Congress
Congress’ health deal still has hurdles
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.
Rep. Max Miller is threatening legal action to block a television ad created by his Democratic challenger Brian Poindexter that includes allegations of domestic abuse.
A lawyer for Miller is demanding Cleveland-area television station WKYC stop publishing “false, malicious, and defamatory statements” in a cease-and-desist letter sent Thursday and shared with Blue Light News by the Poindexter campaign. Miller has previously denied the abuse accusations.
The ad and ensuing legal threat mark a major escalation in the race between Miller and Poindexter. For much of his campaign, Poindexter avoided directly attacking Miller’s legal troubles, highlighting instead his working-class background and affordability.
With the ad, the two candidates are litigating the accusations in the public eye and placing Miller’s family drama at the heart of the race.
Miller’s lawyer Alejandro Brito — who has repeatedly represented President Donald Trump — said WKYC’s failure to comply with the cease and desist “will leave Congressman Miller with no choice but to pursue any and all legal rights and remedies available to recover damages for the overwhelming financial and reputational harm that Defendant will cause him to suffer.”
Miller is facing allegations of abuse from his ex-wife, Emily Moreno, the daughter of Ohio Sen. Bernie Moreno. They include accusations he poured hot water on Emily Moreno, held a gun to her head and broke his two-year-old daughter’s collarbone.
The 30-second Poindexter ad depicts a local sheriff listing some of those allegations, and saying, “34 years in law enforcement tells me: Max Miller does not belong in power.”
A spokesperson for Miller declined to comment. WKYC also did not return a request for comment.
In a video response shared with Blue Light News — which the campaign will use to fundraise — Poindexter rips up the letter.
“He’s threatening to sue because he doesn’t want people to hear the facts. Here are the facts,” Poindexter said. “Max Miller has been accused of abuse by three women… Max Miller used his money and fancy lawyers to get himself out of his trouble his whole life. Not this time.”
Miller is not on the House Republican campaign arm’s “Patriots” list which features the most vulnerable members who typically get the bulk of its spending. However, recent polling suggests a tight race between Miller and Poindexter, and national campaign brass has taken notice.
The Congressional Leadership Fund, a top Republican super PAC, placed a staggering $4.85 million ad buy for Miller to air Sept. 30 to Nov. 3. The NRCC also dropped $450,000 on a three week ad-buy supporting Miller that started Sept. 7.
Jensen Huang’s clout as the leader of the world’s largest company is about to be tested on Capitol Hill as debates around artificial intelligence safety intensify.
The Nvidia boss and his army of lobbyists want Congress to lay off restricting exports, particularly to China, of high-end computer chips — the building blocks necessary to power AI development. Lawmakers could include these guardrails as part of the annual defense policy bill set for negotiations this fall.
But despite Huang’s team having had some success over the past year in convincing lawmakers to peel back regulations that would hamper exports, the swift shift in the AI political landscape has led the company to start sounding out of touch — at least to some lawmakers’ ears.
One Senate Democratic aide, granted anonymity to describe private meetings, said Huang’s recent visits to congressional offices have “repeatedly been seen as tone deaf, as he’s openly dismissed or downplayed the risks of AI, including denying any likely workforce disruptions from the technology.”
“Jensen makes an argument — I’m not sure I fully buy it — that as long as the world is relying on Nvidia chips, that’s a good thing,” the Senate Intelligence panel’s top Democrat, Mark Warner, said in an interview. He’s among those who fear giving a top U.S. competitor more tools to advance AI technology, which other industry executives have recently warned could have catastrophic consequences for humanity if left unchecked.
Huang last week echoed President Donald Trump’s sentiment that no new AI laws or regulations are necessary. But even Trump this weekend seemed to concede there are some dangers to the emerging technology. In a Truth Social post, he announced an “AI Force” and an AI czar to lead it — though he offered few details about what powers it would have or whether its creation would need congressional approval.
Meanwhile, a trio of GOP senators is trying to convince their leaders to do something — anything — on AI safety, an issue they believe could tilt the midterms and 2028 elections.
