In this edition of AcademyHealth’s Situation Report, we highlight uncertainty surrounding the future of ACA subsidies following competing visions for health care affordability. We also highlight new developments shaping health care and policy, including impeachment proceedings against HHS Secretary Kennedy, diverging House and Senate strategies to reshape insurance markets, expert warnings against new vaccine policies, regulatory guidance regarding health savings accounts, and more. Read on to understand the critical role health services researchers play in responding with evidence.
In this issue:
- House Democrat Introduces Articles of Impeachment Against RFK Jr.
- House GOP Health Care package will Exclude ACA Subsidy Extension
- Doctor Groups Form United Front Against Secretary Kennedy’s Efforts to Limit Vaccine Access
- New Guidance Opens Health Savings Account Access to More Consumers
- ACA Enrollment Currently Higher Than Last Year, Likely to Change Before Subsidies Expire
House Democrat Introduces Articles of Impeachment Against RFK Jr.
This week Representative Haley Steven’s (D-MI) filed formal articles of impeachment against Health and Human Services Secretary (HHS) Robert Kennedy. Rep. Steven’s, who has previously called on Kennedy to resign, said that Kennedy's repeated abuses of power, disregard for science, and pattern of misinformation left her no choice but to file impeachment articles. Some of the incidents cited in the filing include Kennedy’s funding cuts to lifesaving cancer research, misinformation about Tylenol, withdrawal of recommendations for COVID-19 vaccines among children and pregnant women, restructuring of the Advisory Committee on Immunization Practices (ACIP), and the removal of public comment for HHS rule making.
House GOP Health Care package will Exclude ACA Subsidy Extension
The GOP health care package that the House will be voting on next week will exclude ACA subsidy extensions following the longest government shutdown in history. While Mike Johnson (R-La.) claimed that the package will “reduce premiums for 100 percent of Americans who are on health insurance,” experts argue that the exclusion of the subsidies in the package will dramatically increase out of pocket health care costs for millions. Indeed, GOP leaders argued that only 22 million, or 7 percent, of Americans receive enhanced subsidies whereas the proposal they set forth would decrease health care premiums for all Americans. The proposals in question include drug price transparency, changes to the pharmacy benefit manager industry, and expansions to health savings accounts and related health care plans.
Experts argue that the bill is unlikely to pass the Senate without addressing the expiring subsidies. At the same time, the Senate on Thursday voted down two health care plans set forth by Republicans and Democrats, one of which would change the subsidies into health savings accounts for Americans on high-deductible plans while the other would extend the subsidies. At this point, higher ACA premiums are all but guaranteed for consumers next year. Bipartisan plans set forth by Republicans that include a temporary subsidy extension were heavily criticized by Republicans who claimed that the subsidies were too expensive. Moreover, they refused to vote to pass any subsidy extension that did not include prohibitions on abortion care under the Hyde Amendment. Several representatives have considered the impact of signing a discharge petition, which would force a vote on any given health care reform bill. While Representative Gregory Murphy (R-N.C.) has discouraged his fellow representatives from signing such a petition, for example, Representative Brian Fitzpatrick (R-Pa.) put forth a health care plan that includes a subsidy extension and is contemplating a discharge petition that would subsequently force his colleagues to vote on his plan. Moreover, House Minority Leader Hakeem Jeffries (D-N.Y.) is also aiming for moderate Republicans to approve his discharge petition, which includes a three year subsidy extension.
Health services researchers whose research exemplifies the importance of the subsidies in making health care affordable and accessible to low-income Americans can contact their representatives to emphasize the importance of the subsidies. Moreover, any research demonstrating any cost savings in overall health care spending that is associated with these subsidies could be particularly convincing to policymakers.
Doctor Groups Form United Front Against Secretary Kennedy’s Efforts to Limit Vaccine Access
During a press conference with representatives from six leading health organizations, experts responded to a vote by members of the new Advisory Committee on Immunization Practices (ACIP) to limit the use of hepatitis B vaccine in newborns saying children will die if those proposed changes take effect.
