Health care costs

Amputation Reduction and Compassion Act of 2025 or the ARC Act of 2025

This bill provides for coverage of peripheral artery disease screening tests without cost-sharing under Medicare and Medicaid for certain at-risk individuals. It also requires the development of certain educational programs, a payment model, and Medicare quality measures to reduce amputations relating to such disease.

Health Care Affordability Act of 2025

This bill makes permanent temporary changes enacted by the American Rescue Plan Act of 2021 (ARPA) and the Inflation Reduction Act of 2022 (IRA) that generally expand eligibility for and increase the amount of the premium tax credit.

Currently, eligible taxpayers may be able to claim the premium tax credit, which applies toward the cost of obtaining health insurance through health insurance exchanges. To be eligible for the premium tax credit, a taxpayer’s household income must meet or exceed 100% of the federal poverty level (FPL) and, after 2025, may not exceed 400% of the FPL (maximum income limit). For 2021-2025, the ARPA and IRA eliminated the maximum income limit, which generally expands eligibility for the premium tax credit.

Further, under current law, the amount of the premium tax credit is (1) generally the plan premium (conditions apply), minus (2) the taxpayer’s household income multiplied by the applicable percentage. The applicable percentage is a specific percentage that varies depending on which of six income ranges (adjusted for inflation after 2025) the taxpayer’s household income falls within. For 2021-2025, the ARPA and IRA lowered the applicable percentages and eliminated the adjustment of the applicable percentages for inflation, which generally increases the amount of the premium tax credit.

The bill makes permanent the elimination of the 400% maximum income limit, the lower applicable percentages, and the elimination of the inflation adjustment for the applicable percentages.

CHAMPVA Children's Care Protection Act of 2025

This bill provides that a child shall be eligible for medical care under the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) until the child's 26th birthday, regardless of the child's marital status.

Prostate-Specific Antigen Screening for High-risk Insured Men Act or the PSA Screening for HIM Act

This bill requires private health insurance plans to cover evidence-based, preventive care and screenings for prostate cancer that are not already covered under the recommendations of the U.S. Preventive Services Task Force for certain men.

Specifically, plans must cover such care and screenings for men who are age 40 and over and are at high risk of developing prostate cancer (e.g., with a family history of prostrate cancer). Such coverage must be provided without imposing any cost-sharing requirement.

Alternatives to Prevent Addiction In the Nation Act or the Alternatives to PAIN Act

This bill reduces cost-sharing and prohibits the imposition of certain utilization requirements under the Medicare prescription drug benefit for certain non-opioid pain management drugs.

Specifically, the bill requires such drugs to be covered without a deductible and to be placed on the lowest cost-sharing tier (if any). The bill also prohibits the imposition of prior authorization requirements (i.e., requiring prior approval from a plan) or step therapy requirements (i.e., requiring the use of alternative drugs before a drug is covered under a plan) with respect to such drugs.

This joint resolution nullifies the rule titled Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability, which was issued by the Centers for Medicare & Medicaid Services on June 25, 2025.

The rule makes several changes to enrollment requirements for health insurance exchanges, including (1) requiring annual open enrollment periods for all exchanges to begin by November 1 and end by December 31, (2) requiring all exchanges to conduct pre-enrollment verification of eligibility for at least 75% of new enrollments through special enrollment periods, and (3) prohibiting Deferred Action for Childhood Arrivals (DACA) recipients from enrolling in plans through exchanges or in state Basic Health Programs (state programs for certain low-income residents).

The rule also prohibits individual and small group health insurers from covering certain sex-trait modification procedures as an essential health benefit.

Equitable Community Access to Pharmacist Services Act

This bill provides for permanent coverage under Medicare of certain pharmacist services.

Specifically, the bill provides for permanent coverage of testing and treatment services provided by pharmacists relating to (1) COVID-19, influenza, respiratory syncytial virus (RSV), and streptococcal pharyngitis (strep throat); and (2) other public health needs in relation to a declared public health emergency. (Similar authorities were temporarily granted during the COVID-19 public health emergency.) Such services must be provided in accordance with the applicable state laws governing pharmacists' scope of practice.

Children’s Health Insurance Program Permanency Act or the CHIPP Act

This bill permanently extends the Children's Health Insurance Program (CHIP) and related measures, programs, and authorities.

Specifically, the bill permanently funds CHIP and related programs that support the development of child health quality measures and outreach and enrollment efforts. The bill also permanently authorizes the Medicaid and CHIP express lane eligibility option, which allows states to use information from designated programs (e.g., the Supplemental Nutrition Assistance Program) to streamline eligibility determinations for children. Additionally, under the bill, states may expand eligibility to children whose family income exceeds the otherwise applicable limits.

Protecting America’s Seniors’ Access to Care Act

This bill prohibits administration, implementation, or enforcement of the rule titled Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting, which was issued by the Centers for Medicare & Medicaid Services on May 10, 2024.