Sens. John Curtis, Josh Hawley and John Kennedy aren’t coordinating their efforts, but each is making a push from the back benches to jolt more senior senators to take action, with Curtis and Hawley teaming up with Democrats on various efforts.
Curtis said in an interview lawmakers need to “show that we’re adults in the room, that we can talk about this, that we can find solutions.”
Hawley is also convening a hearing this week in the Judiciary subcommittee he chairs on AI-powered Flock cameras, and using another subcommittee gavel to investigate OpenAI over the runaway model that led to rogue AI agents escaping testing.
But any hopes of passing legislation are facing skepticism among Senate Republicans that they will ever be able to overcome Trump’s opposition to AI regulations and House GOP leaders who side with the administration, according to three people granted anonymity to describe private conversations.
Kennedy said in an interview he hadn’t heard “anything” about movement in the Senate to address AI and that lawmakers who ignore the growing voter uproar around the issue were courting peril.
“We really need to send a memo around explaining we’ve got midterm elections coming,” he said. “I may send that out.”
Meanwhile, a deep dive in POLITICO’s magazine digs into the Trump administration’s complicated relationship with Anthropic and how officials’ perspective has shifted on AI this year as they discover the fearsome computing power being assembled by private companies on their watch.
What else we’re watching:
— DEMS EYE ONE MORE IRAN VOTE — Senate Democrats are hoping to rebuke Trump and the Iran war in one last war powers vote this week before the midterms. Sen. Thom Tillis is expected to flip his vote after saying he would support efforts to curtail the war if the administration hadn’t sought an authorization from Congress to continue it by mid-September. Senate Dems have attempted 14 similar votes in the past seven months with only two advancing due to GOP absences, but are now hoping increased dissatisfaction with the war will drive more defectors.
— CASSIDY SETS TEST FOR FDA PICK — Trump’s pick to lead the FDA must acknowledge the president’s claim that the measles vaccine is lethal is “absurd,” Sen. Bill Cassidy said Sunday. Senate HELP, which Cassidy chairs, is set to consider Dr. Heidi Overton’s nomination to lead the FDA on Thursday. “I need to hear that she understands that calling the measles vaccine lethal is absurd, and we need radical honesty,” Cassidy said on CBS when asked what he needs to be persuaded during the hearing.
Kelsey Brugger, Ari Hawkins, Jordain Carney, Sophia Cai, Cheyenne Haslett, Leo Shane III, Connor O’Brien and Jalen Beckford contributed to this report.
House Republicans have left Washington till November. President Donald Trump is decrying concerns about the issue as a “HOAX.” But a few Senate Republicans are trying to nudge their party into doing something — anything — about artificial intelligence.
There isn’t much binding them together aside from the “R” next to their names, but Sens. John Curtis, Josh Hawley and John Kennedy have each been closely attuned as voters suddenly grow alarmed — not only about the data centers powering the AI industry, but the recent insider warnings about potentially catastrophic consequences for humanity.
Curtis is a Utah moderate who has been among the few in his party to take seriously scientists’ warnings about climate change. Hawley is a populist Missouri conservative who has long been skeptical of Silicon Valley business titans. And Kennedy’s simple-Louisiana-country-lawyer persona belies a relatively sophisticated understanding of frontier AI developments.
The trio is not coordinating efforts, but their individual actions were part of a clear push from the GOP’s back benches over the past week to get party leaders to wake up and address an issue they believe could tilt the upcoming midterms and certainly the presidential and congressional races in 2028.
“We might want to be on the side of voters — just a thought,” Hawley said, noting that while he has his own “views” on how Washington should respond, party leaders have offered members no guidance on how to approach the topic.
Hawley is taking matters in his own hands this week by convening a hearing in the Judiciary subcommittee he chairs on AI-powered Flock cameras. He’s also using another subcommittee gavel to investigate OpenAI over the runaway model that saw hundreds of rogue agents escape testing and hack another tech company.
