In this edition of AcademyHealth’s Situation Report, we explore continued debates over ACA tax credits, growing uncertainty surrounding federal research funding, and newly proposed federal actions that could reshape vaccine policy and the public health workforce. We also spotlight urgent concerns about the Department of Education’s proposed redefinition of “professional fields,” which could significantly affect public health degree programs and the future health workforce. If you would like to support our advocacy work, including the Situation Report, we are participating in Giving Tuesday. Learn more about how you can support us here.
In today’s issue:
- Support Unclear for Proposed Plan for Direct Payments in Place of ACA Tax Credits
- Funding Uncertainty Continues After Government Shutdown
- Colleges and Associations Call to the Field to Protect Public Health Professional Degrees
- Proposed Vaccine Policies Alarm Manufacturers, Experts; ACIP Set to Discuss
- Chiles v. Salazar Highlights Growing Threats to Science in Policymaking
- We Want to Keep Producing the Situation Report – Your Support Can Help!
Support Unclear for Proposed Plan for Direct Payments in Place of ACA Tax Credits
Senate Republicans are looking into ways to send funding directly to consumers in place of extending the Affordable Care Act (ACA) tax credits. President Trump voiced support for direct payments, telling Republicans not to “waste” time negotiating an extension deal. Senator Cassidy, Chair of the Senate Health, Education, Labor and Pensions Committee, favors direct cash payments, but experts warn that this proposal could cause a “death spiral” where healthier consumers would drop coverage and use the payment for out-of-pocket costs, leaving sicker and more expensive patients with very high premiums. Senator Cassidy’s plan—which has not yet been introduced—would allow people who purchase bronze plans on the ACA marketplace to receive a pre-taxed Health Savings Account (HSA) partly funded by the expired tax credits. While bronze plans have higher deductibles and lower premiums, funds in an HSA cannot be used to pay monthly premiums. Senator Cassidy’s proposal would not cover all Americans who benefit from the ACA subsidies; 22.4 million Americans benefit from the subsidies, while only 7.2 million Americans were enrolled in a bronze plan in 2025. Senate Majority Leader Thune suggested still being open to bipartisan negotiations for an extension of the subsidies in exchange for stronger abortion restrictions under the Hyde Amendment. House Republicans are looking at other options, including a one-year extension of the subsidies with minor changes implemented in 2026. It’s unclear where most members of both parties stand in relation to these largely vague proposals, but as of now the parties appear to be sticking to the self-imposed vote deadline of mid-December.
Funding Uncertainty Continues After Government Shutdown
Even as health department employees returned to work last week after the end of the longest government shutdown in United States history, research scientists are facing even longer delays for research funds to be dispersed. Most notably affected are researchers in labs who rely on National Institutes of Health (NIH) funding for their projects, as the NIH faces over a month of grant application review to catch up on. Moreover, some researchers opted to wait to submit grant applications until the government shutdown lifted, causing similarly lengthy delays. The Department of Health and Human Services (HHS) did not respond to inquiries on how long they anticipate beginning grant funding dispersal to take, and while some university programs can cover the funding gaps for now, there are limits to what extent and how long they can fill in the gaps.
While the impacts of delayed grant funding are manifold, one particularly concerning potential outcome is stymied scientific innovation. Some researchers may opt for more sure funding topics and projects that may be less cutting edge, but more likely to be grant-awarded.
The White House has indicated that they could put a healthcare-related bill forward while keeping the budget reconciliation option open. Health services researchers should continue to track updates on a potential health-related bill while also aiming to make contact with their project officers for any NIH funded work. If the shutdown caused any missed submissions or communications, researchers should ensure their project officers are briefed.
Colleges and Associations Call to the Field to Protect Public Health Professional Degrees
As proposed under the budget reconciliation bill, the Department of Education is considering redefining “professional fields” to remove public health degrees and many health professional degrees. This would limit the field’s access to federal support, which would erode the pipeline for the health care workforce. The Association of Schools & Programs of Public Health (ASPPH) wrote a coalition letter to the Department of Education’s Reimagining and Improving Student Education (RISE) Committee highlighting these concerns, but this is something that all health care advocates and degree holders need to be highlighting to their Members of Congress.
Proposed Vaccine Policies Alarm Manufacturers, Experts; ACIP Set to Discuss
Under the direction of HHS Secretary Kennedy, health authorities are considering how to discourage or ban vaccines that rely on aluminum and break up vaccines that protect against multiple illnesses in a single shot, alarming vaccine manufacturers and experts. Aluminum in vaccines is used to boost the recipient’s immune response and has been repeatedly proven safe across large studies reviewing multiple vaccines. Vaccine makers note that replacing aluminum would require significant time and funding, and developing new alternatives to several key vaccines would impact a substantial share of the shots on the US childhood vaccine schedule. Ultimately, experts note that the rapid changes the administration seeks could make certain shots less available and protection against dangerous diseases could wane.
Both policy decisions run contrary to evidence on vaccine safety and efficacy. Industry leaders note that the cost of reformulation and uncertainly around government decision-making could discourage investment in new vaccines and make the market broadly less appealing. The Advisory Committee on Immunization Practices (ACIP), which Secretary Kennedy has reconfigured with notable vaccine skeptics, will meet in December, and their agenda includes a discussion on “adjuvants and contaminants.” Under Secretary Kennedy, manufacturers are no longer included in working groups for ACIP, meaning they cannot answer questions regarding development and research. Health services researchers can work with their state and local public health officials to inform strategies lessening the negative impacts of these potential policy changes on their communities.
In related context, our CEO wrote about this issue a decade ago. In this 2015 New York Times column, Aaron Carroll emphasized that the science behind vaccination is unequivocal: vaccines do not cause autism, the current childhood schedule is safe, and spacing out or delaying shots provides no benefit while leaving children at risk. He highlighted that vaccine safety is one of the most extensively researched topics in medicine, involving millions of children across decades of studies. Carroll also noted that all recommended vaccines—including those sometimes seen as “optional”—play an important role in protecting communities, with strong evidence showing their impact in preventing serious illness and death. His message then remains relevant now: vaccination policy should be grounded in robust scientific evidence, not misinformation or political debate.
Chiles v. Salazar Highlights Growing Threats to Science in Policymaking
In a new AcademyHealth blog, Health Policy Fellow Valerie Ernat, J.D., highlights how the Supreme Court actively undermined the role of evidence in policymaking during the Chiles v. Salazar oral arguments. The case, which deals with the constitutionality of Colorado’s “conversion therapy” ban, hinges on multiple legal questions, but one—largely irrelevant—issue consumed oral arguments: the value of science in evidence-based policymaking. The blog explores how the justices and petitioner’s attorneys subverted established science in the oral arguments, and how this rhetoric casts doubt on the future use of data and evidence to inform policy. You can access the blog here.
We Want to Keep Producing the Situation Report – Your Support Can Help!
In case you missed it: AcademyHealth has been selected by Research!America to receive the Paul G. Rogers Distinguished Organization Advocacy Award, recognizing our leadership in advocating for the Agency for Healthcare Research and Quality (AHRQ) and strengthening the field’s collective voice through our Situation Report series. We are proud of our work keeping our members informed and mobilized via the Situation Report and appreciate the consistent interest and support in this product.
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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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