Health Care Week in Review | House Passes Three-Year Extension of ACA Premium Tax Credits; CDC Updates Childhood Immunization Schedule

Below is Alston & Bird’s Health Care Week in Review, which provides a synopsis of the latest news in health care regulations, notices, and guidance; federal legislation and congressional committee action; reports, studies, and analyses; and other health policy news. 

Regulations, Notices & Guidance

• On December 22, 2025, the Centers for Medicare & Medicaid Services (CMS) released guidance entitled, Working Families Tax Cuts Act (WFTCA), Section 71302: Guidance for Plan Year 2026.This guidance focuses on Section 71302 of the Working Families Tax Cut Act (WFTCA), which disallows premium tax credits (PTCs) for individuals who are ineligible for Medicaid due to their immigration status and those who have annual household income below 100 percent of the federal poverty level (FPL). This guidance outlines the impact of this provision on the Affordable Care Act (ACA) Exchanges.
• On December 22, 2025, the Food and Drug Administration (FDA) released guidance entitled, Formal Dispute Resolution and Administrative Hearings of Final Administrative Orders Under Section 505G of the Federal Food, Drug, and Cosmetic Act. This guidance provides recommendations for industry and review staff on the formal dispute resolution (FDR) and administrative hearings procedures for resolving scientific or medical disputes between the Center for Drug Evaluation and Research (CDER) and requestors and sponsors of drugs that will be subject to a final administrative order under the Federal Food, Drug, and Cosmetic (FD&C) Act. This guidance finalizes the draft guidance of the same title issued on June 23, 2023.
• On December 23, 2025, the Assistant Secretary for Technology Policy and Office of the National Coordinator for Health Information Technology (ASTP/ONC) released a proposed rule entitled, Health Data, Technology, and Interoperability: ASTP/ONC Deregulatory Actions to Unleash Prosperity. This proposed rule focuses on deregulatory actions identified in Department of Health and Human Services (HHS) regulations related to health information technology (IT) standards, implementation specifications, certification criteria and programs, and information blocking. This proposed rule seeks to reduce burden, offer flexibility to developers and providers, and support innovation through the removal and revisions of certain certification criteria and regulatory provisions. This proposed rule also seeks to address reported misuse and abuse of information blocking definitions and exceptions.
• On December 23, 2025, FDA released a notice entitled, Medical Devices; Exemption from Premarket Notification: Radiology Computer-Aided Detection and/or Diagnosis Devices and Computer-Aided Triage and Notification Devices. FDA is announcing that it has received a petition requesting partial exemption from the premarket notification requirements for radiology computer-aided detection or diagnosis devices and computer-aided triage and notification devices. Specifically, the petition requests exemption from the premarket notification requirements for the following generic device types when certain conditions described in the petition are met: (1) radiological computer-assisted diagnostic software for lesions suspicious of cancer; (2) medical image analyzers; radiological computer aided triage and notification software; and (3) radiological computer-assisted detection and diagnosis software.
• On December 23, 2025, FDA released a notice entitled, Over-the-Counter Monograph Drug User Fee Amendments—OTC Monograph Order Request Fee Rates for Fiscal Year 2026. The FD&C Act, as amended by the Over-the-Counter Monograph Drug User Fee Amendments, authorizes FDA to assess and collect user fees from qualifying manufacturers of over-the-counter (OTC) monograph drugs and submitters of OTC monograph order requests (OMOR) for fiscal years (FY) 2026 through 2030. In this notice, FDA is announcing the OMOR fee rates for FY 2026. FDA plans to announce the FY 2026 OMUFA facility fee rates in a subsequent Federal Register notice.
