Congress has returned to Capitol Hill following August recess with lots to do before the end of the year and a shrinking window to get it done. Lawmakers have temporarily cleared one major hurdle, with government funding extended through Dec. 11, but several significant legislative and policy priorities remain outstanding. Additionally, with the November midterm elections now less than two months away, the political environment is increasingly shaping the congressional agenda.
Amid this backdrop, our team has continued advancing essential hospitals’ priority advocacy issues.
Essential Health System Designation
Bipartisan legislation to establish a federal definition of “essential health systems” is gaining traction in the House after reintroduction in January. H.R. 7145, led by Reps. Lori Trahan (D-Mass.) and David Valadao (R-Calif.), would give Congress a tool to target support to the foundational members of the nation’s health care safety net. There are several new cosponsors; the full list now features:
- Rep. Darren Soto (D-Fla.)*
- Rep. Juan Ciscomani (R-Ariz.)*
- Rep. Marc Veasey (D-Texas)*
- Rep. Troy Carter (D-La.)*
- Rep. Jen Kiggans (R-Va.)
- Rep. Brittany Pettersen (D-Colo.)
- Rep. Gus Bilirakis (R-Fla.)
- Rep. Ritchie Torres (D-N.Y.)
- Rep. Ann Wagner (R-Mo.)
- Rep. Burgess Owens (R-Utah)
- Rep. Emanuel Cleaver (D-Mo.)
- Rep. Terri Sewell (D-Ala.)
- Rep. Troy Balderson (R-Ohio)
- Rep. Tim Kennedy (D-N.Y.)
- Rep. Angie Craig (D-Minn.)
- Rep. Jim McGovern (D-Mass.)
- Rep. Gabe Vasquez (D-N.M.)
- Rep. Gabe Evans (R-Colo.)
- Rep. Nick Langworthy (R-N.Y.)
- Rep. Jonathan Jackson (D-Ill.)
- Rep. Rob Bresnahan (R-Pa.)
* original cosponsors
Visit our website for essential health system designation advocacy resources, including a position paper, policy brief, podcast, and FAQ. We continue to encourage you to ask your delegation to cosponsor. Be sure to highlight that seven existing cosponsors are on the House Committee on Energy and Commerce, the primary committee of jurisdiction for the legislation.
340B Drug Pricing Program
340B remains a hot topic on Capitol Hill. The Senate 340B Bipartisan Working Group, also known as the “Gang of Six,” updated the SUSTAIN 340B Act. The latest iteration incorporates some of the association’s feedback from a request for information process when the legislation was first introduced in the 118th Congress. Although there are some positive provisions, including a reiteration of original congressional intent for the program, many provisions would increase burden on covered entities and compromise patient access to care. The association plans to provide feedback on these provisions. The “Gang of Six” is composed of Sens. Jerry Moran (R-Kan.), Tammy Baldwin (D-Wis.), Shelley Moore Capito (R-W.V.), Tim Kaine (D-Va.), John Hickenlooper (D-Colo.), and new addition John Boozman (R-Ark.), who replaced Sen. Markwayne Mullin (R-Okla.) after he transitioned to a role in the administration.
Although not a “Gang of Six” member, Senate Committee on Health, Education, Labor, and Pensions (HELP) Chair Bill Cassidy (R-La.) continues to be interested in revamping the program. On June 29, Cassidy released draft legislation that would significantly change the program by altering patient definition, adding a rebate option, and imposing restrictions on child sites and contract pharmacies. America’s Essential Hospitals raised significant concerns in its robust response.
In the House, Reps. Scott Peters (D-Calif.) and John Joyce (R-Pa.) on July 6 introduced the bipartisan SECURE 340B Act, cosponsored by Reps. Jake Auchincloss (D-Mass.), Dan Crenshaw (R-Texas), and Nanette Barragán (D-Calif.). The association has engaged with the leading offices to share concerns about proposed alterations to patient definition, increased eligibility requirements for child sites, new data reporting requirements that would be onerous for covered entities, and an annual assessment and collection of fees from covered entities to participate in the program, among other provisions. Urge your delegation not to cosponsor this legislation.
The association anticipates continued collaboration with Sen. Cassidy, the “Gang of Six,” Reps. Peters and Joyce, and others in Congress to ensure that 340B remains an available resource for essential hospitals to reach more patients and provide comprehensive, high-quality services to all.
Noteworthy Congressional Hearing Activity
This Congress has made hospital price transparency a significant focus of its health care agenda.
In June, the House Committee on Energy and Commerce’s Health Subcommittee held a hearing on policies intended to increase health care transparency and lower costs. The subcommittee examined a range of proposals affecting hospitals, health plans, and other health care providers. The subcommittee then advanced a package of transparency-related legislation, reflecting bipartisan interest in strengthening federal requirements for the public disclosure of health care prices and negotiated rates.
The committee since has continued its work through legislative markups, including consideration of the Lower Costs, More Transparency Act, H.R. 9393, and the Prices on the Wall Act, H.R. 9390. These bills would expand and codify hospital price transparency requirements, including public posting of pricing information and additional reporting and compliance obligations. The full committee advanced both measures in July, positioning them for possible further consideration by the House. America’s Essential Hospitals is closely monitoring these legislative developments and evaluating their potential impact on essential hospitals, particularly with respect to administrative burden, implementation requirements, and the need to preserve access to care for underserved communities.
In July, the House Committee on Ways and Means marked up several health care transparency bills, including two of note to essential hospitals.
