May Government Affairs — What You Need to Know

ACOI Endorses New Prior Authorization Bill

ACOI has put its support behind a newly introduced bipartisan bill that would reform the practice of prior authorization within Medicare and among Medicare Advantage (MA) and prescription drug plans.  

The Reducing Medically Unnecessary Delays in Care Act of 2025 (H.R. 2433), introduced by Representatives Mark Green (R-TN), Kim Schrier (D-WA) and Greg Murphy (R-NC), builds on current regulations by requiring all preauthorizations and adverse determinations be made by a licensed, board-certified physician who “typically manages the medical condition or disease or provides the health care service.”

In a letter endorsing the legislation, ACOI President Susan Enright, DO, MACOI, wrote, “Medicare beneficiaries deserve the assurance that prior authorization reviews and decisions are being made by someone who is experienced in their condition and recommended treatment.”

The legislation also aims to ensure that decisions about the medical necessity or appropriateness of health care services are being made based on sound clinical evidence and involve input from actively practicing physicians.

ACOI Responds to Draft Budget Revealing Deep Cuts to HHS

On May 2, President Trump released his “skinny budget” request for Fiscal Year (FY) 2026. The budget calls for spending reductions across government. Funding across all non-defense discretionary programs would drop 22.6 percent below current spending levels.  The National Institutes of Health’s (NIH) budget would be cut by nearly $18 billion, or about 44 percent, and the current 25 NIH Institutes and Centers would be consolidated to just eight. Funding for the Centers for Disease Control and Prevention would be cut by $3.588 billion or 45 percent. The budget creates a new Make America Healthy Again agency and funds it at $500 million.  

ACOI joined in April more than 500 other organizations on a letter to House and Senate appropriators calling on them to reject budget reductions to HHS saying cuts would “devastate our nation’s research, scientific, and public health infrastructure.”

The President’s budget request will serve as a blueprint as congressional appropriators draft the FY 2026 spending bills.  

In related news, on April 4, a federal judge issued a nationwide permanent injunction that blocks the NIH from instituting a 15 percent cap on indirect cost rates. As ACOI previously reported, the order would have taken effect on February 10, 2025 and would have applied to new and existing grants. 

SCOTUS Hears Oral Arguments on Preventive Services Requirement

On April 21, the U.S. Supreme Court heard arguments in Kennedy v. Braidwood Management, Inc., a case that challenges an Affordable Care Act (ACA) requirement that most private health plans must cover preventive services without cost sharing if they have an ‘A’ or ‘B’ rating from the U.S. Preventive Services Task Force (USPSTF).

In the case, Braidwood argues the USPSTF is unconstitutional because its members were improperly appointed. If the Supreme Court were to uphold the ruling of the Fifth Circuit Court, health plans and issuers would no longer be required to cover without cost sharing preventive services that were given an ‘A’ or ‘B’ rating by the USPSTF on or after the March 23, 2010 — the date of the ACA’s enactment.  

The Fifth Circuit Court ruling was appealed to the Supreme Court by the Biden Administration. During arguments on April 21, the Department of Justice, now under the Trump Administration, argued in favor of the ACA preventive services no cost-sharing requirement. In February, ACOI joined the American Cancer Society, American Medical Association and 30 other patient organizations and medical societies in filing an amicus brief in support of protecting the ACA preventive services coverage mandate.  

A ruling from the Supreme Court is expected in June.