Congress

Congress’ health deal still has hurdles

Published

5 months 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

Congressional Black Caucus blasts Slotkin over her calls for new leadership in the House

Published

12 hours ago

June 27, 2026

Blue Light Newsroom

The Congressional Black Caucus is emphatically declaring its support for House Minority Leader Hakeem Jeffries — and denouncing Sen. Elissa Slotkin’s call for new leadership in Congress.

In a statement posted to social media on Friday, the entirely Democratic CBC declared that it stands united behind the nation’s first Black minority leader of the House. The caucus accused the Michigan senator of “posturing for higher office in 2028” and called attention to her votes to approve multiple members of President Donald Trump’s Cabinet.

“House Democrats don’t need a lesson on reading the political moment from someone who handed Donald Trump one of the most corrupt Cabinets in American history,” the CBC said. “Voting to confirm Kristi Noem, Pam Bondi, and five other Trump Cabinet secretaries is not the posture of someone who understood the moment’ after 2024.”

The CBC closed its defense of Jeffries with a sharp parting shot of remaining focused on providing for Americans rather than “engaging in distractions that only serve to divide Democrats at a moment when unity and resolve are essential.”

A spokesperson for Slotkin, who has repeatedly called for a new generation of leadership in Congress, did not immediately respond to a request for comment.

Congress

Key Democrats urge House to reject kids’ safety proposal

Published

15 hours ago

June 26, 2026

Blue Light Newsroom

The Commerce Committee’s top Democrat Maria Cantwell (Wash.) and Sen. Richard Blumenthal (D-Conn.) warned House lawmakers against advancing their chamber’s version of the Kids Online Safety Act, arguing it would face intense lobbying from tech companies in the Senate and risk unraveling years of bipartisan work.

“If it is passed by the House it will come to the Senate,” Blumenthal, the bill’s Senate cosponsor, told reporters at a Friday press briefing. The Connecticut Democrat said he is concerned senators will be influenced by the tech industry’s “armies of lawyers and lobbyists” who may “confuse and exploit” misunderstandings about a House bill with the same name as a Senate version but excludes key provisions, such as the “duty of care.” (This concept requires online companies to design social media platforms with an eye for children’s safety.)

“We’re not going to let bad legislation with a good title just get across and think somebody’s done something,” Cantwell said.

The House version of KOSA — which is included in the KIDS Act, a revised bipartisan package that the Energy and Commerce Committee advanced along party lines in March — is scheduled to be considered on the House floor next week under suspension of the rules.

“We need to stop this bill in the House, and we need to prevent the White House from forming an alliance with Big Tech on this issue,” said Blumenthal, who characterized the version of KOSA that House leadership is pushing as a “sham.”

Both Democratic lawmakers also expressed concern that Senate Commerce Committee Chair Ted Cruz (R-Texas) could adopt the House version of KOSA in a kids’ safety package he has yet to publicly release but has pledged to markup by August recess. Cruz said “negotiations are ongoing” earlier this week when asked by Blue Light News whether he would be open to incorporating such changes put forward in the House.

Cruz’s package is expected to include KOSA as well legislation barring companies from using minors’ personal data for targeted advertising, banning kids under age 13 from social media, and providing greater oversight for how children interact with AI chatbots.

Although Blumenthal remains hopeful that Cruz will “stay true to his first vote in favor of KOSA,” which overwhelmingly passed in the Senate last Congress, the Connecticut Democrat said Friday he’s worried Cruz and others may be tempted to “take the bait” and abandon the bill’s basic principles.

Congress

Moderates beware: Mamdani coalition portends a dramatically different Democratic Party in NYC

Published

19 hours ago

June 26, 2026

Blue Light Newsroom

NEW YORK — A coalition powered by Mayor Zohran Mamdani expanded the left’s reach Tuesday, winning younger voters across racial and ethnic lines and once again upending conventional wisdom about elections in New York City.

A series of hotly contested congressional and state elections pit a slate of Mamdani-backed democratic socialists and progressives against establishment candidates who, in several cases, differed little on policy aside from U.S.-Israel relations.

The results were staggering.

Midterm election cycles in deep-blue New York City tend to be sleepy affairs. Both this year and in 2022, just over 500,000 people cast ballots, less than 20 percent of eligible voters. But turnout within a congressional district spanning Upper Manhattan and the Bronx increased by roughly 50 percent between 2022 and Tuesday, with more than 66,000 voters heading to the polls.

In another seat covering parts of Brooklyn and Queens, turnout more than doubled from 2022, though state and federal elections were held on different days that year and the seat was not competitive, which would have reduced the number of voters going to the polls.