Both Curtis and Hawley have teamed up with Democrats, who have generally been more aggressive in calling for AI safety measures — particularly since a former OpenAI and Anthropic employee went public saying advanced models could “could kill us all by the end of the decade.”
Hawley and Sen. Richard Blumenthal (D-Conn.) — who both sit on the Judiciary and Homeland Security and Governmental Affairs committee — pushed congressional leaders last week to hold a vote on their “risk evaluation” legislation, arguing that “frontier AI demands frontier legislation.”
Curtis, meanwhile, joined with a fellow Commerce Committee member, Sen. Lisa Blunt Rochester (D-Del.), to call for “immediate public hearings” to “work through solutions that maintain America’s competitive edge in development while ensuring that these technologies serve human interests and remain fully under human control.”
Curtis said in an interview lawmakers need to “show that we’re adults in the room, that we can talk about this, that we can find solutions.”
“I don’t want to say we’re making it too hard, but I think we’re making it too hard,” Curtis said. “And what I mean by that is, there’s a lot of false narratives out there — we need to just jump on this immediately and clamp it down, or we need to not touch it, and all of that only I think causes anxiety back home.”
Both efforts could be seen as attempts to jolt more senior senators who are in positions to advance AI-related legislation. So far they are treading carefully amid skepticism among Senate Republicans that they will ever be able to overcome Trump’s opposition on AI regulations and recalcitrance among House GOP leaders, according to three people granted anonymity to describe private conversations.
They include Judiciary Chair Chuck Grassley (R-Iowa), who indicated in an interview that he had no plans to hold hearings or take other action related to AI.
“I think that I’d be getting into the jurisdiction of the Commerce Committee,” Grassley said, directing further questions to Commerce Chair Ted Cruz (R-Texas).
Cruz has been more deeply engaged than Grassley in AI matters, but his plans for action remain uncertain. He said last week he is still hoping to hold a committee vote on AI safety legislation this month before the Senate leaves for the final stretch of pre-midterm campaigning.
Cruz is engaged in negotiating a revised version of an AI safety bill that Senate Majority Leader John Thune and Sen. Amy Klobuchar (D-Minn.) first introduced in 2023. But multiple Commerce Committee Republicans said they have so far heard zilch behind the scenes about what the committee could do, and some doubt they will be able to get an agreement in time to act before the Senate leaves — possibly as soon as the end of this week.
While Thune himself has been the most engaged on AI issues among top GOP leaders, he still advocated for a “light touch” on industry regulation last week while acknowledging the “considerable amount of interest” among lawmakers in taking action.
Sen. John Barrasso of Wyoming, the No. 2 Senate Republican, said — as Hawley suggested — that he isn’t giving members guidance on how to talk about AI.
“People have opinions and they’re going to make their opinions known and talk to their voters,” he said.
And then there’s Kennedy, who recently said the industry is run by “high-IQ stupid people” and was the rare Republican who attended a briefing put together by Sen. Bernie Sanders (I-Vt.) last week to meet with AI experts to talk about potential safeguards for the technology.
He took his AI concerns straight to the Senate floor Wednesday, seeking to pass legislation this week that would require companies to install so-called “kill switches” for their AI models. In a speech before seeking unanimous consent to pass the bill, he delivered a homespun but technically detailed summation of the OpenAI swarm attack and the risks posed by “recursive self-improvement.”
His bill was blocked by Sen. Rand Paul (R-Ky.), who instead proposed creating a panel to make recommendations about potential guardrails.
Kennedy said appointing a committee would be “the weenie way out” after warning his colleagues from the Senate floor that Americans were growing “very skeptical” of AI and the tech titans behind it.
“They’ve seen this vampire movie before,” he said.
In a separate interview, Kennedy said he hadn’t heard “anything” about action in the Senate to address AI and that lawmakers who ignore the growing voter uproar around the issue were courting peril.
“We really need to send a memo around explaining we’ve got midterm elections coming,” he said. “I may send that out.”
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