H.R. 9504: Tax-Exempt Hospital Transparency Act
- Tax-exempt hospitals and hospital systems with more than 100 staffed beds and $100 million in patient revenue would be required to annually report how they are addressing needs identified in their Community Health Needs Assessment (CHNA); explain any unmet needs; and disclose financial assistance provided, including the number of applicants and recipients.
- Large tax-exempt hospital systems would also be required to identify their top three CHNA priorities, describe efforts to address them, explain any unmet priorities, and report spending on quality improvement and other nonclinical programs. High-revenue nonprofit hospital systems would further be required to report service-line revenue, costs, and cost-allocation methodologies; disclose 340B program activity, including patient utilization, payer mix, net financial benefit, and participation costs; and report advertising expenditures.
H.R. 9645: Health Care Price Certainty for All Americans Act
- This bill expands and codifies health care price transparency requirements for hospitals, labs, imaging providers, ambulatory surgical centers, health plans and issuers, and pharmacy benefit managers. Hospitals must publicly report gross charges, negotiated rates, and discounted cash prices in a machine-readable format, provide consumer-friendly pricing information for at least 300 shoppable services with annual updates, prominently display discounted cash prices, and attest to the accuracy of all disclosed data. The association will continue to monitor both bills for further movement in the House.
The Senate HELP Committee also has focused on transparency, primarily through the Patients Deserve Price Tags Act, S. 2355, which recently passed out of the committee. Led by Sens. Roger Marshall (R-Kan.) and John Hickenlooper (D-Colo.), the bill aims to make health care costs transparent by codifying and expanding price disclosure rules for hospitals, insurers, and pharmacy benefit managers. The association engaged with congressional staff leading the development of this legislation to express concerns about the significant administrative burden its most onerous provisions would impose on essential hospitals. The Senate HELP Committee is expected to hold a member roundtable on surprise billing this fall. Chair Bill Cassidy (R-La.) said lawmakers from both parties are collaborating on efforts to “prevent ineligible claims while also ensuring timely physician payment.”
Surprise Billing
The House Committee on Ways and Means is developing legislation to overhaul the federal law that protects patients from surprise medical bills, according to people familiar with the discussions. The proposal could receive a committee markup as early as September, though its timeline remains uncertain given the limited number of legislative days remaining and the complexity of the ongoing negotiations. Congress enacted a bipartisan law in 2020 aimed at shielding patients from unexpected medical bills when they receive care at an in-network hospital but are treated by an out-of-network provider.
The law has since faced persistent implementation challenges. The independent dispute resolution process, established to determine payments between insurers and providers after patients are removed from billing disputes, has produced what critics describe as highly inflated reimbursement awards, raising concerns about higher health care costs. The new proposal aims to mitigate several of those issues. It would combine legislation from Rep. Greg Murphy (R-N.C.) that imposes penalties on insurers that miss payment deadlines with provisions designed to curb ineligible provider claims.
Ways and Means is unlikely to be the only committee weighing in on the issue. The House Committee on Energy and Commerce also has jurisdiction, and the Senate HELP Committee is expected to hold a member roundtable on surprise billing this fall. Chair Bill Cassidy (R-La.) said lawmakers from both parties are seeking prevention of ineligible claims and timely physician payment.
Republican Budget Reconciliation Efforts
Budget reconciliation is a legislative process that allows Congress to fast-track certain tax and spending legislation, including changes to programs such as Medicaid, by avoiding the Senate filibuster and passing legislation with a simple majority. Therefore, it is a tool the majority party uses when it holds the presidency and both chambers of Congress.
At the behest of President Trump, House Republican leadership has agreed to pursue a third budget reconciliation package. There are currently no provisions related to Medicaid (or health care at all) that would concern essential hospitals. The package is focused on the SAVE America Act, legislation related to elections and voter registration, as well as increased defense spending, border security and immigration enforcement funding, and agricultural provisions.
Before the August recess, House Republicans passed a narrowly focused reconciliation package, but the Senate is in a much different position. Senate Majority Leader John Thune (R-S.D.) has expressed skepticism at the upper chamber’s ability to move quickly, or at all, on a third reconciliation package. Despite that, Sen. Ron Johnson (R-Wis.), the newly appointed chair of the Senate Budget Committee, has vocally supported pursuing a third package. While the first order of business in September will be funding the government, we expect President Trump to push Leader Thune to pursue this option.
Potential Post-Election Health Package
There is a possibility that Congress pursues a year-end health care package, which depends on competing political priorities, looming legislative deadlines, and growing concerns over health care costs. Issues likely to be included in the package are an extension of community health center funding and relief from scheduled reductions under the Medicare Physician Fee Schedule. With temporary physician payment increases set to expire and the Centers for Medicare & Medicaid Services proposing lower conversion factors for 2027, lawmakers are under pressure from a bipartisan coalition of providers and physician-members of Congress to prevent further payment cuts. Additional bipartisan priorities gaining momentum include health care price transparency initiatives and policies to accelerate access to biosimilars.
To offset the cost of extending physician payment relief, Congress is increasingly looking at Medicare cuts to hospitals, i.e., “site-neutral” payment cuts, as a pay-for. Senate HELP Committee Chairman Bill Cassidy is working to advance several legacy health care priorities before leaving Congress, including potential reforms to the 340B program and expanded health data privacy protections. While 340B reform remains under discussion, divisions among stakeholders make its inclusion in a final package less certain than other bipartisan measures. Overall, any end-of-year health package is likely to be shaped by the need to balance provider payment concerns, cost-saving offsets, and broadly supported reforms that can attract bipartisan support.