Congress

Congress’ health deal still has hurdles

Published

4 days ago

January 22, 2026

After months of fruitless negotiations to extend Affordable Care Act subsidies that have since expired, congressional leaders announced Tuesday they’d notched a rare bipartisan win to overhaul other parts of the health care system.

Now they just have to hold onto it.

The agreement, attached to a government spending bill, would implement long-sought changes to the way pharmacy benefit managers operate, as well as extensions of public health programs and increased funding for community health centers. But even with strong support in both chambers, the bill faces significant hurdles.

Lawmakers must navigate around the powerful lobbyists for pharmacy benefit managers, or PBMs — the intermediaries who negotiate drug prices on the behalf of employers and insurers — who have handily defeated similar proposals in the past.

They also must reckon with conservative hard-liners who don’t like some of the provisions and could be prepared to weaponize the House GOP’s perilously slim margins to tank the effort by opposing a party-line procedural rule that would bring the funding measure to the floor.

One such provision in the health care package, championed by Sen. Bill Cassidy (R-La) and Bernie Sanders (I-Vt.) — the chair and ranking member of the Senate HELP Committee, respectively — would prevent PBMs from getting revenue from drug rebates. This proposal, which has buy-in from Senate and House GOP leadership, has infuriated the industry and its allies.

“Especially in the time in which we’re seeing health insurance premiums go up, this is just going to make it worse,” said Rep. Eric Burlison (R-Mo.) in an interview Wednesday. “What Senator Cassidy has done has gone, I think, way too far over the line.”

PBMs negotiate rebates, or discounts, with drugmakers for employer health plans and other payers in an opaque process that has drawn scrutiny over whether discounts are passed on to consumers or retained to boost profits. Drugmakers, under pressure to reduce high prescription drug prices, have been pointing the finger at PBMs as the culprit.

A spokesperson for Cassidy declined to comment.

If the health care package passes as part of the government funding measure, Democrats will have helped Republicans with a major health victory at a time when the GOP is particularly vulnerable on the issue.

Democrats have been hammering Republicans for months over their inaction on extending the enhanced Obamacare subsidies that lapsed at the end of last year. They have made the premiums that have skyrocketed as a result the centerpiece of a nascent midterm campaign assailing Republicans on “affordability.”

Talks for a subsidy extension remain ongoing in the Senate, but lawmakers left last week for a 10-day recess without reaching a deal. Abortion restrictions and minimum premium payments are the biggest impediments to landing a compromise.

For many Republicans, the health care bill they want to pass now as part of legislation to fund several government agencies —including Health and Human Services — also answers President Donald Trump’s demands that Congress end kickbacks to PBMs and require more transparency from insurers. Those elements were included in the president’s health care proposal released last week.

Some Democrats said the policy goal was too important to pass up, even though the deal did not include an extension of the ACA subsidies. A similar effort at the end of 2024 was torpedoed when billionaire Elon Musk blasted government funding legislation that contained the PBM measures, and there’s a desire not to squander the same opportunity this time around.

“We’ve wanted to clean up PBMs. We have to believe that not everything they do is wrong,” said Rep. Don Beyer (D-Va.) Wednesday.

Rep. Kathy Castor (D-Fla.), meanwhile, warned that while Republicans did the right thing on PBMs, it doesn’t mean healthcare will not be a major issue in the midterms.

“Do they get credit for doing the right thing [that] they should have been doing all year long? Okay,” she said.

The GOP and free-market healthcare

Cassidy, in a statement, said the health package delivers “real, conservative reforms that rein in healthcare middlemen, make prescription drugs more affordable and increase access to lifesaving treatments for children.”

The rebate provision in the bill he authored with Sanders does have support from traditional GOP allies in the business sector. The ERISA Industry Committee, which represents self-funded large employer health plans, has repeatedly pushed for targeting PBM rebates among other reforms.

Rep. Chip Roy (R-Texas) said earlier this week he is still reviewing the package, but mainly wanted more transformational overhauls as insurers who own PBMs could potentially negate any changes.

“I am for the reforms, but at the end of the day insurers own the PBMs and they are just going to shuffle the deck chairs around and keep doing what they want to do,” he said.

For Washington’s influence sector, Republican support for the PBM changes mark a shift within the party away from its free market orthodoxy.

“It’s really like Congress dictating how two private companies can contract … From a historical context, Republicans are not big on interfering with the present marketplace,” said one insurance lobbyist granted anonymity to speak candidly.

Making a deal

Lawmakers have pushed to return to PBM overhaul legislation since the Dec. 2024 package’s collapse.

