1 – Mar 31, 2025) at an annual rate of $175 million, which is a slight decrease
  • Telehealth
  • Extends Medicare reimbursement to FQHCs for medical services provided by telehealth, at the current fee schedule rate, through March 31, 2025.
  • Delayed until April 1, 2025, the requirement that Medicare persons receiving behavioral health services via telehealth have occasional in-person appointments.

CR Punts on PBM Reform

In the weeks leading up to December 20, the health world was bobbling between whether lawmakers would do a simple extension of must-do health items or a package of sweeping bipartisan reforms. For a second, it looked like the latter. Democrats and Republicans were taking victory laps over the first version (1,547 pages) of the continuing resolution, which included an overhaul of pharmacy benefit managers that was years in the making.

After that first CR deal imploded, we heard that PBMs were out. For PBMs, avoiding these new rules was a huge win. But it won’t last long. President-elect Donald Trump has said he wants to go after PBMs, calling them “the middlemen.” We’ll see about that. Regardless, lawmakers plan to address some health care issues in the reconciliation process next year, so there will be plenty of chances.

Sanofi’s Puts Breaks on Rebate Model, Sues HRSA

The detailed rebate model that Sanofi announced in November and planned to implement early this year is on hold for now. The French pharmaceutical giant, feeling pressure from HRSA has halted implementation of their controversial rebate model and is instead suing HRSA to force the agency to allow its rebate model to go forward.

Sanofi is the fourth drugmaker to sue HRSA to impose a 340B rebate model, joining Johnson & Johnson (J&J), Eli Lilly, and Bristol-Myers Squibb (BMS). HRSA maintains that the 340B statute prohibits drugmakers from unilaterally imposing 340B rebate models without agency approval. The future of 340B is now in the hands of the courts.

What We Are Reading

Six Members of the U.S. House that 340B Stakeholders Should Keep an Eye on in 2025 – By Ted Slafsky

OPCA’s Policy, Regulatory, & Advocacy Update

Join OPCA’s Policy staff for our Policy, Regulatory, & Advocacy Update Call where they will provide monthly updates on important policy and regulatory issues that matter to health centers.

OPCA’s Policy Office Hours

Join OPCA staff for our new Policy and Regulatory Office Hours! This is a dedicated space for you to share policy or regulatory concerns, successes, or questions with OPCA’s policy team.

Contact OPCA’s Policy Team

Policy & Governmental
Affairs Sr. Director
Danielle Sobel
503-228-8852, x248
dsobel@orpca.org

Governmental
Affairs Director
Marty Carty
503-228-8852, x239
mcarty@orpca.org

Health Policy Analyst
Erin Woods
ewoods@orpca.org