How the fight over ICE could pave the way for health reforms

Republicans are considering using a special budget process known as reconciliation to fund the Immigration and Customs Enforcement agency without help from Democrats. That could create an opening for going it alone on other legislation, including President Trump's Great Healthcare Plan.

Trump's plan aims to shift from the insurance structure of the Affordable Care Act to putting money into individual health savings accounts. Trump also wants to codify in law the voluntary agreements with drugmakers to set U.S. prices on par with peer countries and stop pharmacy benefit managers from paying the large consulting firms that help employers with their benefit selections.

Natasha Murphy, director of health policy at the Center for American Progress, said health savings accounts are a more likely target of reconciliation than the drug pricing piece, even though the administration is pressuring Republicans on drug pricing.

Earlier this year, it seemed unlikely that Republicans would use reconciliation to pass legislative priorities. But some Republicans think it might be the only way to get around Democrats, who are demanding reforms to ICE that Republicans oppose following the killing of two protestors in Minneapolis.

The two parties are contemplating a plan to fund all of the Department of Homeland Security, except for the parts of ICE that charge and deport undocumented immigrants. Then, Republicans would attempt to use budget reconciliation, which requires a simple majority to pass, to separately fund ICE and possibly the Iran conflict.

It's still unclear whether Republicans will attempt reconciliation again. They used the process last year to pass tax legislation without support from Democrats. However, with a one-vote margin in the House and major tax cuts already in place, it would be a difficult thing to accomplish.

"If you look at last year, the only thing that held it all together was we knew we had to use it for tax reductions," Sen. Rick Scott (R-Fla.) said.

This isn't the first time health care policy might be affected by debates over ICE. In January, HHS funding legislation got caught up in the debate over ICE funding. The HHS appropriations bill was part of a larger funding package that included DHS. Republicans and Democrats broke that impasse by agreeing to fund DHS separately from the other agencies, much the same way that they're now considering splitting the DHS funding bill.

cdc

All-hands CDC meeting

On the day a permanent CDC director was supposed to be nominated by Trump, acting Director Jay Bhattacharya held his first all-hands meeting with agency staff, Helen Branswell reports.

Many in attendance hoped Bhattacharya would announce the administration's pick for running the agency at the meeting. Instead, he said that announcement is expected today. (HHS later said that Bhattacharya would continue in the part-time leadership role at the agency, without laying out a new timeline.)

Helen got her hands on a transcript from the meeting. Read more about the tough questions Bhattacharya faced, his defense of health secretary Robert F. Kennedy Jr., and what he has planned in the wake of the attack on CDC's headquarters in Atlanta.

insulin

The poster child for high drug prices

A bipartisan group of lawmakers introduced a bill that would cap out-of-pocket insulin costs at $35 per month for people with private insurance and would lower the cost for some without insurance through a $100 million pilot program, according to Daniel Payne.

It builds on legislation to cap the price of insulin for Medicare patients at the same price, which passed as part of Democrats' Inflation Reduction Act.

The INSULIN Act of 2026, which has the support of Sens. Raphael Warnock (D-Ga.), Jeanne Shaheen (D-N.H.), John Kennedy (R-La.), and Susan Collins (R-Maine), would create new requirements for pharmacy benefit managers and aim to increase biosimilar and generic competition. The effort was first reported by Semafor.

In 2023, a bill with the same name and similar aims was introduced, but not ultimately enacted.

Insulin has come to epitomize high drug prices because it's widely used and, although updated several times over the years, its core ingredient was discovered about 100 years ago.

drug middlemen

FTC proposes settlement over insulin pricing

To the point above, the Federal Trade Commission reached a proposed settlement with CVS Caremark over allegations that the pharmacy benefit manager artificially inflated the price of insulin, according to Ed Silverman.

Last month, the FTC reached a final settlement with Cigna's Express Scripts over similar allegations. The cases stem from a complaint that the FTC filed in September 2024 against CVS Caremark, Express Scripts, and UnitedHealth's OptumRx.

acip

Bye Malone

Robert Malone, an outspoken doctor and ally of RFK Jr., is stepping away from a panel of federal vaccine advisers, Chelsea Cirruzzo reports.

Malone was one of the new Advisory Committee on Immunization Practices members that Kennedy chose after firing every member of the panel.

A federal judge recently issued a preliminary ruling that says the reconstitution of ACIP, and changes made to the childhood vaccine schedule in January, were likely illegal because of how they were done.

care coordination

CMS unveils new payment pilot

CMS officials unveiled a pilot program that aims to improve the care of children with complex medical and behavioral needs by encouraging coordination and accountability among doctors.

CMS Administrator Mehmet Oz and Abe Sutton, the director of the Center for Medicare and Medicaid Innovation, wrote a First Opinion article in STAT about the new program, called ASPIRE (Accelerating State Pediatric Innovation Readiness and Effectiveness).

They described the pilot as "standardizing a more robust value-based payment framework that will give pediatric providers an on-ramp to greater accountability and more substantial rewards for high-quality care."

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What we're reading

California considers seal of approval for foods that are not ultra-processed, STAT
'We're on the inside now': Meet the man building a political empire behind RFK Jr., The Boston Globe
How an outsider crept into Eli Lilly's top ranks — and plans to drive its business forward, STAT
The meme-washing of RFK Jr., The Atlantic