Bipartisan Health Bill Vote Next Week: What's In, What's Out
This week, lawmakers reached a bipartisan agreement on the latest HHS appropriations bill that is a critical step forward in funding essential health programs for the year ahead. The bill includes important investments in public health infrastructure, disease prevention, biomedical research, and health workforce initiatives that will strengthen care delivery and support innovation across the country. Also included are extensions of telehealth Medicare flexibilities and the Medicare hospital at home program. PBM reforms are included but not an extension of the ACA enhanced subsidies.
What’s Covered in the Bipartisan HHS Spending Bill
NIH (National Institutes of Health): Continued robust funding to support biomedical research on major diseases such as cancer, Alzheimer’s, ALS, and women’s health initiatives — including increased support for maternal health research.
Note that advocates have raised concerns not just about levels of funding but about restrictions on how funds can be used. For example, there are limitations on certain types of biomedical or NIH-related research that appeared in earlier drafts of the bill. Though many of those specifics may have evolved through negotiations, tension remains over striking the right balance between oversight, innovation, and scientific freedom.
CDC (Centers for Disease Control and Prevention): Includes targeted investments for Safe Motherhood and Infant Health programs, HIV detection and response, and global HIV/AIDS activities — with protections against proposed deep cuts.
HRSA (Health Resources and Services Administration): Almost $9 billion in funding, including:
~$1.9B for Community Health Centers
~$1.4B for the Health Workforce Bureau
~$1.2B for Maternal & Child Health, including Healthy Start and maternal nutrition supports
~$417M for rural health programs
~$130M for the National Health Service Corps
Continued support for Title X family planning and Ryan White HIV/AIDS programs.
Public Health Preparedness & Biodefense - Funding for the Administration for Strategic Preparedness and Response (ASPR) (~$3.69B), including increases for:
Biomedical Advanced Research & Development Authority (BARDA)
Project BioShield
Strategic National Stockpile
Pandemic influenza preparedness and hospital readiness programs • Continued support for emergency response infrastructure and state stockpile readiness.
SAMHSA (Substance Abuse and Mental Health Services Administration): ~$7.4B in funding, including:
$2.8B for mental health activities
$4.2B for substance abuse treatment services, including State Opioid Response Grants
Support for pregnant and postpartum women’s behavioral health.
Women’s Health & Maternal/Child Health Investments - Nearly $60M increasefor maternal health programs across HHS agencies, geared toward:
Reducing pregnancy-related deaths and maternal mental health support
Best practices to improve birth outcomes
New funding for menopause research and maternal health hotlines
Protected funding for Healthy Start and teen pregnancy prevention.
Health Workforce & Rural Health Support - Funding targeted at expanding and training the health workforce, from community health workers to clinicians in underserved areas. Also, over $400M for rural health programs, supporting access to care and infrastructure in rural and frontier communities.
Telehealth Extensions
The bill would extend Medicare telehealth flexibilities including key pandemic-era provisions through December 31, 2027. This extension preserves a broader range of virtual care services for Medicare beneficiaries beyond previous short-term stopgap extensions.
Key telehealth provisions included in the bill:
Medicare telehealth flexibilities extended through 2027 (for an additional two years).
Requirement that HHS issue new guidance on furnishing telehealth services to individuals with limited English proficiency.
Some expanded service flexibilities such as in-home cardiopulmonary rehab extended into 2028 under certain provisions.
Extending telehealth flexibilities provides greater predictability for providers and improves access to primary, specialist, and behavioral health care, especially for rural, elderly, and mobility-limited patients.
Hospital at Home Program
The bill includes a five-year extension of the Medicare Acute Hospital Care at Home program, running through September 30, 2030, that allows qualifying hospitals to deliver certain acute care services in the patient’s home.
This extension is important because it gives hospitals more certainty to continue and grow “hospital at home” models that can reduce costs, improve patient satisfaction, and maintain capacity in traditional inpatient settings.
However, despite significant bipartisan cooperation on appropriations, the bill does not address a looming crisis for Affordable Care Act (ACA) marketplace enrollees: the extension of enhanced premium tax credits (PTCs).
Key PBM-Related Provisions in the Bipartisan Health Bill
Ends certain PBM contracting advantages under Medicare Part D The bill would change how PBMs contract with pharmacies under Medicare Part D by requiring clearer, enforceable and more balanced contract terms. This is aimed at reducing the ability of large PBMs to use confusing or one-sided contracts that disadvantage independent pharmacies.
Directs greater transparency and enforcement PBMs would face much greater transparency requirements in how they contract and price drugs under Medicare Part D, including reporting and enforcement mechanisms if they violate contract standards, which is intended to discourage opaque and arbitrary practices.
Unlinks PBM revenue from drug list prices The legislation would unlink how PBMs are compensated from overall drug list prices, a structural change that aims to reduce incentives for PBMs to favor higher list prices or steer drugs based on rebates.
The bill’s PBM provisions primarily focus on Medicare Part D and federal programs; it does not broadly regulate PBMs in employer-sponsored health plans. That broader reform continues as separate bipartisan legislative effort but is not part of the current minibus package.
What’s Missing and Why It Matters
The enhanced ACA subsidies, originally enacted under the American Rescue Plan and extended through 2025 under the Inflation Reduction Act, made health insurance far more affordable for millions of Americans. These enhancements expanded eligibility and reduced premium costs, in many cases to $0 monthly, dramatically improving access to coverage.
Unfortunately, the current HHS spending bill does not include a permanent or extended fix for these enhanced subsidies. With the enhancements having expired at the end of 2025:
Premiums have begun to spike in some cases more than doubling for 2026 coverage year enrollees. Marketplace enrollment has already dipped by over 1.4 million people, largely tied to subsidy expiration and higher out-of-pocket costs.
These enhanced subsidies once helped more than 20 million Americans afford insurance through the ACA marketplaces and contributed significantly to enrollment growth over the past several years.
Without action, many low- and middle-income individuals and families face steeper premiums, tougher coverage decisions, or the real possibility of going uninsured — particularly in states without additional state-level assistance.
Why This Matters for Employers, Providers, and Communities
While appropriations keep federal health agencies running, the absence of extended ACA enhancements in this bill leaves millions of Americans vulnerable at a time when health care affordability remains top of mind. As negotiations continue in the Senate and with stakeholders across the health care system, extending or reforming the enhanced premium tax credits should remain a priority, not just for budget politics, but for the health and economic security of families nationwide.
Bottom Line:
A bipartisan funding agreement is a win; an agreement ensuring affordable coverage for Americans must be on Congress' legislative agenda.