“These should have been passed, a lot of them, last year,” said Castor. “They were poised to pass until Elon Musk got involved.”

House Republicans have also been eager to make up for failed attempts to include several health care provisions in their sweeping tax and spending megabill last summer, but they were stripped out in the Senate for not complying with the rules governing the budget reconciliation process.

January offered an enticing opportunity for lawmakers to try again as efforts to craft full-year appropriations bills picked up steam. Normally a health package runs as part of a larger, must-pass government funding measure to help ensure its success.

But the government has been running on stopgap spending bills since March 2024. House Republican leadership has been reluctant to add policy riders to such bills to ensure enough support from fiscal hawks.

This health care package came together relatively quickly this month as most of the items had already been considered – and vetted – previously, chiefly in the scrapped Dec. 2024 government funding legislation. There also were markups and committee hearings on the package’s contents, including regarding PBMs, throughout 2025, giving lawmakers a chance to become familiar with the policies. including on PBM reform, according to a Senate aide familiar with the negotiations.

Pharmacy benefit managers “hate” the reforms “but they … should not be surprised, because it’s been baked,” said another Senate GOP aide familiar with the health care package, granted anonymity to speak candidly of the PBM provisions. “And the cake has been sitting on a shelf in a deep freezer, perfectly maintained for like three years.”

Industry evasion

Even with the latest proposed changes designed to bring accountability to PBMs and how they operate, lobbyists representing insurers, pharmaceutical companies and pharmacies say that PBMs have still largely outmaneuvered Congress.

The industry has spent years evading bipartisan congressional scrutiny, even as state legislatures moved in to reign in the sector. Since calls for reform took off in 2023, the Pharmaceutical Care Management Association, a major trade group, spent $47 million lobbying elected officials against placing guardrails on PBMs — about twice its spending from the prior three-year period.

“The market has outpaced Congress on this by a pretty wide margin,” said Adam Colborn, associate vice president at the Academy of Managed Care Pharmacy, which counts UnitedHealth, CVS Health, and Express Scripts as members. “There’s been a lot of emotion on both sides of the debate, but getting down to the nuts and bolts, there’s a relatively low ceiling for change.”

In October, Cigna announced that it would overhaul its pricing model and remove its system based on rebates, following a commitment from UnitedHealth to pass through 100 percent of rebates in January and a decision from CVS to do so in 2019 — a move analysts view as an effort by industry to get ahead of reform efforts on Capitol Hill.

“I don’t think anybody’s gonna be shooting off fireworks here … It’s not going to be a game changer,” said one pharmaceutical lobbyist, granted anonymity to share internal discussions of the health care deal currently pending before lawmakers.

On Tuesday, PCMA slammed the Cassidy-Sanders PBM provision, warning that such a proposal would limit companies’ ability to use alternative payment models and raise prices and urging Congress to shift its scrutiny on the pharmaceutical industry instead.

“PBMs are innovating business models to lower costs and meet employer demands far more quickly than Congress could ever implement,” Brendan Buck, PCMA’s chief communications officer, said in a statement. “It makes no sense to ban flexibility and choice and lock employers into a single system that will lead to higher drug costs.”

In September, PCMA launched a six-figure ad campaign in Washington accusing pharmaceutical companies of keeping prices high, following a similar campaign targeting PBMs from the Pharmaceutical Research and Manufacturers of America, which represents brand-name drugmakers in May.

Lobbyists and experts predict the PBM overhauls proposed by Congress are likely only the beginning as lawmakers ramp up scrutiny of the health care sector over high prices – and seek more opportunities to show voters in an election year they care about lowering health care costs.

“This is the opening salvo in what is going to be a long battle for reform,” said Sujith Ramachandran, an assistant professor at the University of Mississippi School of Pharmacy.

Congress

Capitol agenda: Shutdown odds spike after Minnesota killing

Published

2 hours ago

January 26, 2026

Blue Light Newsroom

The killing of Alex Pretti at the hands of federal agents is hitting hard on Capitol Hill, ratcheting up the odds of a partial government shutdown and spurring Republican lawmakers to make another break with the Trump administration.

Here’s the latest on how the fallout from the Minnesota shooting is playing out in Congress:

— Shutdown looks likely: The Senate is set to take its first vote on the last tranche of government funding bills Thursday, and things aren’t looking good.

