(Dec. 19, 2025) – Throughout the past month, we have been busy at the federal level, educating members of our Congressional delegation about issues that have come to the forefront since the passage of H.R. 1, the One Big Beautiful Bill Act, this summer. These issues generally fall into three major categories: health insurance affordability, Medicare payments and Kansas's provider tax.
Front of mind during Congress's late 2025 session has been the pending expiration of the Affordable Care Act's enhanced premium tax credit. Passed in 2021 as part of the early-Biden-era American Rescue Plan Act, these refundable tax credits have helped make health insurance on the ACA exchange affordable for millions of Americans. They are set to expire at the end of the calendar year 2025, and Congress is debating how to handle this impending cliff.
Democrats have proposed extending EPTCs for another three years. Right now, a majority of both Senators (51) and House members (218) have either voted for this plan or signed a petition calling for a vote on it. However, Senate rules require that any bill making substantive legal changes have at least 60 Senators agree to advance it to a final vote. Most Republicans oppose this plan and would like to see the federal government place resources in health savings accounts for EPTC-eligible Americans to help them pay for bronze plans on the exchange. This plan also failed, receiving only 51 affirmative votes.
The current continuing resolution funding the federal government at fiscal year 2025 levels expires on Jan. 30. This is the next checkpoint in the EPTC debate, as Democrats have made clear it is their top priority for the January session. Senate Republican leadership will need at least some Democratic votes to fund the federal government into February.
We continue to work with members of our delegation to avoid Medicare site-neutral payment schemes as pay-fors for either an ETPC extension or any other health care policy matter. The House recently passed a health care policy bill that addressed many issues, including PBM reforms, but wisely avoided any site-neutral payment scheme. While this bill is unlikely to find traction in the Senate, we are encouraged that this particular piece of legislation, which was a heavy lift in the House, the chamber more likely to press for site-neutral, left such ill-advised provisions aside.
We are also continuing to work with our delegation on the Kansas provider tax program. The Kansas delegation advocated for grandfathering Kansas's 2025 and 2026 provider tax expansions beyond the cutoff date for such programs included in H.R. 1. The bill's language is complex, but everyone involved agrees that Congress's intent was to grandfather Kansas's changes. However, CMS's regulatory guidelines related to H.R. 1 have been confusing, so we continue working with the Hill, the Centers for Medicare & Medicaid Services and the Kansas Department of Health and Environment to seek clarifications. At this point, we are cautiously optimistic that Kansas's 2025 changes will move forward as planned, and we continue working toward the same outcome for the State's 2026 changes. Stay tuned for any new developments.
--Chad Austin