Happy Monday! Health care is back at the center of Washington’s economic and political debate. With ACA premium help on the line, new rural grants rolling out, and industry racing ahead on GLP-1s, synthetic biology, and AI, the next few weeks will shape costs and coverage for the years to come. Here is what you need to know going into the week:

In this week’s Nimitz Health:

• Federal News: ACA premium tax credits, SUPPORT Act reauthorization, Vaccine schedule review, hepatitis B debate, and FDA leadership changes

• State News: Rural Health Transformation Program applications, Planned Parenthood Medicaid funding litigation

• Industry News: WHO endorses GLP-1s, moving away from primate testing, lab-grown genomes, and digital mental health

WHO’S HAVING EVENTS THIS WEEK?

Wednesday, December 10th

• *House Oversight: “Lowering the Cost of Healthcare: Technology’s Role in Driving Affordability” at 10am. Watch here.

• *Senate HSGAC: “Defining Our Healthcare Problem, and Principles We Should Follow to Solve it” at 2pm. Watch here.

• House Judiciary: “Fighting Obamacare Subsidy Fraud: Is the Administrative Procedure Act Working as Intended?” at 2pm. Watch here.

Thursday, December 11th

• House Natural Resources: “Modernizing the Implementation of 638 Contracting at the Indian Health Service” at 10am. Watch here.

• Senate HELP: “Examining the Future of the U.S. Organ Procurement and Transplantation Network” at 10am. Watch here.

Friday, December 12th

• House Energy & Commerce: “Member Day Hearing” at 9am. Watch here.

*Will be covered by Nimitz Health. Please email [email protected] if you would like a readout of any other hearings.

NEWS DRIVING THE WEEK

Federal News

On Capitol Hill, the clock is ticking on the enhanced Affordable Care Act tax credits, and both parties are maneuvering to avoid blame for premium spikes if those subsidies lapse. Senate Democrats are pushing a three year extension, while Republicans are split among letting the enhanced help expire, backing a shorter extension with tighter eligibility, or tying any deal to broader changes in benefit design and abortion coverage rules. Moderates in both parties are increasingly vocal about the political risk of doing nothing for the more than 20 million people who rely on marketplace coverage.

Sen. Bill Cassidy is pressing colleagues to embrace a model built around high deductible plans paired with more generous and flexible Health Savings Accounts, arguing that sending subsidies directly to consumers would align with President Trump’s call to “give the money to the people.” Health economists warn that shifting toward cheaper, more catastrophic coverage could leave many chronically ill patients exposed to large out of pocket costs and that existing HSA rules still make it hard for lower and middle income families to benefit.

Drug pricing is another pressure point. Sen. James Lankford is openly exploring whether pharmacy benefit manager reforms and other drug cost provisions can hitch a ride on the Labor HHS appropriations bill, betting that a must pass funding package is one of the few remaining vehicles this Congress. House Republicans have been told by Trump’s top pollster that pivoting hard to drug prices is essential politically, which is nudging leadership to keep PBM legislation in play even as appropriations talks drag on.

The opioid crisis remains on the agenda as well. The administration has now signed a reauthorization of the SUPPORT for Patients and Communities Act, reviving key grant streams for states, tribes, and local health systems to expand treatment, recovery housing, and naloxone access. Advocates are welcoming the new funding but caution that persistent workforce shortages and rising stimulant use will test how far the law’s dollars can go.

Vaccine governance is becoming more unsettled. President Trump has asked HHS Secretary RFK Jr. to fast track a review of the childhood immunization schedule, and Kennedy aligned advisers are taking up posts at CDC and the department’s policy shop, raising concerns among traditional public health groups about the direction of federal guidance. At CDC’s advisory committee, members recently postponed a vote and softened proposed language around the hepatitis B birth dose after a heated meeting where a panel linked to Kennedy argued that not all newborns need the shot, a position at odds with long standing recommendations.

Federal agencies are also trying to get ahead of artificial intelligence. HHS has unveiled a new AI strategy built on a “One HHS” data infrastructure that aims to support fraud detection in Medicare and Medicaid, accelerate regulatory review, and eventually enable payment for certain AI driven tools in chronic disease management, all under a new governance structure that promises closer monitoring of bias and safety.

At FDA, the resignation of the agency’s top drug regulator and the appointment of Beth Høeg as acting head of the Center for Drug Evaluation and Research add leadership uncertainty at a time when the agency is under pressure to set clearer expectations for AI enabled trials and complex biologics.

State News

States are racing to position themselves for the Rural Health Transformation Program, a new pool of roughly 50 billion dollars that will be distributed based in part on how closely state policies track the administration’s priorities. An analysis of state applications shows broad support for relatively low controversy moves like expanding telehealth and adding nutrition education to medical school curricula, but deep divides over more ideological items such as restricting SNAP purchases and deregulating short term “skinny” health plans. Rural advocates and some Democratic officials have labeled the structure “sort of blackmail,” arguing that tying a slice of funding to state level policy changes will disadvantage divided governments and could skew resources toward political allies.

In the courts, a federal judge has temporarily blocked a provision of the administration’s signature health law that would have forced states to cut Planned Parenthood affiliates out of Medicaid networks, siding with providers who argued the change conflicts with longstanding federal rules that protect beneficiary choice of qualified providers. The ruling leaves Medicaid funding for Planned Parenthood intact for now and has governors and Medicaid directors watching closely, since it will shape how much flexibility states actually have to follow new federal priorities on reproductive health access.

Industry News

Global access to GLP 1 weight loss and diabetes drugs is under new scrutiny after the World Health Organization’s guideline panel signaled that medicines like Ozempic and Wegovy should be available to all patients who meet clinical criteria, not just wealthy consumers in rich countries. Experts advising WHO warned that, without deliberate policy steps, constrained manufacturing capacity and aggressive marketing could deepen existing disparities, leaving low and middle income countries without supply and pushing national health systems to confront difficult questions about long term coverage of very expensive chronic therapies.

On the R and D side, regulatory and scientific trends point toward a future with fewer monkeys in preclinical testing and more reliance on alternative models. US regulators are preparing to accept more data from human cell models, organ on chip systems, and advanced simulations for certain drug classes, which could ease pressure on a chronically tight non human primate supply chain and eventually shorten development timelines, although companies will need to demonstrate that new methods can reliably predict safety signals.

Synthetic biology is another frontier to watch. Researchers working on lab grown genomes are pushing toward the ability to assemble more complex human DNA constructs, raising the prospect of highly customized cell therapies and novel biologics, but also forcing regulators and ethics boards to grapple with questions about off target effects, privacy of genomic “blueprints,” and what counts as acceptable human enhancement. Early policy discussions suggest that FDA and international counterparts will look for guardrails on both clinical use and the manufacturing pipelines that support these technologies.

Finally, digital mental health firms are trying to differentiate themselves in an AI heavy market. Headspace’s leadership, for example, has been blunt that many general purpose AI tools are not built for mental health use and could do harm if deployed without clinical guardrails, even as the company experiments with its own guided support features embedded in therapy and coaching products. That stance captures a broader industry tension between the promise of scalable, always on support and the need to prove safety, efficacy, and equity to health systems, employers, and regulators who are increasingly skeptical of unvetted AI chatbots.

FOR FUN

There is a fun “Women of Congress Meet Women of Wine” event on Wednesday hosted by 131 & Counting and Vin Vitalité.

The event will bring together women of Congress and women shaping public policy with women vintners, innovators, and leaders in wine.

Details: Wednesday, December 10th from 6–8 PM at 660 North Capitol St NW, Washington, DC 20001, USA

Buy your $10 tickets here!

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