• On December 23, 2025, CMS released guidance entitled, Exercise of Enforcement Discretion until Calendar Year 2029 for Medicaid Interested Parties Advisory Group. The Center for Medicaid and CHIP Services (CMCS) is issuing this CMCS Informational Bulletin (CIB) to announce that, until January 1, 2029, CMS does not anticipate taking enforcement action against states with respect to the deadline for the interested parties’ advisory group to initially convene and provide recommendations to the Medicaid agency. Through this CIB, CMS is providing states with additional time while they work to comply with the revised Medicaid Advisory Committee (MAC) and new Beneficiary Advisory Council (BAC) requirements, so states may then determine if a standalone interested parties advisory group is appropriate in their state. CMS will use this time to consider proposing changes to these requirements in future notice and comment rulemaking.
• On December 23, 2025, CMS released guidance entitled, Prohibition on Termination of Enrollment Due to Incarceration (Division G, Title I, Section 205, of the Consolidated Appropriations Act, 2024). The purpose of this CMCS CIB is to highlight statutory changes that impact Medicaid and Children’s Health Insurance Program (CHIP) eligibility requirements for individuals who are inmates of public institutions. The Consolidated Appropriations Act, 2024 amended the Social Security Act to expand the populations for which states are prohibited from terminating Medicaid and CHIP eligibility to all individuals who are inmates of a public institution. Effective January 1, 2026, states must ensure they do not terminate Medicaid eligibility for an individual or CHIP eligibility for any targeted low-income child or pregnant woman when only due to their status as an inmate of a public institution.
• On December 30, 2025, HHS released a rule entitled, Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications. The Drug Enforcement Administration (DEA), jointly with HHS, is issuing a fourth extension of telemedicine flexibilities for the prescribing of controlled medications through December 31, 2026.
• On December 30, 2025, CMS released guidance entitled, 2027 Updates to the Child and Adult Core Health Care Quality Measurement Sets and Mandatory Reporting Guidance. CMS is issuing this annual State Health Official (SHO) letter to provide the 2027 updates to the Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP (Child Core Set) and the Core Set of Adult Health Care Quality Measures for Medicaid (Adult Core Set). The SHO letter also outlines expectations for 2027 Core Set quality measure reporting, due to CMS by December 31, 2027, and includes updates to the 2026 Core Sets.
• On December 31, 2025, FDA released a notice entitled, Revocation of Two Authorizations of Emergency Use of In Vitro Diagnostic Devices for Detection and/or Diagnosis of COVID-19; Availability. FDA is announcing the revocation of the Emergency Use Authorizations (EUAs) issued to Pfizer Inc. for the Lucira by Pfizer COVID-19 & Flu Test and Lucira by Pfizer COVID-19 & Flu Home Test. FDA revoked the authorizations under the FD&C Act as requested by the EUA holder. The revocations, which include an explanation of the reasons for each revocation, are reprinted at the end of this notice.
• On January 2, 2026, HHS released a proposed rule entitled, Restoring Flexibility in the Child Care and Development Fund. HHS and the Administration for Children and Families (ACF) propose to amend the Child Care and Development Fund (CCDF) regulations to reduce costs and burden for states and territories administering the program. It proposes rescinding the requirements to limit family co-payments to seven percent of family income, provide some direct services through grants or contracts, pay providers based on child’s enrollment, and pay providers prospectively that were added to the CCDF regulations in the March 2024 final rule entitled, Improving Child Care Access, Affordability, and Stability in the Child Care and Development Fund (CCDF).