Congressional candidates backed by the Democratic Socialists of America were able to replicate the mayor’s success by winning younger Latino voters in Brooklyn and a majority of Black voters in Harlem. Combined with the DSA’s base in relatively wealthy neighborhoods, the result charted the far left’s broadening appeal and a potential reorientation of the electorate that will influence races for years to come.

“This was a big wave for DSA and they did a good job capitalizing on it,” said Evan Roth Smith, a pollster with Slingshot Strategies. “The question now is: Was this a wave cycle that will abate, or is it the start of the takeover?”

Much of Mamdani’s base is concentrated in the so-called “commie-corridor,” a series of neighborhoods along the Brooklyn-Queens waterfront filled with young, educated and affluent voters who’ve propelled several DSA candidates into office. They went gaga over Mamdani’s candidacy and, as Tuesday’s results show, will turn out for candidates he supports.

The area was crucial to Assemblymember Claire Valdez’s crushing 56-38 defeat of Brooklyn Borough President Antonio Reynoso.

“The factor that felt most significant to me were all of these New Yorkers who got activated and politicized in the mayor’s race last year who were looking for the next fight,” said Andrew Epstein, a political adviser to Mamdani who worked on Valdez’ campaign. “Those people didn’t go away. And they want to keep going.”

Valdez also won several heavily Latino areas that were expected to break for her opponent.

Reynoso was born in Brooklyn to Dominican parents and just a few years ago was a City Council member representing Bushwick, a long-gentrifying Brooklyn neighborhood that’s home to Latino families and young hipsters. Valdez was born in Texas, moved to New York City in 2015 and served in the state Assembly for just one term before launching her Mamdani-backed bid for retiring Rep. Nydia Velázquez’s seat.

She ended up winning areas of Bushwick by even greater margins than the total results — in some election districts winning upwards of 80 percent of the vote.

“You don’t win the district by 35 points if you don’t have broad advantages across age and demographic groups,” said Michael Lange, an election analyst and Mamdani supporter who has tracked several contested races with extreme granularity. “Is she blowing him out of the water with Hispanic voters under 50? I see tons of evidence that the answer is yes.”

The age advantage was the common thread across several other races.

In Upper Manhattan and the Bronx, for example, younger Black voters in Harlem were key to Darializa Avila Chevalier’s win over Rep. Adriano Espaillat, the chair of the Congressional Hispanic Caucus who had built a small political empire in the district.

While gentrifying, the neighborhood remains a seat of Black political power and is home to younger households who tend to rent. That particular demographic is a strong indicator of why Mamdani won the area in 2025, even as he lost the Black vote overall to former Gov. Andrew Cuomo, whose support was concentrated among older Black homeowners in Brooklyn and Queens.

While Espaillat never healed a rift with the Black community in upper Manhattan opened during his election in 2016, which contributed to his weak performance, Avila Chevalier demonstrated Tuesday that a significant share of voters there were not just supportive of Mamdani the person, but of the broader political movement he’s now leading.

Overall, she edged out Espaillat with Black voters 48-46, according to an analysis from The New York Times, which charted demographic breakdowns for several contested races.

Three winning congressional candidates endorsed by Mamdani — including former city Comptroller Brad Lander in Brooklyn, who unseated incumbent Dan Goldman — share several similarities. They won younger, college-educated and wealthier voters by huge margins, in several cases by 30 points or more, and lost lower-income voters to incumbents or candidates affiliated with incumbents — a sign that the movement seeking to boost struggling New Yorkers has not won them over.

While the DSA was able to win three state races without the support of Mamdani — a testament to the organizing prowess of the left that was essential to reactivating the mayor’s coalition — there were limits to the city’s leftward shift.

Rep. Grace Meng won her reelection race, though she only vanquished challenger Chuck Park by 14 points, an uncomfortable margin for an incumbent of her stature. Park, who ran to Meng’s left, was boosted by a huge turnout in Woodside, Queens, a multiethnic neighborhood that went heavily for Mamdani in last year’s mayoral race.

Elsewhere in the Bronx, however, incumbents remained strong. Rep. Ritchie Torres handily won reelection with 72 percent of the vote, though it was a low-turnout affair more consistent with an uncompetitive midterm. Nevertheless, House Minority Leader Hakeem Jeffries touted the results — even as he watched a series of his endorsed candidates fall to the DSA in Brooklyn, his home borough, in a preview of the intraparty battles to come.

“In some higher-income districts, there was an outsized focus on the Middle East. In other districts, for instance, in the South Bronx, Ritchie Torres ran against somebody who was heavily critical of his position on Israel, and he won by fifty points,” Jeffries told MS NOW on Wednesday.