For over three decades, the ACIP had recommended vaccinating all healthy newborns against hepatitis B at birth, which contributed to a reduction in the number of hepatitis B infections in children by 99 percent. However, last week, the new ACIP, entirely comprised of appointees selected by RFK Jr., voted to recommend a dose of hepatitis B at birth only for babies born to birthing people testing positive for the virus or whose infection status is unknown. The committee decided that babies who are not vaccinated against hepatitis at birth should wait at least two months for their first dose.
Research shows, however, that blood tests are not always accurate, and that postponing hepatitis vaccines for two months could cause at least 1,400 preventable hepatitis B infections among children and hundreds of subsequent cases of liver cancer and preventable deaths. These changes add to several other actions threatening vaccine access such as planned FDA review of respiratory syncytial virus (RSV) vaccines, FDA proposals for new vaccine testing standards, and revisions to the Centers for Disease Control and Prevention’s immunization webpages.
In a rapidly evolving immunization policy landscape, and one that continues to restrict vaccine access, researchers fill an imperative role of generating and raising evidence, particularly to audiences that continue to seek it out.
New Guidance Opens Health Savings Account Access to More Consumers
The Treasury Department and IRS have shared updated guidance on health savings account (HSA) eligibility, prompted by this year’s recent spending bill, HR 1. For patients who receive health care through high-deductible health plans (HDHPs), direct primary care arrangements, or through Bronze and Catastrophic plans through or outside of insurance exchanges, will see changes to how they manage their out-of-pocket health expenses. The changes include the following:
- Patients may continue to use telehealth and remote care services prior to meeting their HDHP’s deductible and remain eligible to contribute to their HSA;
- Both Bronze and Catastrophic health plans purchased on or off the federal health exchange will qualify as HDHPs for HSA purposes; and
- Individuals enrolled in approved direct primary care service arrangements may contribute to HSAs and use those tax-free funds to pay the fees of such arrangements.
Under these changes, more Americans will have access to HSAs, allowing them to make tax-deductible contributions, see tax-free growth in the accounts, and make tax-free withdrawals for qualifying medical expenses. The IRS is seeking public comment on this Notice through March 6, 2026, from consumers, providers, insurers, and other stakeholders. Health services researchers can respond to this request for information and share evidence on how these new HSA provisions may impact health care affordability for consumers with HDHPs, particularly those who may be impacted if the ACA premium tax credits are not extended.
ACA Enrollment Currently Higher Than Last Year, Likely to Change Before Subsidies Expire
The number of Americans signing up for Affordable Care Act (ACA) health insurance for 2026 is higher than it was at this time last year, despite coverage likely to be more expensive due to the soon-to-expire ACA tax credits. This data from the Centers for Medicare and Medicaid Services (CMS) may show the opposite of what would be expected—higher costs generally lead to less people insured—but experts warn that the data will not be demonstrative of final total enrollment figures. While there is some variation in when people sign up for health insurance, most Americans who want insurance on January 1 purchase coverage between November 1 and December 15, and people who want their coverage to start after January 1 can select plans through January 15. A relatively higher number of enrollees may be attributed to a few factors. First, individuals currently enrolled in an ACA Marketplace plan are automatically enrolled for 2026. These people may be unaware that they were automatically enrollment or of the cost increase of their plan, leading some to cancel coverage later in the enrollment period. Second, people who are on the fence about canceling coverage may be considering options or holding out to see whether Congress extends the expiring tax credits. Lastly, people may have enrolled in a plan but will cancel coverage once the impact of the expired tax credits hits. This is especially true for folks enrolled in high-deductible, low- premium “catastrophic” health plans. The Senate is likely to vote today on both Democratic and Republican plans to address health care affordability. Republicans have already rejected the Democrats’ plan to extend the ACA subsidies, and Democrats are against Republicans’ plans to restrict abortion or funnel money to certain ACA Marketplace plans with health savings accounts.
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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