Senate Minority Leader Chuck Schumer is insisting that Republicans work across the aisle to rewrite DHS funding legislation but also signaling that Democrats would be willing to help advance the other five pending appropriations bills in the meantime. Several Democrats who helped end the previous shutdown say they plan to vote against the funding bills unless there are changes to the ICE operation in Minnesota.

At this stage, Senate GOP leadership expects to move forward as planned on the six-bill package including DHS. Republicans and the White House have reached out to Senate Democrats about how to proceed, but one Senate Democratic leadership aide granted anonymity said they haven’t raised “realistic solutions.” A number of rank-and-file Senate Republicans are speaking out against any attempt to “defund” DHS — and leadership would need buy-in from all 100 senators to quickly strip out the DHS bill. President Donald Trump is now pushing Republicans to pass a bill to “END Sanctuary Cities.”

A couple key reminders: The pending funding bills include money for the departments of Defense, Health and Human Services and State, and account for more than 75 percent of federal discretionary spending.

And don’t forget the House is out this week and wouldn’t be around to pass any revamped funding bills before Friday. The Senate won’t hold its first vote of the week until Tuesday afternoon because of the snow storm.

— Trump faces nervous GOP: A growing number of House and Senate Republicans are voicing public concerns about the incident and calling for an investigation, as top administration officials defend the agents involved.

Even close Trump allies are beginning to speak out. Sen. David McCormick (R-Pa.) said on X Sunday night that he supports the Border Patrol and ICE but that he agrees with the NRA about the need for a “full investigation.”

House Homeland Security Chair Andrew Garbarino (R-N.Y.) is calling for DHS officials to testify. House Oversight Chair James Comer (R-Ky.) suggested to Fox News that Trump would want to “maybe go to another city” as Minnesota officials push back.

Some Republicans have been privately warning administration officials and GOP leaders for months that Trump’s immigration crackdown is not going over well in some pockets of the country.

“Many of us wonder if the administration has any clue as to how much this will hurt us legislatively and electorally this year,” said one House Republican.

Jordain Carney and Meredith Lee Hill contributed to this report.

Congress

Fiscal hawks set out to kill earmarks. They are very much alive.

Published

6 hours ago

January 26, 2026

Blue Light Newsroom

Fiscal conservatives in Congress threatened for months to block government funding if GOP leaders didn’t shun earmarks. They succeeded in scrapping just one; the rest, almost $16 billion worth, are slated in the package the Senate needs to clear by Friday to avoid a shutdown.

Republican hard-liners on both sides of the Capitol have made things difficult this winter for their leadership, which has been scrambling to fund the government before cash runs out Friday for the vast majority of federal agencies. But they failed to significantly curtail the practice of directing federal dollars to specific projects back home.

Republicans swore off earmarks for more than a decade in 2010 amid corruption scandals and demands from conservatives empowered by the rise of the Tea Party movement that has since receded. Then in 2021, Democrats brought back the practice after the party swept control of the White House and Congress, softening the return with a rebrand as “community project funding,” new rules to prevent abuse and a cap at 1 percent of funding.

Now Republicans run Washington once again, and they’re overwhelmingly embracing the renaissance. As the Senate considers a nearly $1.3 trillion funding package this week loaded with thousands of earmarks for projects in specific congressional districts, fiscal hawks are acknowledging defeat.

“When a majority of the United States House and a large chunk of the Senate seemingly want to advance earmarks, there’s only so much you can do,” Rep. Chip Roy (R-Texas), a member of the House Freedom Caucus, said in an interview.

“I’ve long stated I think it’s the currency of corruption, and we shouldn’t do it,” he added. “But, you know, members like to do it.”

Capitol Hill’s most vocal earmark proponents argue that, if not for the revival of earmarks, congressional leaders would not have succeeded in clinching bipartisan deals to fund the Pentagon and nondefense agencies with new budgets for the first time in almost two years.

The multibill funding package has yet to reach President Donald Trump’s desk and is now complicated by Democratic outrage over ICE funding after a federal immigration enforcement agent fatally shot another U.S. citizen in Minnesota over the weekend. But lawmakers in both parties are already touting the cash they secured for local projects as they campaign for reelection nine months out from the midterms.

“It’s not worth being in Congress if you can’t find ways to help your district,” Rep. Mike Flood said in an interview.

The Nebraska Republican secured almost $30 million in projects for his district in the current slate of funding bills, including millions of dollars to repave roads, about $750,000 for police cruisers and $500,000 for improvements to a shelter for minors who would otherwise be in juvenile detention.

