In this edition of AcademyHealth’s Situation Report, critical developments unfold with the Government Accountability Office (GAO) investigating potential illegal impoundments of funds by the Administration affecting the Agency for Healthcare Research and Quality (AHRQ), a cornerstone of federal health services research. This investigation follows actions that have dismantled AHRQ’s grantmaking capabilities, posing severe implications for research and patient outcomes nationwide. Concurrently, the early hurdles faced by RFK Jr.'s vaccine panel highlight complexities in public trust, and the reconciliation bill's Medicaid cuts threaten provider stability and patient access. In Minnesota, a $160 million Medicaid overhaul presents administrative challenges, while debates over ACA tax credit changes intensify concerns over health care access. These issues collectively threaten the resilience of our public health system and exacerbate disparities.
In today's issue:
- GAO Challenges AHRQ Impoundments
- Health Care Providers Brace for Changes Amidst Medicaid Cuts
- States Confront Major Challenges with Medicaid Overhaul and $160M Changes in Minnesota
- Decisions by New Vaccine Panel Create Confusion on Vaccine Access and Coverage
- ACA Tax Credit Changes: Scrutiny Intensifies as Potential Cuts Threaten Health care Access and Costs
GAO Challenges AHRQ Impoundments
The Agency for Healthcare Research and Quality (AHRQ) is known as the federal home of health services research. Since April 1, 2025, the Trump administration has instituted a policy that effectively dismantled AHRQ’s grantmaking operations, including terminating staff that legally process, evaluate, fund, and monitor the grant programs that are signed into law to improve health outcomes for patients across the country. On Monday, the Committee on Energy and Commerce, Subcommittee on Health Ranking Member Diana DeGette (D-CO) and Congresswoman Doris Matsui (D-CA) requested that the Government Accountability Office (GAO) investigate whether the Administration illegally withheld congressionally appropriated funds at AHRQ. You can read more about the investigation, and what it means for health services researchers, here.
As the home for the Friends of AHRQ, AcademyHealth is committed to advocating for the existence and funding of this essential agency so it can continue improving the quality of health care delivery in this country. If you’d like to support our ongoing advocacy efforts to advance better health and health care, please consider donating here.
Health Care Providers Brace for Changes Amidst Medicaid Cuts
Cuts to federal Medicaid funding will have acute impacts on local health facilities and the providers who serve them. Facilities that may already be dealing with higher labor costs and pressures associated with inflation will have to chart paths forward with lower reimbursements due to the near $1 trillion in cuts to Medicaid. Administrators are now tasked with maximizing the impact of non-revenue producing services such as outreach programs and case management while identifying new ways to cover health care. While many Medicaid changes are not scheduled to go into effect until 2027, some clinics and services have already been shuttered in anticipation of the cuts and more may be subsumed under wealthier health systems as capital diminishes.
Health services research plays an important role in understanding how people can continue to receive lifesaving, preventative, and routine care despite sweeping cuts to the Medicaid program. Moreover, as health systems begin to brace for big change, health services research can help inform administrators’ decisions and reveal equitable solutions.
States Confront Major Challenges with Medicaid Overhaul and $160M Changes in Minnesota
The largest overhaul of Medicaid in its 60-year history is placing significant new administrative and financial burdens on state and local governments. With approximately $1 trillion in federal cuts and new work requirements projected to leave over 10 million people uninsured, states must implement sweeping changes with limited resources. In Minnesota’s Stearns County, human services offices are already overwhelmed, processing nearly 300,000 pieces of Medicaid-related paperwork and handling 30,000 monthly calls. These numbers are expected to continue to climb under the new rules. Counties, many of which handle Medicaid eligibility processing, face escalating costs—$160 million annually in Minnesota alone—without corresponding increases in funding. Antiquated systems further complicate enrollment, and local officials warn that the flood of paperwork and tight implementation timelines could result in eligible individuals losing coverage due to administrative errors and delays.
This Medicaid overhaul highlights the need for health services research to evaluate how large-scale policy changes affect access, administrative capacity, and system performance. Researchers have an opportunity to study the downstream effects of reduced funding, increased eligibility complexity, and technological deficiencies on enrollment continuity, particularly among vulnerable populations. It also raises critical questions about the efficiency and equity of decentralized administration models, the human and financial costs of increased bureaucratic burden, and the role of outdated infrastructure in shaping health outcomes. These findings will be essential for informing evidence-based Medicaid reform and guiding investments in modernizing public health systems.
Decisions by New Vaccine Panel Create Confusion on Vaccine Access and Coverage
The first meeting of the newly appointed Advisory Committee on Immunization Practices (ACIP) had a shaky start, as the advisers to Secretary Kennedy discussed risks around COVID-19, hepatitis B, and MMRV shots. Notably, the newest members that RFK Jr. appointed cited unvetted studies and dismissed concerns about the lack of rigorous review, all while insisting they were upholding the “gold standard” science. Experts note that raising doubts about vaccine safety and amplifying unfounded arguments can risk destabilizing public health progress and undercut scientific evidence-based interventions. Indeed, the new panel members struggled with procedural questions and didn’t appear to always understand what they were voting on.
Ultimately, the panel voted to recommend limiting the availability of a combined shot for measles, mumps, rubella, and varicella, and narrowly defeated a call to require a prescription for a COVID-19 booster. However, the panel also voted that the CDC drop its recommendation that most adults get a COVID-19 vaccine, instead recommending vaccination for adults 65 and older and younger people, subject to “shared decision-making,” calling for patients to speak with a clinician about risks and benefits. Increasing numbers of experts have begun questioning the process and quality of the data that ACIP reviewed, while many clinicians have begun to advocate for using guidance from medical associations, given the poor scientific rigor shared within the ACIP meetings. These rulings create further confusion for individuals looking to get COVID-19 vaccinations for themselves and their children, as well as questions on whether their insurance will cover the vaccines, and under what circumstances. Researchers can continue to share the evidence around the safety and proper timing of vaccines with individuals in their communities, as well as state and federal policymakers.
ACA Tax Credit Changes: Scrutiny Intensifies as Potential Cuts Threaten Health Care Access and Costs
Proposed changes to the Affordable Care Act (ACA) tax credits, which help make premiums affordable to around 22 million enrollees, are under intense scrutiny, with potential revisions poised to significantly impact the health care access and cost landscape. Republican leaders are considering restructuring these credits, potentially eliminating zero-premium plans and limiting tax credits to render enrollees above a certain income limit ineligible. While some Republicans seem to be open to extending these subsidies, many are concerned about the estimated $335 billion cost in the next decade.
The importance of these subsidies is highlighted by the situation in Washington State, where about 80,000 people might forgo individual market insurance without them, causing an average premium rate hike of 21 percent for state exchange plans. Furthermore, the Kaiser Family Foundation (KFF) estimates that if the subsidies expire, premiums for over 20 million ACA enrollees could rise by more than 75 percent, potentially straining the overall health care system and increasing the uninsured rate. The renewal of subsidies also faces political hurdles, particularly debates over the inclusion of the Hyde Amendment, which restricts federal funding for abortions. Health services researchers can play an important role in translating the cost trade off from not extending these subsidies and the subsequent impact on the overall health care system to policymakers.
Previous Editions
This is the latest in a series of Situation Report updates from AcademyHealth. You can find prior issues here.
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