By Megan R. Wilson

In today’s issue:

• Hospitals are facing simultaneous payment cuts, new oversight and transparency proposals as policymakers look to rein in health care spending
• Democrats are making the GOP’s tax-and-spending law a centerpiece of their midterm messaging as Republicans pivot to selling its tax cuts
• A federal judge temporarily blocked Colorado’s first-in-the-nation prescription drug payment cap, handing Amgen an early win

… and more.

Happy Monday, and welcome back to Health Brief. Hope everyone had a relaxing holiday! Congress isn’t here this week, but the health policy world is showing no signs of slowing down. So let’s get into it.

What do you have on your radar? Drop me a line. You can find me at megan.wilson@washpost.com, or message me securely on Signal at megan.434.

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The hospital industry is confronting a series of policy threats. (Patrick Semansky/AP Photo)

Hospitals are in the midst of one of the toughest policy environments they’ve faced in years, with both Congress and the Trump administration hitting the industry from multiple angles at once.

→ Last week, the Centers for Medicare and Medicaid Services released a sweeping proposed rule updating hospital outpatient and ambulatory surgical center payment policies that drew rebuke from much of the industry.

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• It would cut billions of dollars in Medicare outpatient drug payments to many hospitals participating in the 340B drug discount program, which impacts nonprofit hospitals.
• The proposed rule also imposes so-called site-neutral payment policies on imaging services, meaning that hospital outpatient departments would be reimbursed at the same rate as a doctor’s office.
• That follows on the Trump administration move last year to equalize payments for drug administration services at certain hospital-owned outpatient clinics.
• Meanwhile, the powerful House Ways and Means Committee advanced legislation that would tighten oversight of nonprofit hospitals by requiring more detailed reporting on executive compensation, billing and community benefit spending.
• Plus, there’s a renewed effort more broadly on Capitol Hill to usher in additional price transparency requirements as Americans rank health care affordability as a top concern.

Individually, these policy proposals are nothing new. But together, they’re representative of a shift in Washington, where hospitals are increasingly being viewed as a source of federal savings and a contributor to rising health care costs rather than an industry to shield from cuts.

Hospital CEOs have been among the industry executives hauled before Congress to explain the high cost of care. They argue that they’re seeing an influx of sicker patients, while trying to deal with increased overhead.

Why it matters: Hospitals have fought off many of these proposals for years. What’s different now is that all of these policies are advancing simultaneously as the industry prepares for deep Medicaid cuts and a rise in uninsured patients. That convergence represents one of the most challenging policy environments hospitals have faced in years.

“There are no silver bullets in health care financing, and there is rarely a single policy that breaks the system. But the cumulative impact of policy decisions matters, particularly as hospitals care for a growing number of patients who either can’t afford insurance or can’t afford to use the coverage they have,” Charlene MacDonald, the president and CEO of the Federation of American Hospitals, tells me.

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The industry group represents for-profit hospitals, which haven’t been under the microscope as much as their nonprofit counterparts — but are still bracing for many regulatory and market changes.

“The focus of any reimbursement policy should be on ensuring patients can access the care they need when they need it,” said MacDonald.

→ The moves are also happening as the industry confronts attacks from health insurers, drugmakers and the conservative health think tank Paragon Institute that blame hospitals as a key cause of high health care costs.

“Simply put, the proposals make it harder for hospitals to provide critical care for patients,” said Stacey Hughes, the American Hospital Association‘s executive vice president of government relations and public policy. “This comes at a time when hospitals are preparing to absorb billions of dollars of Medicaid cuts and loss of coverage for millions of patients.”

→ Hospitals have long been able to wield political power in Washington, often serving as the largest employer in a state or congressional district. But that clout is being tested as policymakers look to hospitals for budget savings and greater accountability, particularly around pricing and tax-exempt status.

Jennifer DeCubellis, the president and CEO of America’s Essential Hospitals, said the proposed rule “takes an axe to critical funding that supports essential hospitals without concern for how it will affect the patients they serve.”

The group represents hundreds of so-called safety-net hospitals that serve large numbers of low-income patients. It called the proposal to slash Medicare outpatient drug payments “unlawful.”

There’s a lot to unpack from the proposed rule, and I’ll be covering how the hospital industry plans to push back — particularly on the changes to the 340B discount drug program reimbursements — in the coming weeks.

For now, Jillanne Schulte Wall, senior director of health and regulatory policy at the American Society of Health-System Pharmacists, tells me the industry group is exploring “collaborations” with other organizations to fight back. In addition to submitting official comments, the group is engaging with members on Capitol Hill and trying to garner lawmaker opposition to the administration’s proposal.

What to watch: The administration’s pressure on 340B program compounds requirements and restrictions that pharmaceutical manufacturers have been imposing on hospitals. These proposed cuts to hospital payments could only be just the beginning, industry experts note.

Rob Smith, a managing partner at Capital Alpha, wrote in a note to investors that regulators and lawmakers are likely to expand site-neutral payment policies into other services — an effort to save some federal cash. The Medicare Payment Advisory Commission, a federal advisory panel better known as MedPAC, has recommended imposing these policies for dozens of services.

“Much like CMS’ regulatory efforts, we think Congress passing large-scale site-neutrality legislation is a matter of when and how big rather than if,” Smith writes.