• On January 2, 2026, the Health Resources and Services Administration (HRSA) released a notice entitled, Update to the Women's Preventive Services Guidelines. HRSA published a Federal Register notice on October 1, 2025, with proposed updates to the HRSA-supported Women's Preventive Services Guidelines. The proposed updates specifically relate to recommendations for screening for cervical cancer. Recommendations to update the guidelines are developed under a HRSA-funded cooperative agreement, the Women's Preventive Services Initiative (WPSI), for consideration by HRSA. Under this agreement, WPSI convenes expert health professionals to conduct rigorous reviews of the evidence and develop draft recommendations for HRSA's consideration. After consideration of public comment, HRSA has accepted the recommendations as revised and detailed in this notice. Under applicable law, non-grandfathered group health plans and health insurance issuers offering non-grandfathered group and individual health insurance coverage must include coverage, without cost sharing, for certain preventive services, including those provided for in the HRSA-supported guidelines.
• On January 6, 2026, FDA released guidance entitled, General Wellness: Policy for Low Risk Devices. FDA is issuing this guidance document to provide clarity to industry and FDA staff on the Center for Devices and Radiological Health’s (CDRH’s) compliance policy for low-risk products that promote a healthy lifestyle. This guidance does not apply to products regulated by other FDA Centers or to combination products.
• On January 6, 2026, FDA released guidance entitled, Clinical Decision Support Software. FDA has long regulated software that meets the definition of a device in section 201(h) of the FD&C Act, including software that is intended to provide decision support for the diagnosis, treatment, prevention, cure, or mitigation of diseases or other conditions. This guidance clarifies the scope of FDA’s oversight of clinical decision support software intended for health care professionals (HCPs) as devices.
• On January 9, 2026, FDA released draft guidance entitled, Use of Bayesian Methodology in Clinical Trials of Drug and Biological Products. This draft guidance provides guidance to sponsors and applicants submitting investigational new drug applications (INDs), new drug applications (NDAs), biologics licensing applications (BLAs), or supplemental applications on the appropriate use of Bayesian methods in clinical trials. Bayesian methods can be used in various ways in clinical trials, including: (1) to govern the timing and adaptation rules for an interim analysis in an adaptive design; (2) to inform design elements (e.g., dose selection) for subsequent clinical trials; or (3) to support primary inference in a trial. The primary focus of this guidance is on the use of Bayesian methods to support primary inference in clinical trials intended to support the effectiveness and safety of drugs.
• On January 9, 2026, CMS released a notice entitled, Notice of Opportunity for Hearing on Compliance of Minnesota State Plan Provisions Concerning Program Integrity and Fraud, Waste, and Abuse With Title XIX (Medicaid) of the Social Security Act. This notice announces the opportunity for an administrative hearing concerning the finding of the CMS Administrator that the State of Minnesota is substantially out of compliance with federal requirements in administering its Medicaid state plan. CMS notes that the Minnesota Medicaid agency fails to adequately identify, prevent, and address fraud, waste, and abuse in its Medicaid program. This finding will be the basis for withholding federal financial participation (FFP) from Minnesota’s Medicaid program. The withholding will end when the Minnesota Medicaid agency fully and satisfactorily implements a corrective action plan (CAP) to bring its program integrity operations into compliance with federal requirements.

