Health Legislative Priorities for the Remainder of 2025
October 17, 2025 | Catherine Murphy
Note: At the time of writing, fiscal year (FY26) appropriations remain underway as legislators work to negotiate a continuing resolution (CR) to re-open the government from a partial shutdown that began at the start of the fiscal year on October 1. The situation remains fluid as Congress works on funding for FY26.
As we enter the last quarter of 2025, members of Congress have plenty of work to carry them through the new year. Currently, the federal government is experiencing a shutdown due to a failure to pass a CR or finalize FY26 appropriations bills. In Washington, D.C., our crystal balls, which often help us de-mystify the potential actions of Congress, have gotten a bit cloudy. Still, we know that beyond the shutdown, members will seek passage for a number of extensions and reauthorizations, likely tied to appropriations and other large legislative packages.
Medicaid and the Affordable Care Act
What is on the table within these negotiations? First, within the context of overall government funding, Democrats hope to repeal some of the potential cuts to Medicaid funding included in H.R.1, One Big Beautiful Bill. This legislation could create $500 million in cuts to Medicaid. Generally, Republicans remain staunch supporters of these cuts, while Democrats oppose any loss of Medicaid funding.
Also generating considerable traction is the conversation around the Affordable Care Act’s advance premium tax credits (APTCs), set to expire at the end of 2025. Currently, 92% of enrollees through the marketplace use APTCs to pay insurance premiums. The priority of an extension varies by party: Democrats want to include an extension in a short-term CR, while Republican leadership hopes to shift focus to this extension after ensuring the government is, at least temporarily, funded. Other priorities are circulating in various proposed pieces of legislation.
Ongoing Priorities from Proposed CRs
The proposed CRs from both parties address ongoing priorities, including: an extension of the Special Diabetes Program for Type 1 Diabetes and the Special Diabetes Program for Indians, extension of Community Health Centers and Teaching Health Center funding, a delay of scheduled cuts for Medicaid Disproportionate Share Hospitals, and a temporary extension of Medicare telehealth flexibilities at Federally Qualified Health Centers and Rural Health Clinics (while popular, it is unlikely to see a permanent extension of these COVID-era flexibilities, as the Congressional Budget Office estimates that these would cost $25 billion over 10 years).
340B Drug Pricing Program and Medicare
Senator Cassidy (R-LA), Chair of the Senate HELP Committee, has shared his priorities in examining the 340B Drug Pricing program as well as looking into Medicare upcoding, a practice that makes patients look sicker to maximize billing. Examining waste, fraud, and abuse in Medicare has been a hot topic over the last few years, but legislation to alter the program has not yet gained significant traction.
Site-Neutral Payments
In another bipartisan priority, legislators are eyeing site-neutral payments, a practice of equalizing reimbursement for the same service rendered, regardless of the location. Currently, services like imaging and lab work can be reimbursed at a higher rate when performed in a hospital setting rather than a physician’s office.
Pandemic All-Hazards Preparedness Act
Among many legislators, reauthorization of the Pandemic All-Hazards Preparedness Act (PAHPA) is a priority. Many programs from this act were operating on a temporary extension included in the FY25 year-long CR. This legislation is particularly important, as two major priorities for ASTHO — the Hospital Preparedness Program and Public Health Emergency Preparedness Program — are authorized through this legislation. These key programs provide funding for state, local, and territorial health departments to prepare for and respond to emergencies in their community.
Other Insights from Last December’s Health Package
One additional window into legislator priorities is last year’s December health package, which ultimately did not pass. Still, provisions included and subsequently removed from the end-of-year CR underscore what legislators are closely watching, most of which has already been introduced in legislation, and some of which has passed in packages over the last 10 months: Pharmacy Benefit Manager reform, a pay increase for Medicare providers, and funding extensions for Community Health Centers and other programs.
Ultimately, last year’s December legislative package failed due to cost concerns and opposition from the incoming president, but the ongoing prioritization of these items and the passage of some into law show that if another late-year health package arises, its provisions are likely to remain salient on the negotiation table even if they do not become law this year.
Outlook
While Congressional leaders on both sides of the aisle share a vast majority of these priorities, it is not likely that many will gain traction until the government shutdown ends. ASTHO will continue to track member priorities, meet with legislators and staff to underscore the importance of funding for public health programs, and share how federal funding empowers state health departments to support their jurisdictions.