Speaking of the $900 billion in impending cuts to Medicaid: The One Big Beautiful Bill Act was supposed to be a crowning legislative achievement for Republicans to tout while campaigning in the midterm elections.

Among other things: It prevented massive tax increases for most Americans and established a program that allows parents to open investment accounts for children born during President Donald Trump’s second term and receive $1,000 from the government.

But the legislation has emerged as a central talking point for the Democratic Party, with congressional Democrats mentioning the law twice as often as Republicans, report Matthew Choi and Clara Ence Morse in The Washington Post newsroom.

• Democratic candidates are deriding it as the “Big Ugly Bill” and linking the changes it brought to Medicaid and food assistance programs to voters’ anxieties about the cost of living.
• Republicans, meanwhile, have largely retreated from talking about the law by name, instead opting to emphasize the tax savings and other proposals.
• Democrats assert that the shift is a sign of the Republican Party’s acknowledgment of the law’s low overall approval.
• “I don’t care what you call it. It’s what delivers for America,” House Republican Conference Chair Lisa McClain (Michigan) told my colleagues.

Read the full story: “Democrats invoke ‘big, beautiful bill’ far more than Republicans as midterms near.”

A federal judge temporarily blocked Colorado from enforcing a state-set payment cap on a pricey medication for autoimmune disorders called Enbrel, siding with Amgen, the company that makes it, while the lawsuit moves forward.

The case centers on whether Colorado’s Prescription Drug Affordability Review Board has the authority to limit what can be reimbursed for a patented drug. The board had determined that Enbrel was unaffordable and set a maximum payment level at roughly 70 percent below Amgen’s wholesale price.

• The judge found that Amgen is likely to win because an earlier federal appeals court ruling says states cannot impose price caps on patented drugs if doing so conflicts with federal patent law. The court said Congress — not individual states — gets to decide how to balance affordable drug prices with the financial incentives that patents provide for developing new medicines.
• The judge also agreed that Amgen could suffer “significant harm” if the cap took effect, including weaker negotiating power with wholesalers and contracts that would be difficult to undo later. It rejected the state’s claims that any harm was balanced by carveouts in the law, such as the payment limit applying to employer-based plans. “This is an argument about the scope of damages, not their existence,” the judge wrote.

Why it matters: States across the country have been setting up their own Prescription Drug Affordability Boards (PDABs) in an effort to try and rein in drug costs. Some act as advisory panels that develop policy, while others — including Colorado — are able to set upper payment limits. Enbrel’s price cap became the first in the nation, proving to be a test for other PDABs nationwide.

The boards’ overall effectiveness and ability to lower medication prices in the states in which they’ve been established has come into question and became one of the reasons Democratic Gov. Abigail Spanberger (Virginia) vetoed bipartisan legislation to set up a PDAB in the state.

“Drug manufacturers took a huge sigh of relief from this decision,” Andrew Twinamatsiko, a director of the Center for Health Policy and the Law at Georgetown Law, tells me.

For now, Colorado cannot enforce the payment limit for Enbrel while the lawsuit continues. The ruling does not decide the entire case, but it pauses the state’s price cap until the court reaches a final decision.

What’s next: The court leans on a federal ruling that struck down a pharmaceutical price gouging law in Washington D.C., but Twinamatsiko said that structure of the law — which utilized international reference pricing — is different from how Colorado’s PDAB operates and “there are creative ways” the state could differentiate the two legally.

The Biotechnology Innovation Organization has named Andrew Barnhill as its senior vice president of membership. He comes from IQVIA, where he served as the head of public policy and chief government affairs officer. Barnhill will work with Liz Gaskins, BIO’s vice president of membership, to engage with current and prospective members for the industry group.

Here are some major topics from last week:

• The World Health Organization has launched a clinical study to test two treatments that target the rare type of Ebola, called Bundibugyo, that is confirmed to have killed more than 450 people and sickened about 1,000 more in the Democratic Republic of the Congo and Uganda.

Gilead Sciences is supporting the study by donating more than 2,000 vials of its antiviral drug remdesivir for investigational use, following a separate donation to Uganda for emergency response efforts.

Why it matters: There are no vaccines or treatments that target the Bundibugyo virus, which is continuing to spread. Prior to the trial, some patients have received remdesivir to treat Ebola off-label.

• The American Hospital Association named Steve Walsh, who leads the Massachusetts Health & Hospital Association, as its next president and CEO.

He succeeds Rick Pollack, who is retiring after a decade at the helm, and Walsh will take the reins in the fall, according to the association. Walsh has been president and CEO of the Massachusetts Health & Hospital Association for nearly a decade and, before that, served six terms in the Massachusetts House of Representatives.

Why it matters: The AHA is the nation’s largest hospital and health system industry group, with nearly 5,000 members and more than $146 million in revenue. The association spent nearly $25.5 million on lobbying the federal government last year.

“Why U.S. measles outbreaks have grown harder to extinguish,” Lena H. Sun reports at The Post.

“A drop in fatal overdoses helps push the U.S. death rate to a record low,” The Post’s Rachel Roubein writes.

“Rural health funds to fix prior authorization,” Maya Goldman reports at Axios.

“Top 10 medtech deals in the first half of 2026,” Nick Paul Taylor writes for MedTech Dive.

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