Event Notices

Please note that two asterisks (**) preceding the item indicate a new event. 

• January 12-14, 2026: The National Institutes of Health (NIH) announced a meeting of the National Institute of Diabetes and Digestive and Kidney Diseases. This is a virtual meeting with some sessions open to the public.
• **January 13, 2026: The Department of Veterans Affairs (VA) announced a meeting of the Joint Biomedical Laboratory (BL) and Clinical Science (CS) Research and Development Services Scientific Merit Review Board. This is a virtual meeting with some sessions open to the public.
• January 21, 2026: NIH announced a meeting of the National Advisory Dental and Craniofacial Research Council. This is a virtual meeting with some sessions open to the public.
• January 22, 2026: FDA announced a meeting of the Tobacco Products Scientific Advisory Committee. This is a hybrid meeting open to the public.
• January 22, 2026: NIH announced a meeting of the National Institute on Deafness and Other Communication Disorders. This is a virtual meeting open to the public.
• **January 23, 2026: VA announced a meeting of the Cooperative Studies Scientific Evaluation Committee. This is a virtual meeting with some sessions open to the public.
• January 23, 2026: NIH announced a meeting of the National Center for Complementary & Integrative Health. This is a virtual meeting open to the public.
• January 26, 2026: NIH announced a meeting of the Eunice Kennedy Shriver National Institute of Child Health & Human Development. This is a virtual meeting with some sessions open to the public.
• **January 27, 2026: NIH announced a meeting of the National Advisory Council for Nursing Research. This is a virtual meeting open to the public.
• January 27, 2026: NIH announced a meeting of the National Institute of Arthritis and Musculoskeletal and Skin Diseases. This is a virtual meeting with some sessions open to the public.
• January 27, 2026: NIH announced a meeting of the National Advisory Council on Aging. This is a virtual meeting with some sessions open to the public.
• January 28, 2026: NIH announced a meeting of the National Diabetes and Digestive and Kidney Diseases Advisory Council. This is a virtual meeting with some sessions open to the public.
• **January 28, 2026: The Centers for Disease Control and Prevention (CDC) announced a meeting of the Subcommittee on Procedures Reviews of the Advisory Board on Radiation and Worker Health. This is a virtual meeting open to the public.
• January 28, 2026: NIH announced a meeting of the National Institute of Biomedical Imaging and Bioengineering. This is a virtual meeting with some sessions open to the public.
• January 29, 2026: NIH announced a meeting of the National Center for Advancing Translational Sciences. This is a virtual meeting with some sessions open to the public.
• January 29, 2026: NIH announced a meeting of the Office of AIDS Research Advisory Council. This is a virtual meeting open to the public.
• January 30, 2026: NIH announced a meeting of the NIH Clinical Center Research Hospital Board. This is a hybrid meeting open to the public.
• **February 6, 2026: NIH announced a meeting of the National Advisory Council on Minority Health and Health Disparities. This is a virtual meeting open to the public.
• **February 6, 2026: NIH announced a meeting of the National Cancer Advisory Board Ad hoc Working Group on Extramural Research Concepts and Programs. This is a hybrid meeting open to the public.
• February 8-10, 2026: NIH announced a meeting of the National Institute of Environmental Sciences. This is a hybrid meeting with some sessions open to the public.
• February 9-10, 2026: NIH announced a meeting of the Fogarty International Center Advisory Board. This is a hybrid meeting with some sessions open to the public.
• February 9-10, 2026: NIH announced a meeting of the National Library of Medicine. This is a virtual meeting with some sessions open to the public.
• **February 10, 2026: FDA announced a roundtable discussion with small tobacco product manufacturers to solicit input on premarket tobacco product application (PMTA) submissions for electronic nicotine delivery systems (ENDS) products. This is a hybrid meeting open to the public.
• **February 11, 2026: NIH announced a meeting of the National Advisory Neurological Disorders and Stroke Council. This is a virtual meeting open to the public.
• **February 13, 2026: NIH announced a meeting of the National Advisory Eye Council. This is a virtual meeting open to the public.
• March 18, 2026: NIH announced a meeting of the National Institute of Environmental Health Sciences. This is a hybrid meeting with some sessions open to the public.
• **March 18, 2026: NIH announced a meeting of the National Advisory Mental Health Council. This is a virtual meeting open to the public.
• April 7, 2026: NIH announced a meeting of the Advisory Committee on Research on Women’s Health. This is a hybrid meeting open to the public.
• April 17, 2026: NIH announced a meeting of the National Center for Complementary & Integrative Health. This is a hybrid meeting with some sessions open to the public.
• March 30-31, 2026: NIH announced a meeting of the National Institute of Diabetes and Digestive and Kidney Diseases. This is a hybrid meeting with some sessions open to the public.
• March 30-31, 2026: NIH announced a meeting of the National Institute on Aging. This is a hybrid meeting with some sessions open to the public.
• May 4, 2026: NIH announced a meeting of the Eunice Kennedy Shriver National Institute of Child Health & Human Development. This is a hybrid meeting open to the public.
• May 13, 2026: NIH announced a meeting of the National Institute on Aging. This is an in-person meeting with some sessions open to the public.
• May 13, 2026: NIH announced a meeting of the National Diabetes and Digestive and Kidney Diseases Advisory Council. This is a hybrid meeting with some sessions open to the public.
• June 1-2, 2026: NIH announced a meeting of the Fogarty International Center Advisory Board. This is a hybrid meeting with some sessions open to the public.
• June 5, 2026: NIH announced a meeting of the Eunice Kennedy Shriver National Institute of Child Health & Human Development. This is a hybrid meeting with some sessions open to the public.
• September 10-11, 2026: NIH announced a meeting of the Fogarty International Center Advisory Board. This is a hybrid meeting with some sessions open to the public.
• September 15-16, 2026: NIH announced a meeting of the National Advisory Council on Aging. This is a hybrid meeting with some sessions open to the public.