Specifically, the bill prohibits administration, implementation, or enforcement of provisions that, among other changes, (1) establish minimum staffing standards for nurses in Medicare and Medicaid long-term care facilities, including requiring a nurse to be onsite 24/7 and requiring a minimum of 3.48 total nurse staffing hours per resident per day; and (2) require state Medicaid programs to report on payments to direct care workers and support staff of nursing facilities and intermediate care facilities for individuals with intellectual disabilities.

Acupuncture for Our Seniors Act of 2025

This bill provides for Medicare coverage of acupuncturist services, including those provided by a physician (as authorized under state law).

Protecting Life from Chemical Abortions Act

This bill nullifies certain changes made by the Food and Drug Administration (FDA) to dispensing requirements for mifepristone. (Mifepristone is a drug that is approved to end pregnancies through 10 weeks gestation when used in conjunction with the drug misoprostol. The procedure is often referred to as medication abortion or the abortion pill.)

The FDA regulates mifepristone through the Mifepristone Risk Evaluation and Mitigation Strategy (REMS) program. The program requires health care providers to comply with certain requirements in order to prescribe or dispense mifepristone to end a pregnancy; the program previously included an in-person dispensing requirement that required mifepristone to be directly dispensed to patients in clinics, medical offices, or hospitals. During the COVID-19 public health emergency, the FDA stopped enforcing the in-person dispensing requirement, which allowed mail-order pharmacies to fill and dispense mifepristone prescriptions.

In January 2023, the FDA modified program requirements so as to (1) remove the in-person dispensing requirement, and (2) require pharmacies to be program-certified in order to dispense mifepristone. The modifications allow certified retail pharmacies to dispense mifepristone pursuant to prescriptions that are written by certified prescribers.

The bill nullifies the January 2023 changes and prohibits the FDA from (1) exercising any enforcement discretion with respect to program requirements, or (2) reducing program protections until every state submits certain data regarding abortions to the Centers for Disease Control and Prevention.

The bill also generally prohibits the declaration of a public health emergency with respect to abortions.

Increasing Access to Dental Insurance Act

This bill permits individuals to enroll in a dental benefits plan on a health insurance exchange without also enrolling in a qualified health plan.

Rebuild America’s Health Care Schools Act of 2025

This bill allows hospitals to receive reimbursement under Medicare for certain costs associated with training nursing and allied health students in settings other than the hospital itself.

Currently, hospitals may receive reimbursement under Medicare for the reasonable costs associated with training nursing and allied health students if certain conditions are met; the criteria vary depending on whether the students are enrolled in an educational program that is operated by the hospital or another entity. If the students are part of a program that is operated by another entity, the training must occur at the hospital itself or in areas immediately surrounding the hospital in order to qualify for reimbursement (among other requirements). The bill allows hospitals to receive reimbursement for these costs if the training is conducted at an entity that is related to the hospital (i.e., common ownership or control).

The bill requires the Centers for Medicare & Medicaid Services (CMS) to update regulations to reflect these changes. Additionally, the CMS may not recoup or reduce payments to hospitals with respect to costs that are allowed under the bill and must refund any such recoupments or reductions that occurred during the six-year period prior to the bill's enactment.

This bill nullifies certain changes made by the Food and Drug Administration (FDA) to dispensing requirements for mifepristone. (Mifepristone is a drug that is approved to end pregnancies through 10 weeks gestation when used in conjunction with the drug misoprostol. The procedure is often referred to as medication abortion or the abortion pill.)

The FDA regulates the use of mifepristone through the Mifepristone Risk Evaluation and Mitigation Strategy (REMS) program. The program requires health care providers to comply with certain requirements in order to prescribe or dispense mifepristone to end a pregnancy; the program previously included an in-person dispensing requirement that required mifepristone to be directly dispensed to patients in clinics, medical offices, or hospitals. During the COVID-19 public health emergency, the FDA temporarily stopped enforcing the in-person dispensing requirement, which allowed mail-order pharmacies to fill and dispense mifepristone prescriptions.

In January 2023, the FDA modified program requirements so as to (1) remove the in-person dispensing requirement, and (2) require pharmacies to be certified in the program in order to dispense mifepristone. The modifications allow retail pharmacies, after receiving certification, to dispense mifepristone pursuant to prescriptions that are written by program-certified prescribers.

The bill nullifies the January 2023 changes and prohibits any similar changes in the future.

Optimizing Research Progress Hope And New Cures Act or the ORPHAN Cures Act

This bill modifies certain provisions under the Medicare Drug Price Negotiation Program with respect to orphan drugs.

The Medicare Drug Price Negotiation Program requires the Centers for Medicare & Medicaid Services to negotiate the prices of certain prescription drugs under Medicare beginning in 2026. Among other requirements, drugs must have had market approval for at least 7 years (for drug products) or 11 years (for biologics) to qualify for negotiation. The program does not apply to orphan drugs that are approved to treat only one rare disease or condition.

The bill modifies these provisions so as to exclude any period in which a drug was an orphan drug from market approval calculations. It also excludes orphan drugs that are approved to treat more than one rare disease or condition from the program.

Reducing Medically Unnecessary Delays in Care Act of 2025

This bill requires Medicare coverage decisions, including prior authorization requirements and adverse coverage decisions, to be based on written clinical criteria that is developed in consultation with physicians.