GOP senators, President Trump propose alternatives to extending ACA subsidies

Sens. Bill Cassidy (R-La.) and Roger Marshall (R-Kan.) have proposed an alternative to extending enhanced Affordable Care Act (ACA) subsidies that are slated to expire at the end of this year. They'd like to take the expiring subsidies and put that money into a health savings account that people can use for their healthcare costs.

Specifically, Cassidy referred to flexible spending accounts, which typically don't roll over unspent money each year, while Marshall suggested the money could be placed in an account that does roll over, adding that he'd like to let people put some of that money into a retirement plan instead.

"If we extend the enhanced premium tax credits, $26 billion go to insurance companies," Cassidy said. "If we put it into a flexible spending account, 100% is going to the person who's making a decision of where to spend their dollars."

Cassidy added that he's spoken to Democrats about the idea who "support it" and "want to know more."

Meanwhile, President Donald Trump has said he's talking to Democrats about a direct healthcare payment plan. "I've had personal talks with some Democrats," he said, adding that he's talked to them "about paying large amounts of dollars back to the people."

"The insurance companies are making a fortune," he said. "Their stock is up over a thousand percent over a short period of time. They are taking in hundreds of billions of dollars, and they're not really putting it back, certainly like they should."

Michael Cannon, director of health policy studies at the libertarian Cato Institute, said that while he opposes the enhanced ACA subsidies, this plan could increase government spending on healthcare. It could potentially incentivize more people to take cash offered to them, sign up for an ACA plan, and leave employer-sponsored plans, as opposed to just being offered tax credits for signing up for an ACA plan.

"Many who wouldn't cross the street for free health insurance will cross the street for free cash," he said.

(Wilkerson, STAT+ [subscription required], 11/17; Wilkerson, STAT+ [subscription required], 11/13; Manchester, The Hill, 11/17; Guggenheim/Hill, POLITICO, 11/11)

JD Vance praises MAHA movement and RFK Jr. at MAHA summit

Vice President JD Vance praised the "Make America Healthy Again" (MAHA) movement and HHS Secretary Robert F. Kennedy Jr. at a MAHA summit last week, saying the movement has been an "incredible part" of the Trump administration's success.

Vance also praised Kennedy's willingness to question established science, saying that often throughout history, "all the experts were wrong."

"Of all the specific initiatives that you guys have worked on effectively, the most important thing is that your team is willing to ask questions that people in government haven't been asking in a long time," Vance told Kennedy onstage.

During his event with Kennedy, Vance said that the one way he's "instinctively MAHA" is that he doesn't like taking ibuprofen if he has a back sprain or wakes up with back pain.

"I don't like taking medications. I don't like taking anything unless I absolutely have to," he said. "And I think that's another MAHA-style attitude. It's not anti-medication, it's anti-useless medication. We should only be taking stuff, we should only be giving our kids stuff, if it's actually necessary, safe and effective."

Vance also claimed the nation's obesity rates stem, in part, from not asking more questions about food in the United States and called on Americans to look closer at their medicine cabinets.

"We really do have medications that I don't think maybe they're not solving the chronic disease epidemic. Maybe, hell, some of them are causing the chronic disease epidemic," he said. "We've got to be asking more critical questions about what we're putting in the bodies of these kids."

While the event between Vance and Kennedy was livestreamed, the rest of the MAHA summit was closed to the press. At the summit, top federal health officials and health industry executives gathered to discuss psychedelics, food as medicine, and how to reverse aging.

(Swenson, Associated Press, 11/12; Chambers, USA Today, 11/13; Cirruzzo/Payne, STAT, 11/12)

"I'm honored to lead CDER at a time when the FDA is achieving long-sought regulatory reforms," Pazdur said in a statement. "I look forward to working closely with Dr. Makary and the medical experts he's assembled to help our country reach its peak in drug development."

Anand Shah, FDA deputy commissioner during President Donald Trump's first term, praised Pazdur as a well-regarded leader and said he would help implement Trump's agenda on matters like expediting drug approvals and agency transparency.

"He will do right by the patient at all times," Shah said. "This is also a win for innovators in the life sciences industry, and a morale boost for the FDA staff … I think that we'll see great reforms at the drug center in the months and years to come."

(Lawrence, STAT+, [subscription required], 11/11; Diamond/Roubein, Washington Post, 11/11; Jewett/Robbins, New York Times, 11/11)

All 50 states have applied for $50B rural health fund

All 50 states have submitted an application to receive a portion of the $50 billion rural health fund that was established as part of the One Big Beautiful Bill Act (OBBBA), according to CMS Administrator Mehmet Oz.

The fund was created under OBBBA to offset the nearly $1 trillion in Medicaid cuts the law implemented.

"This program moves us from a system that has too often failed rural America to one built on dignity, prevention, and sustainability," Oz said in a statement. "Every state with an approved application will receive funding so it can design what works best for its communities—and CMS will be there providing support every step of the way."

As part of the program, $25 billion will be sent to every state equally, regardless of the size of its rural population. The remaining $25 billion will be awarded at Oz's discretion based on criteria, including whether states have adopted HHS Secretary Robert F. Kennedy Jr.'s "Make America Healthy Again" policies.

Under the law, Oz has broad discretion on what he can approve, and there are no specific requirements for states to direct the funds to rural hospitals or for CMS to only approve funding for rural districts. As a result, many health policy experts have raised concerns that the program will act as a "slush fund" and won't reach the rural patients who need it most.

"The status quo is tremendous distress in rural communities," said Heather Howard, a professor at Princeton University and director of Princeton's State Health and Value Strategies Program, adding that the new funding won't be enough to offset Medicaid losses.

Edwin Park, a research professor at Georgetown University's Center for Children and Families, said that lawmakers gave CMS "really excessive discretion" when awarding the money, adding that federal administrators have added rules that aren't within the statute that created the program.

For example, application guidelines say that states can't use more than 15% of their funding to pay providers for patient care. However, these payments are expected to take a hit because of Medicaid cuts.

Mary Mayhew, president and CEO of the Florida Hospital Association, said that every hospital-led initiative will need a clear, defined purpose aimed at closing healthcare gaps in rural areas.

"Hospitals can't just say they want to invest in the latest, shiny piece of equipment like a mobile clinic," she said. "They need to specify to what end it will be used for."

(Weixel, The Hill, 11/6; Tribble/Zionts, KFF Health News, 11/7; Kacik, Modern Healthcare, 11/11)