Reports, Studies & Analyses

• On December 22, 2025, the HHS Office of Inspector General (OIG) released a report entitled, Nine of Thirty Selected Assisted Living Facilities Did Not Comply With Terms and Conditions and Federal Requirements for Expending Provider Relief Fund Payments. The report examined whether 30 assisted living facilities (ALFs) expended taxpayer funds in accordance with federal and Provider Relief Fund (PRF) program requirements. OIG found that seven ALFs claimed a total of $283,000 in unallowable PRF expenditures, and two ALFs inaccurately reported $11 million in lost revenues. These deficiencies occurred despite ALFs attesting to the PRF terms and conditions and ongoing guidance from HRSA. The ALFs made clerical errors when reporting expenditures, misinterpreted HRSA guidance, did not maintain sufficient documentation to support reported expenditures, and lacked procedures to verify the accuracy of lost revenue calculations. OIG made two recommendations to HRSA, including that it: (1) require the seven ALFs that claimed a total of $283,000 in unallowable PRF expenditures return any unallowable expenditures and lost revenue amounts to the federal government or ensure that the ALFs properly account for these expenditures and lost revenues; and (2) require the two ALFs that inaccurately reported $11 million in lost revenues identify and return any PRF payments used to offset inaccurately calculated lost revenues or replace them with allowable unreimbursed lost revenues or eligible expenses. HRSA concurred with OIG’s recommendations.
• On December 23, 2025, OIG released a report entitled, Medicaid Agencies Made Millions in Unallowable Capitation Payments to Managed Care Organizations on Behalf of Deceased Enrollees. OIG assessed the value of Medicaid capitation payments made to managed care organizations (MCOs) on behalf of deceased enrollees. Based on a review of 100 statistically sampled capitation payments, OIG estimated that Medicaid agencies made $207,501,380 in unallowable capitation payments to MCOs for deceased enrollees during the audit period. OIG found that 99 of the 100 sampled payments were made after the enrollee’s death. For 50 of these payments, Medicaid agencies had recovered the overpayments before OIG provided the sample for review. The remaining 49 payments were either not recovered or were recovered only after OIG notified the agencies. As a result, OIG estimated that there was approximately $207,501,380 in unallowable capitation payments during the audit period.
  
  OIG made two recommendations to CMS, including: (1) provide the Medicaid agencies covered by the audit with OIG’s matched Transformed Medicaid Statistical Information System (T-MSIS) data in order to review the capitation payments and take appropriate action to recover any unallowable payments; and (2) identify opportunities to work with Medicaid agencies to ensure that provisions of the One Big Beautiful Bill Act are properly implemented. CMS concurred with the first recommendation and did not clearly indicate concurrence or nonconcurrence with the second recommendation.
• On January 5, 2026, the Government Accountability Office (GAO) released a report entitled, Federal Awards: Selected Programs Did Not Fully Include Identified Practices to Enhance Oversight and Fraud Prevention. GAO examined how five federal programs oversee and prevent fraud, waste, and abuse in grants, contracts, and loans. The review found that four programs, including HHS’ Health Center Program, did not consistently incorporate all nine requirements and leading practices identified by GAO. GAO outlined several recommendations, including that the HHS Secretary: (1) finalize HHS policies documenting how often programs should conduct fraud risk assessments; (2) ensure that an agencywide risk profile for HHS is documented; (3) ensure that a program-specific risk profile for the Health Center Program is documented; (4) ensure that an anti-fraud strategy for the Health Center Program is documented; and (5) ensure that procedures to monitor fraud risk management activities for the Health Center Program are documented.

Hearings & Markups

• On January 8, 2026, the House Energy & Commerce Committee Health Subcommittee held a hearing entitled, Legislative Proposals to Support Patient Access to Medicare Services. Witnesses included: Ms. Susan Van Meter, President, American Clinical Laboratory Association; Ms. Connie Sullivan, President and CEO, National Home Infusion Association; Mr. Thomas Ryan, President and CEO, American Association for Homecare; and Mr. David Lipschutz, JD, Attorney and Co-Director of Law and Policy, Center for Medicare Advocacy. The hearing focuses on several bills, including H.R. 6210, the Senior Savings Protection Act; H.R. 6361, the Ban AI Denials in Medicare Act; H.R. 5243, To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage; H.R. 2902, the Supplemental Oxygen Access Reform (SOAR) Act of 2025; H.R. 1703, the Choices for Increased Mobility Act of 2025; H.R. 2005, the DMEPOS Relief Act of 2025; H.R. 5347, the Health Care Efficiency Through Flexibility Act; H.R. 2172, the Preserving Patient Access to Home Infusion Act; H.R. 2477, the Portable Ultrasound Reimbursement Equity Act of 2025; and H.R. 5269, the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act of 2025.

Other Health Policy News

• On December 22, 2025, CMS announced a new drug pricing model for GLP-1 medications in the Medicare Part D and Medicaid programs called the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) Model. Under this model, CMS will negotiate directly with participating GLP-1 manufacturers on prices for participating state Medicaid programs and Part D plans. This model will likely serve as the means by which the Administration effectuates Most-Favored-Nation (MFN) drug pricing deals it made with Eli Lilly and Novo Nordisk in November.
  