Flood argues the inclusion of earmarks ultimately helped Republicans negotiate funding bills that keep federal spending mostly steady — a top priority of congressional fiscal hawks. “For all the things that people say are wrong with Congress, this process is working. And it’s working well,” he said. “And we are bringing this in under budget.”

This month members of the House Freedom Caucus threatened to tank a preliminary vote on spending bills if GOP leaders didn’t knock out at least some earmarks. They were able to kill only one: a $1 million earmark Democratic Rep. Ilhan Omar secured for a community organization in her Minnesota district, in part because the address listed for the group was that of a restaurant.

House fiscal hawks made a final stand last week when they demanded, and received, a vote to nix hundreds of earmarks senators had worked to secure. That vote failed overwhelmingly, right before the House passed a funding package with a price tag of more than $1 trillion, with every earmark intact.

Rep. Ralph Norman, a member of the Freedom Caucus, said it was a “sad day” and called it “irredeemable” for a GOP-led Congress and White House to support the earmark-filled package. Norman said he now has no hope Republicans will ever do anything to get rid of earmarks.

“I wish it was different,” he said.

More than 70 House Republicans voted against killing the Senate earmarks. However, some hard-liners argue that it’s really the minority party driving the resurgence in a narrowly divided Congress.

“You need Democratic votes, right? So let’s not forget that,” said Rep. Scott Perry (R-Pa.), a former chair of the House Freedom Caucus. “I’m not here to apologize for, or validate, a bunch of garbage Republican earmarks. But we’d have a much better time at making sure those didn’t prevail if we didn’t need the Democrat votes.”

In the Senate, where Democratic buy-in is necessary to overcome the filibuster, fiscal conservatives delayed action on funding bills for more than a month following the end of the record-breaking government shutdown in November — in part due to their earmark concerns. Now that the final slate of funding bills is before the Senate, those same lawmakers are again demanding a vote to eliminate the pet projects.

Last week Sen. Rick Scott (R-Fla.), a leader of that charge, noted that in 2021 the Senate Republican Conference voted unanimously to maintain their rule against earmarks, a nonbinding prohibition many GOP senators were quick to flout.

“It’s time for Senate Republicans to follow our own rules. END ALL EARMARKS NOW!” Scott posted on social media.

The earmarks Congress has inserted in the new funding bills are the first of Trump’s presidency, since federal agencies have been running on stopgap funding patches for almost two years. Lawmakers in both parties see them as a way to protect their authority to dictate how federal money is spent as the Trump administration continues to shift and cancel billions of dollars in contravention of their wishes.

“It restores the institutional faith in Congress’ ability — albeit in a very small and minor way — to direct congressional spending and gets power back from any executive branch,” Tennessee Rep. Chuck Fleischmann, a senior Republican appropriator, said in an interview.

Many Republican lawmakers have been privately pressing GOP leaders to bring back earmarks for years, including as far back as 2016, when then-Speaker Paul Ryan halted a closed-door vote on restoring the practice.

At least under the old rules, earmarks were entwined with corruption. In the early 2000s, several lawmakers pled guilty to money laundering and bribery charges for abusing the practice. In the most high-profile of those cases, the late Rep. Randy “Duke” Cunningham (R-Calif.) admitted to accepting $2.4 million in bribes to secure earmarks.

Now Congress has much tighter rules governing the process, including a prohibition on steering money to for-profit organizations. Senior members of the Appropriations Committees who want to avoid a repeat of infamous earmarks scandals also closely vet the requests, said House Appropriations Chair Tom Cole (R-Okla.).

“We scrub them pretty hard, and honestly the Democrats do, too,” he said.

In a sign House Republicans are growing more comfortable with the practice, they are now discussing whether to expand earmarks in future funding bills to include education, health and labor projects, according to Rep. Robert Aderholt (R-Ala.), who chairs the panel in charge of that money. Only senators are currently allowed to specify projects for funding within those jurisdictions.

“There’s interest on both sides, as long as it’s done in a way that doesn’t make both sides feel uncomfortable,” Aderholt said. “Members want to have a little bit of say-so, because we do have the power of the purse.”

Jordain Carney and Meredith Lee Hill contributed to this report.

Congress

Republicans start raising concerns about Minneapolis shooting

Published

21 hours ago

January 25, 2026

Blue Light Newsroom

A small but growing number of Republicans are raising public concerns about the killing Saturday of a 37-year-old Minnesota man by federal agents.

Hours after the fatal shooting of Alex Pretti on a Minneapolis street, one House GOP chair called for the top ICE leader and other Trump administration officials to publicly answer lawmakers’ questions. GOP Sens. Bill Cassidy of Louisiana and Thom Tillis of North Carolina called for independent probes into the shooting, with Cassidy arguing the integrity of ICE and the Department of Homeland Security are “at stake.”

