Federal Government Reopens After Longest Shutdown in History

November 13, 2025

EGWP marketplace medicaid Medicare

On Nov. 12, the House passed, and the President signed into law, legislation to reopen the federal government and end the longest U.S. government shutdown in history. The agreement funds most agencies through Jan. 30, 2026, with some full-year appropriations included. Immediate impacts include federal employees returning to work and receiving back pay, resumption of SNAP benefits and other critical programs though operational lags may persist for weeks.

The bill also extends Medicare telehealth coverage – which expired when the shutdown began – through Jan. 30 and retroactively pays for virtual care services delivered to beneficiaries during the shutdown. The deal struck in the Senate includes a stand-alone Senate vote in December on extension of enhanced ACA tax subsidies that will expire at year-end without congressional action. Passage is far from guaranteed and House Speaker Johnson (R-LA) has not committed to a vote.

The White House and key Republicans in Congress have made clear that reforms of the enhanced ACA tax subsidies are necessary for any potential bipartisan agreement. In addition to longstanding interest in addressing program integrity and limiting tax credits for higher-income consumers, the President and key Republicans are calling for reforms that would enable federal health care funding to flow directly to consumers.

legislation

Virginia and Hawaii Introduce PDAB Legislation

The Virginia Senate introduced a bill to establish a Prescription Drug Affordability Board (PDAB) to review drugs with a wholesale acquisition cost (WAC) of $60,000 or more per year or a WAC increase of $3,000 or more in any 12-month period. For drugs deemed to cause an affordability challenge, the legislation authorizes the PDAB to […]
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February 12, 2026

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Solutions

AHIP Shares Update on Plan Progress to Simplify Prior Authorization

AHIP shared progress on the voluntary, multi-year commitments made by AHIP, BCBSA, and leading health plans (including Cigna Healthcare) to streamline and simplify prior authorization. Health plans serving nearly 270 million Americans are participating in this initiative. The 2026 commitments took effect on Jan. 1 and include: reducing the scope of claims subject to prior […]
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February 12, 2026

EGWP marketplace medicaid Medicare

legislation

DOL Issues Proposed Rule on Improving Transparency into PBM Fees

Pursuant to President Trump’s Executive Order “Lowering Drug Prices by Once Again Putting Americans First,” the Department of Labor’s (DOL’s) Employee Benefits Security Administration (EBSA) issued a proposed rule that would require providers of PBM services and affiliated entities of brokerage and consulting services to disclose direct and indirect compensation to their self-funded ERISA fiduciary […]
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February 12, 2026

EGWP marketplace medicaid Medicare

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