Dear ACH Members,
On our third post-election Friday update, we still have plenty of new updates and developments to share. As we continue to prepare for the coming Administration, we are laser-focused on strategies to move forward our policy agenda on behalf of health centers. The dynamics are constantly evolving, so we will continue to keep you up to speed with everything we learn.
Of note, last week the Paragon Health Institute (an influential player within the Trump Administration policy world) released “Health Care for a Lame Duck,” which included policy recommendations for Congress’s lame duck session to include restricting telehealth extensions, limiting CHC funding, and providing no additional funding to the THCGME and NHSC programs.
ACH has denounced Paragon’s recommendations and issued a statement this week strongly advising Congress to reject them. Our response and advocacy were covered extensively today in an article from Inside Health Policy titled "Paragon's Call to Limit Mandatory Funding for Community Health Centers Sparks Backlash from Advocates."
What the year-end package looks like, and whether or not it includes these proposals, will be a strong indicator of how much influence external parties will have on legislative developments in the 119th Congress. We are confident in our allies’ support for health centers on the Hill and will continue to engage with members on both sides of the aisle to secure the highest funding level possible in the final package.
Contacting your member of Congress is the single most important thing you can do to drive health centers to the front of the agenda. Please let us know if you have any questions or if we can help facilitate meetings with your congressional delegation.
Administration
HHS & CMS Nominations: In another flurry of nominations, this week President-elect Trump announced Dr. Mehmet Oz as his pick to run the Centers for Medicare and Medicaid Services (CMS). Trump and Oz have been friends for over 20 years, and Oz served on Trump’s Council on Sports, Fitness, and Nutrition in his first term. More recently, Oz ran an unsuccessful bid for Senate in Pennsylvania against Senator John Fetterman (D-PA).
Oz, like many of Trump’s nominations to high-level positions, does not have experience running a large federal bureaucracy, nor does he have experience working in roles that deal with health insurance policy more broadly. While his position on Medicaid policy is not yet clear, Oz has been supportive of the Affordable Care Act’s goal of expanded coverage but critical of perceived government overreach of the program. Instead, Oz has been a vocal proponent of increasing access and eligibility to Medicare Advantage plans. During his 2022 Senate campaign, he promoted expanding access to Medicare Advantage to any individual who wants to enroll, and in 2020, he co-authored “Medicare Advantage for All Can Save our Health System” in Forbes magazine.
Robert F. Kennedy Jr. is expected to meet with GOP Senators after the Thanksgiving holiday to garner support for his confirmation to Secretary of Health and Human Services. Kennedy will have to walk a fairly fine tight-rope between Democrats and Republicans, calming concerns among GOP senators about his past support for abortion rights and those from farm states concerned about his desires to overhaul the food system while downplaying his vaccine skepticism and COVID-19 conspiracies to Democrats. Although Democrats and public health experts remain uneasy about some of Kennedy’s agenda, some see in him an opportunity to work with the incoming Administration – particularly in nutrition and chronic disease management.
Dr. Oz’s nomination has received a much warmer reception among Republicans (including his former Senate opponent, Fetterman) than Kennedy’s, which could lead to an easier confirmation process for Oz than that of other nominees.
Both Oz and Kennedy have extensively supported overall health and wellness, though as STAT News reports, their capacity to make sweeping changes to the health system will be limited by a number of challenges. Finally, while very little is known about where both Oz and Kennedy stand on Medicaid policy, we anticipate Republicans in Congress will press for major changes to the program including funding cuts and eligibility restrictions.
ACH is prepared to work with the Trump Administration’s HHS and will make the strong case that health centers are essential to the pillars of the Make America Healthy Again agenda.
Florida, Florida, Florida: So far, Florida has a massive presence among those who are being nominated to serve in the Trump Administration. Trump’s incoming chief of Staff, Susie Wiles, his Secretary of State nominee, Senator Marco Rubio, his National Security Advisor, Congressman Mike Waltz, and both nominees for Attorney General, Congressman Matt Gaetz (who has since withdrawn) and Pam Bondi, all reside in the President-elect’s home state.
Recess Appointments: While Republicans will control both chambers of Congress next year, a handful of Republican Senators have indicated their skepticism towards some of Trump’s more controversial cabinet picks. To forgo a lengthy confirmation process, Trump may try to use recess appointments (officials appointed in this manner can only serve two years), but it may require the Senate to agree to recess for 10 days. A few GOP Senators, including Minority Leader Mitch McConnell, have opposed this while indicating the Republicans will not have the votes to recess.
We will continue to engage with the transition team and new administration officials to ensure that the Trump health care agenda meets the needs of community health centers and their patients.
