April 21 Federal Update: President Trump Signs Executive Order to Reduce Prescription Drug Costs

President Donald Trump signed an executive order, Lowering Drug Prices By Once Again Putting Americans First, directing the Department of Health and Human Services (HHS) to reduce prescription drug cost of and expand access. Key provisions include:

• Lowering the cost of insulin and injectable epinephrine for low-income and uninsured individuals
• Standardizing Medicare payments for prescription drugs across care settings
• Stabilizing and reducing Medicare Part D premiums
• Increasing transparency in Medicare drug price negotiations

Mehmet Oz Confirmed as CMS Administrator

The Senate confirmed Dr. Mehmet Oz as the Administrator of the Centers for Medicare and Medicaid Services (CMS) in a 53-45 vote. Oz emphasized priorities including health care cost transparency, expedited access to life saving treatments, and combating fraud and waste. He also expressed a commitment to prevention, wellness, and chronic disease management.

HHS Says Gender Dysphoria Not Enforceable Under Disability Protections

The U.S. Department of Health and Human Services (HHS) clarified that gender dysphoria is not enforceable under federal disability protections outlined in its rule Nondiscrimination on the Basis of Disability in Programs or Activities Receiving Federal Financial Assistance. The department stated that the language appeared in the preamble – not the regulatory text – and therefore does not carry the force of the law.

Congress Advances Budget Framework

The House and Senate passed a budget framework along partisan lines, completing the first step of budget reconciliation. The plan includes:

• A $4 billion reduction in federal spending
• A $150 increase in military spending
• A $175 increase for boarder security and immigrant enforcement

These increases have raised bipartisan concerns over the federal deficit and potential cuts to health and nutrition programs. The final budget is expected to extend provisions of the 2017 Tax Cuts and Jobs Act, with a House vote anticipated by the end of May.

CMS Proposes Rule for Inpatient Psychiatric Facilities

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule updating Medicare payment policies for Inpatient Psychiatric Facilities (IPF) for fiscal year 2026. Highlights include:

• A 2.4% payment rate increase
• Adjustments for teaching status and rural location
• Recognition of increases to teaching caps for resident full-time equivalents

CMS also proposed removing four quality reporting measures starting in CY 2024/FY 2026:

• Facility Commitment to Health Equity
• COVID-19 Vaccination Coverage among Health Care Personnel
• Screening for Social Drivers of Health
• Screen Positive Rate for Social Drivers of Health

If finalized, the rule would take effect Oct. 1, 2025.

CMS Limits Future Section 1115 Waivers

The Centers for Medicare & Medicaid Services (CMS) announced it will no longer approve or renew Section 1115 demonstration waivers for programs previously funded without Medicare dollars. These include initiatives using Designated State Health Programs or Investment Programs. CMS cited redundancy with other federal and state efforts.

Section 1115 waivers have traditionally allowed states to expand Medicaid services and address social determinants, including housing, nutrition, and workforce development.

House Panel Reviews TANF Oversight Following a GAO Report

The House Subcommittee on Work and Welfare held a hearing following the release of a Government Accountability Office (GAO) report recommending stronger oversight of Temporary Assistance for Needy Families (TANF). Key findings include a shift in state spending from direct cash assistance to services, including job training and child welfare. GAO advised enhanced data reporting, improved assessing fraud risk assessments, and better tracking of audit resolutions.

Roxane Somerlot, director of the Marion County Department of Job and Family Services, testified on the value of TANF-funded services, highlighting child care, youth employment programs, and supports for families nearing income thresholds that affect benefit eligibility.

SNAP Employment Programs Highlighted in House Agriculture Hearing

The House Committee on Agriculture explored strategies to increase employment among Supplemental Nutrition Assistance Program (SNAP) participants.

Chairman Glenn “GT” Thompson (R-Pa.) emphasized the importance of work requirements and SNAP Employment and Training (E&T) programs. Witnesses shared personal success stories, though studies show mixed results on work requirement effectiveness for able-bodied adults without dependents.

Recommendations included ensuring consistent implementation of work requirements and supporting the Training and Nutrition Stability Act, which would exempt temporary training income from benefit eligibility calculations.

Updates from the Judiciary 

Supreme Court Upholds Pause on Teacher Training Grants

The U.S. Supreme Court reversed a lower court ruling that would have required the Trump administration to temporarily reinstate $250 million in teacher training grants across eight states.

The grants were terminated because they supported programs that included equity, diversity,  and inclusion (EDI) components. The justices ruled that the pause would cause permanent harm to the states while litigation proceeds and noted that once disbursed, the federal government would likely be unable to recover the funds.

Four justices dissented, arguing the administration failed to justify the cancellations and that the case did not warrant emergency review. They also raised concerns about the impact on teacher shortages and long-term harm to the public education systems in the affected states.

Supreme Court Backs Federal Regulation of Ghost Guns

In a 7-2 decision, the Supreme Court upheld the Biden Administration’s regulation of ghost guns, untraceable firearms assembled from kits or parts often purchased online. These weapons lack serial numbers, making them difficult to trace and increasingly appealing to individuals barred from owning firearms, including minors, domestic abusers, and gun traffickers.

The rule, based on the Gun Control Act of 1968, redefines “frame and receiver” to bring ghost guns under federal oversight. Challengers argued the rule could apply to any ghost guns, but the Court affirmed that the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) has authority to regulate such parts kits.

The ruling keeps the regulation in effect but allows for further legal challenges regarding how it applies to specific cases.

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