Another House GOP chair appeared to suggest President Donald Trump should withdraw from Minneapolis and send the agents there to another city.

“If I were President Trump, I would almost think about, OK, if the mayor and governor are going put our ICE officials in harm’s way and there’s a chance of losing more innocent lives, or whatever, then maybe go to another city and let the people of Minneapolis decide: Do we want to continue to have all of these illegals?” Oversight Committee Chair James Comer (R-Ky.) said Sunday on Fox News, adding that he expected Minnesotans to “rebel against their leadership.”

However gentle and equivocal the pushback might be, it is growing increasingly conspicuous as congressional Republicans privately discuss how to respond to Trump’s aggressive immigration enforcement campaign ahead of the midterm elections. Some Republicans have been privately warning administration officials and GOP leaders for months that the operation is not going over well in some pockets of the country.

“Many of us wonder if the administration has any clue as to how much this will hurt us legislatively and electorally this year,” said one House Republican granted anonymity to candidly discuss private reactions.

While some of those speaking out, like Tillis, are retiring or known to be at odds with Trump, not all fit that bill. Rep. Dusty Johnson, who called Sunday for “a thorough investigation” of the officer-involved shooting and for all parties to “deescalate,” is running in a June GOP primary to be South Dakota’s governor.

After House Homeland Security Committee Chair Andrew Garbarino (R-N.Y.) called Saturday for ICE, Border Patrol and other DHS officials to testify before his panel, Rep. Michael Baumgartner (R-Wash.) praised the move, saying it was important “the American people and Congress be given a better understanding of how immigration enforcement is being handled.”

Still, most Hill Republicans have not weighed in publicly or are backing the Trump administration, which was quick to argue Pretti was a “domestic terrorist” intent on massacring federal agents. Eyewitness video shows no evidence he drew his weapon or otherwise threatened agents with deadly force before he was shot.

House Majority Leader Steve Scalise said in an interview with CBS’ “Face the Nation” Sunday that people are not allowed to carry a gun while committing another crime. “And interfering with law enforcement is a felony,” he added.

“Peaceful protesters don’t have 9mm weapons with two extra magazines,” Rep. Jeff Van Drew (R-N.J.) said on Fox News, referring to the concealed handgun Pretti had a permit to carry.

The shooting and backlash from Democrats has upended a crucial government funding package that the Senate was expected to pass this week. Senate Minority Leader Chuck Schumer said Saturday that Democrats won’t vote to advance the legislation so long as DHS funding is included, raising the likelihood of a partial shutdown at midnight Friday.

Amid the uncertainty, some Republicans have privately fretted about the lack of guidance coming from the Trump administration about the shooting. Four GOP lawmakers and several GOP aides noted they had received many more updates from the administration about the weekend’s major winter storm than the situation in Minneapolis or immigration enforcement operations generally.

Compounding the confusion, a DHS official sent an email alert with incorrect and contradictory information to congressional Republicans about three hours after the shooting Saturday, according to three people with direct knowledge of the message, which Blue Light News obtained.

The email described “the incident this morning between US Border Patrol officers and an illegal alien with a 9 mm semi-automatic handgun, who was wanted for violent assault.” But it linked to a DHS social media post that said federal agents were pursuing “an illegal alien wanted for violent assault” and then an “individual approached US Border Patrol officers with a 9 mm semi-automatic handgun,” referring to Pretti, who was a U.S. citizen.

As Republicans wrangle with the shooting, Democrats are discussing internally how to mount a response — with senators strategizing over the funding bill and House leaders considering options including targeting Homeland Security Secretary Kristi Noem with sanctions.

There’s a growing demand in the caucus to impeach Noem, with one purple-district Democrat who voted for DHS funding last week, Rep. Laura Gillen of New York, publicly backing the move shortly after a Sunday morning caucus call.

Minnesota Gov. Tim Walz and state Attorney General Keith Ellison, both former House Democrats, briefed the lawmakers on the private call.

Walz “sounded the alarm” over the “illegal” DHS activity in Minnesota, “and he urged everyone to unite and defend the integrity of the victims who are being smeared by the Trump administration,” said one House Democrat on the call who was granted anonymity because participants were encouraged not to leak its contents.

“This is dark, unthinkable stuff, but I’ve never seen Democrats more militantly united,” the lawmaker added.

Nicholas Wu contributed to this report.