Senate Updates
Last night, Senator Bob Casey (D-PA) conceded the race for Pennsylvania’s Senate seat to his Republican challenger David McCormick. The race’s slim margin triggered an automatic recount by state law, and while the results aren’t expected to be released until next week, both campaigns acknowledged the outstanding votes favored McCormick. This brings the 2024 Senate races to an end and solidifies the Republican Senate majority with 53 seats.
In other interesting news, outgoing Senate Minority Leader Mitch McConnell (R-KY) will chair the Senate Appropriations Defense Subcommittee and the Senate Rules Committee in 2025. McConnell’s decision to lead the Defense Subcommittee averts a dispute with Sen. Susan Collins (R-ME), who’s in line to become the full committee’s chair. McConnell had the seniority to leapfrog Collins to lead the entire Appropriations Committee. But leading the defense-focused panel aligns with McConnell’s goal of focusing on foreign policy. And pushing Collins aside would have undermined a colleague facing a potentially competitive reelection bid in 2026.
2026 Midterms Look-Ahead: While the new Administration and 119th Congress have yet to be sworn in, both Democrats and Republicans are looking to the 2026 Midterm Election map as they set their legislative and political agendas. 2026 will be a bit of a role reversal for Republicans, as they’ll have to defend 22 Senate seats compared to the Democrats’ 13, including special elections to fill the vacancies for Senator JD Vance (R-OH) and Senator Marco Rubio (R-FL).
Senator Tim Scott (R-SC) ran unopposed to chair the National Republican Senatorial Committee. He will have big shoes to fill, replacing Sen. Steve Daines (R-MT) who helped flip four seats in the 2024 election cycle and steering the party from a 49-51 minority to a 53-47 majority.
Senator Kirsten Gillibrand (D-NY) is expected to chair the Democratic Senatorial Campaign Committee, although Democratic Leader Chuck Schumer (D-NY) has yet to make a final decision. Senator Gary Peters (D-MI) is the current chair and will himself face one of the more difficult races in 2026.
Races to Watch: Nine of the currently seated Senate HELP Committee members, including soon-to-be Chairman Bill Cassidy (R-LA), are up for re-election in 2026. Leader McConnell is also up for election in 2026 but has yet to announce whether he intends to run for re-election. He has faced multiple recent health issues and would be 90 years old by the end of another six-year term. If he retires, Kentucky would have an open seat and the popular Democratic Governor, Andy Beshear, could enter the race, putting a traditionally Republican seat in play. Senator Sherrod Brown, a popular Democrat in a crimson state, has not ruled out running in Ohio’s special election to replace JD Vance.
Senator Thom Tillis (R-NC), one of DC’s “most vulnerable” Senators, is also up for re-election in 2026. In 2023, he was censured by the state Republican party for voting to certify the 2020 election, supporting nominations in the Biden Administration, and generally not falling in line with conservative “MAGA” beliefs. How Tillis navigates a second Trump Administration will serve as a bellwether for other moderate Republicans in Congress, as he’ll have to simultaneously fall in line with the Trump Administration to avoid a primary with a Trump-backed Republican without losing support of moderate voters and donors in the state.
House Updates
Republicans have retained control of the majority in the House, with 219 seats for Republicans and 213 seats for Democrats. Only three seats in the House are still too close to call: CA-13, CA-45, and IA-1. All three seats are held by Republican incumbents, two of whom sit on Committees of jurisdiction relevant to ACH: Rep. Michelle Steele (CA-45) who serves on the Ways and Means Committee Subcommittee on Health, and Rep. Marionette Miller-Meeks (IA-1) who serves on the Energy and Commerce Committee. Each of the outstanding races is within a 0.2% vote margin, and regardless of the ultimate outcome, Republicans in the majority will have little to no room for party defectors as they work through their legislative agenda.
One thing to keep in mind - the 219 total includes three Representatives who have been nominated by Trump to serve in his Administration: Reps. Michael Waltz (R-FL), Elise Stefanik (R-NY), and Matt Gaetz (R-FL). This could further impede Republicans’ ability to garner votes for their legislation in the 119th Congress.
Rep. Gaetz, who has since withdrawn his name from consideration for Attorney General, had resigned his seat effective immediately after being given the official nomination from President-elect Trump. He also came out today and said he does not plan to rejoin Congress. Reps. Waltz and Stefanik will remain in the House pending Senate confirmation, but if their appointments are approved, both seats will need to be filled by special elections.
Considering this, there is a possible (although highly improbable) scenario in which Democrats win the three outstanding elections, ultimately tying the House at 216 seats in each party until the three vacated seats are filled.
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