Shutdown Continues as Stalemate Over ACA Tax Credits Persists. The government shutdown continues amid partisan gridlock. Republicans’ stopgap funding bill has failed to garner the necessary 60 votes ten times since September 30. Yesterday, Senate Democrats also rejected a Republican effort to pass the annual funding bill for the Department of Defense, preventing an attempt at Congress’ “normal” government funding process during the shutdown. Republican leaders reportedly floated a promise to Democrats to schedule a vote on extending the ACA enhanced premium tax credits once the shutdown ends. It seems unlikely at this stage that enough Democrats will be swayed by this concession, as Democratic leadership holds firm that an agreement to extend the enhanced subsidies—not an agreement to vote on them—is needed to secure Democratic votes. ACA Marketplace “window shopping” ahead of the November 1, 2025 start to the Open Enrollment Period, may further solidify Democrats in their messaging, as Marketplace customers see severe increases in premiums. Though both parties seem entrenched in their positions, the shutdown situation could change rapidly. A4H will continue to monitor the government funding and ACA enhanced subsidy debates and will provide updates as we have them.

MedPage Today: Skin Substitutes Abuse Wounds Both Taxpayers and Seniors. A4H members Bloom Healthcare and HarmonyCares wrote a MedPage Today op-ed, which highlights the skin substitutes fraud and abuse, the impact on Medicare spending, and adverse patient outcomes. The op-ed also encourages CMS to finalize its proposal to set a single, rational payment rate for skin substitutes to eliminate profiteering incentives. A4H continues to work with federal policymakers to increase the profile of skin substitutes fraud and abuse and advocate for commonsense policies to reduce fraud.

Health Affairs: Skin Substitutes: A Case for How ACOs Can Help Prevent Fraud, Waste, and Abuse.  In this article, A4H CEO Mara McDermott, along with A4H members HarmonyCares and C-TAC, discuss the vital role of ACOs in combating fraud and abuse in Medicare’s spending on skin substitutes. The authors highlight how ACOs were among the first to flag excessive and inappropriate use of skin substitutes, helping CMS recognize how its payment model—paying average sales price plus 6%—encouraged profiteering and patient harm. The article further recognizes that ACOs remain financially exposed to fraud occurring outside their control and urges CMS to adjust ACO benchmarks for anomalous spending spikes, reopen settlements to exclude proven fraudulent claims, and strengthen stop-loss protections.

The Congressional Briefing on Kidney Care scheduled for October 21 has been CANCELLED due to the government shutdown. We will keep you posted once the event is rescheduled.