HRES 694 is a non-binding House resolution calling on the Centers for Medicare & Medicaid Services (CMS) to halt a pilot program using artificial intelligence to decide Medicare coverage for medical services. It directly affects seniors who rely on Medicare, as the resolution argues AI-driven coverage decisions could jeopardize their access to critical healthcare. The resolution expresses the House's "sense" that CMS should not proceed with this AI evaluation method, referencing CMS's June 2025 announcement of the pilot. As a resolution, it does not create new law but urges CMS to pause the program.
HR 719, the "No Abortion Coverage for Medicaid Act," would prohibit federal Medicaid funds from covering abortions under any Medicaid demonstration projects or waivers, with limited exceptions. It specifically blocks federal financial assistance for abortion services or related expenses (like travel) in Medicaid programs, except in cases of rape or incest, life-threatening pregnancy conditions, or treatment for miscarriage or ectopic pregnancy. This bill directly affects Medicaid recipients in states participating in federal demonstration projects, preventing them from using Medicaid funds for abortion services except under the narrow exceptions listed. The bill aims to permanently align Medicaid funding with the longstanding Hyde Amendment restrictions.
This bill limits how many Medicare Advantage (MA) plans a single organization can offer under Medicare contracts. It prohibits the Medicare program from contracting with an MA organization for more than three plans in a single year, and requires that if an organization offers multiple plans, each must be meaningfully different in premiums, benefits, or out-of-pocket costs. The rule applies to new or renewed contracts starting one year after the bill becomes law. It directly affects MA plan providers and Medicare's contracting process, aiming to reduce plan complexity for beneficiaries.
HR 1349, the Women’s Protection in Telehealth Act, excludes Medicare participation for providers who prescribe, administer, dispense, or furnish abortion-inducing drugs via telehealth unless they meet strict conditions. Specifically, providers must be physicians who physically examine the patient, be present in the same room during drug administration, and schedule an in-person follow-up within 14 days. The bill defines "abortion-inducing drug" as any substance used to terminate a clinically diagnosable pregnancy with knowledge it will likely cause fetal death. This directly affects Medicare-covered telehealth abortion services, requiring in-person care for such treatments rather than remote consultations. The exclusion is permanent for non-compliant providers under Medicare rules.
S 3019, the "No Big Blockbuster Bailouts Act," amends Medicare's drug price negotiation program to change how orphan drugs (treatments for rare diseases) are handled. It raises the revenue threshold from $200 million to $400 million before orphan drugs become subject to price negotiations under Medicare. This directly affects pharmaceutical companies developing drugs solely for rare diseases, as they will face price negotiations only if their annual U.S. revenue exceeds $400 million. The change applies to initial price negotiations starting January 1, 2028.
This bill would deny federal tax deductions for medical expenses related to gender transition procedures and prohibit federal funding through Medicaid, Medicare, and essential health benefits for such procedures. It defines gender transition procedures broadly to include various hormonal treatments and surgeries, while excluding certain medical conditions like disorders of sex development and specific medical emergencies. The bill would affect individuals seeking gender transition care who rely on federal health programs for coverage. The provisions would apply to services furnished after the bill's enactment, with specific exclusions for certain medically necessary treatments.
This bill prohibits federal health programs (Medicare, Medicaid) and private health insurance from covering organ transplants originating in China or not procured through the U.S. Organ Procurement Network, effective January 1, 2026. It defines a "prohibited organ transplant" as one performed in China or using organs not sourced via the U.S. network, including follow-up care like lab tests or drugs. Exceptions only apply to life-saving services provided *after* such a transplant. The law also imposes criminal penalties (up to 2 years in prison) and civil penalties (three times the cost) for violations.
HJRES 58 is a procedural resolution requesting Congress reject a rule issued by the Centers for Medicare & Medicaid Services (CMS) for 2025. The rule would have set payment rates, quality reporting standards, and other policies for home health care services under Medicare, including updates for intravenous immune globulin (IVIG) treatments. This resolution, if passed, would block the CMS rule from taking effect, directly affecting home health care providers and Medicare beneficiaries who rely on these services. It does not create new policy but aims to prevent the implementation of the specific 2025 Medicare home health regulations.
SJRES 84 is a joint resolution seeking to block a rule issued by the Centers for Medicare & Medicaid Services (CMS) under the Affordable Care Act. The rule, published in the Federal Register on June 25, 2025, aimed to improve affordability and integrity in health insurance marketplaces. If approved, this resolution would invalidate the rule under a federal disapproval process, preventing its implementation. This directly affects how health insurance plans are structured and priced for consumers using ACA marketplaces.
HRES 704 is a non-binding resolution expressing the House's opposition to the proposed "Wasteful and Inappropriate Service Reduction Model" (WISeR) for traditional Medicare. It opposes expanding prior authorization requirements for Medicare services by 30% - requiring doctors to seek approval before treatment - using private companies with a history of incorrect denials and AI tools reported to have high error rates. The resolution states this would undermine beneficiary access to timely care, citing data showing prior authorization causes physician burnout and that Medicare Advantage denials are overturned 81.7% of the time. It urges CMS to terminate the model but does not change existing law.