  Additional information can be found here.
• On December 29, 2025, the U.S. District Court for the District of Maine issued a preliminary injunction preventing the federal government from implementing the 340B Rebate Model Pilot Program until further legal proceedings take place. The court ruled that the government had likely not sufficiently developed the administrative record to clear the Administrative Procedure Act’s requirements. The government appealed the court’s injunction to the U.S. Court of Appeals for the First Circuit.
  
  While the government moved both the district court and the First Circuit to stay the injunction pending appeal, both courts declined to do so. Accordingly, the 340B Rebate Model Pilot Program remains enjoined.
  
  The district court’s order on the preliminary injunction can be found here. The First Circuit’s order denying the motion to stay the injunction can be found here. Additional information on the 340B Rebate Model Pilot Program can be found here.
• On December 29, 2025, CMS announced that all 50 states will be receiving funding from the Rural Health Transformation Program (RHTP) established by the One Big Beautiful Bill Act. Awards for FY 2026 averaged $200 million per state, with a range of $147 million to $281 million. CMS also announced that it was establishing the Office of Rural Health Transformation (ORHT) within CMCS to oversee and implement RHTP. ORHT will also provide technical assistance and coordinate federal and state partnerships in implementing RHTP.
  
  A press release can be found here.
• On January 5, 2026, a federal appeals court upheld a lower court decision to prevent the NIH from implementing a policy capping indirect cost rates at 15 percent of an award’s value. The court ruled that the policy contradicted a congressional mandate in an appropriations law that prevented the Administration from significantly deviating from negotiated rates.
  
  The decision can be found here.
• On January 5, 2026, CDC announced that it would be adopting recommendations to more closely align the U.S. childhood immunization schedule with other “peer, developed countries.” This includes adopting three distinct categories for immunization recommendations, all of which will still require insurance plans to cover their administration without cost-sharing: (1) Immunizations Recommended for All Children; (2) Immunizations Recommended for Certain High-Risk Groups or Populations; and (3) Immunizations Based on Shared Clinical Decision-Making.
  
  A full list of the vaccines included in each category can be found here.
  
  CDC’s press release can be found here. A fact sheet can be found here.
• The Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA) have extended the temporary telemedicine flexibilities for prescribing controlled substances through December 31, 2026. This rule permits all DEA-registered prescribers to remotely prescribe Schedules II-V controlled substances without an in-person medical evaluation.
  
  DEA and SAMHSA previously finalized new rules allowing for the prescription of Schedules III-V controlled substances approved for the treatment of opioid use disorder (OUD) via telemedicine, including an audio-only telemedicine encounter, and for the prescription of Schedules II-V controlled substances to VA patients if another VA practitioner has already conducted an in-person medical evaluation.
  
  This rule is separate from the Medicare telehealth flexibilities, which are still set to expire at the end of this month.
  
  The full notice extending the flexibilities can be found here.
• NIH has reached a settlement in its ongoing litigation with the American Public Health Association (APHA) to reconsider grant applications that were denied for reasons related to the Administration’s directive to not fund research connected to diversity, equity, and inclusion (DEI) or “gender ideology.”  Under this settlement, the NIH must have reviewed and made decisions for non-competing renewals by December 29, 2025. New award applications that have been reviewed by a study section and an advisory council must receive decisions by January 12, 2026. Applications reviewed by study sections alone must receive decisions by April 14, 2026, and those not yet reviewed by a study section must receive decisions by July 31, 2026. Notably, NIH is not obligated by the settlement to fund any particular application nor is NIH’s discretion over funding decisions affected.
  
  The settlement text can be found here.
• On January 8, 2026, the U.S. House of Representatives voted 230-196 in favor of a bill to extend EPTCs for ACA Marketplace plans for three years, with 17 Republicans joining all Democrats in favor.
  
  Despite this progress, the future of the EPTCs remains in doubt. The Senate already voted down a three-year extension in December, and the 2026 coverage year has begun without the EPTCs in place. However, there are ongoing efforts in the Senate to negotiate a proposal that may include a two-year, retroactive extension of the EPTCs along with minimum premium payment requirements and a cap on income eligibility. The proposal may also include cost-sharing reductions for ACA Silver plans and expanded access to health savings accounts (HSAs). A draft of this proposal has yet to be released publicly but is the likelier of the two bills to potentially become law.

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