In this update:
- Trump Administration
- Trump Executive Order Centralizes Grantmaking Under Political Appointees
- Trump Administration Loses Two Spending Battles
- Federal Agencies
- Dr. Vinay Prasad Returns to the FDA
- CMS Releases FAQ on WISeR Program
- CMS Releases Data on Enrollees without Claims
- Other Updates
- KFF Finds Median ACA Premium Increase of 18%
- CBO Publishes Additional Distributional Effects of OBBBA Including SNAP Analysis
- Fitch Reports Non-Profit Hospital Ratings Improvements for 2025
Trump Administration
Trump Executive Order Centralizes Grantmaking Under Political Appointees
On August 7th, President Trump issued an Executive Order (EO), “Improving Oversight of Federal Grantmaking” to transform how the federal government distributes research grant dollars. Traditionally, career civil servants with specific subject-area expertise set funding priorities and make grant decisions. Referencing “problematic” grants such as those funding “drag shows in Ecuador” and the “unsafe lab in Wuhan, China”, the EO shifts this decision-making to presidential appointees, in coordination with the White House. It also instructs agencies to build a pathway to cancel previously-awarded grants that no longer support program goals or national interests.
The Executive Order is available here.
Trump Administration Loses Two Spending Battles
This week, judges ruled against the Trump Administration in two federal spending cases:
On August 9th, a three-judge D.C. Circuit Court of Appeals panel voted unanimously to prohibit the Trump Administration from making a public database of federal spending secret. The administration shuttered the database in March saying that its transparency threatened President Trump’s authority over spending. Two judges went further, noting that the effort to restrict the data threatened the separation of powers by challenging Congress’ spending authority. The panel gave the administration until Friday, August 15th to restore the data online.
On August 11th, U.S. District Judge Dabney Friedrich ruled that the Trump Administration is illegally withholding funds previously approved by Congress, violating the Impoundment Control Act. The case was brought in March by the National Endowment for Democracy, which received a $315 million appropriation for the current fiscal year, but was unable to access $239 million of the funds beginning in January. Judge Friedrich, a Trump appointee, noted that the administration has made “repeated maneuvers to impede the Endowment’s flow of funds…for impermissible policy reasons” and that the National Endowment for Democracy had suffered irreparable harm as a result. The judge ordered the release of $95 million in federal funds to the organization.
Federal Agencies
Dr. Vinay Prasad Returns to the FDA
On August 9th, an HHS spokesman confirmed that Dr. Vinay Prasad is “resuming leadership of the Center for Biologics Evaluation and Research” at the FDA’s request. In this role, Dr. Prasad oversees vaccine, gene therapy, and blood product regulation, though it is unclear whether he will also return as the FDA’s Chief Medical and Scientific Officer. At the end of July, Prasad resigned from his post after three months on the job. He had drawn criticism from the White House and right-wing influencer Laura Loomer after denying a series of new treatments for rare diseases and ordering a pause on Sarepta Therapeutics’s therapy for Duchenne muscular dystrophy. His firing was reported to be against the desires of Secretary Kennedy and FDA Commissioner Marty Makary.
CMS Releases FAQ on WISeR Program
On August 13th, CMS released a Frequently Asked Questions document on the Wasteful and Inappropriate Service Reduction (WISeR) model. WISeR allows third-party technology companies to introduce new prior authorization processes for a select group of items and services in the Medicare program, and be rewarded for savings that are achieved. CMS posed and answered 13 fairly high-level questions about the model, such as whether the model changes Medicare policy, what Medicare items and services WISeR applies to, how patients will be protected, how coverage review will be streamlined, how beneficiary data will be protected, and more. Applications for prior authorization companies who wish to participate in the model were due July 25th and the model is scheduled to begin in AZ, NJ, OH, OK, TX, and WA on January 1st.
The FAQ is available here.
CMS Releases Data on Enrollees Without Claims
On August 8th, CMS released data on Affordable Care Act (ACA) plan enrollees without claims for the 2019-2024 period. Data is broken down by state, market, and metal level, with silver level plans further detailed by on-Exchange, off-Exchange, and on-Exchange 94% actuarial value. Nationwide, the percentage of individual market enrollees without claims increased from 23% in 2019 to 35% in 2024. However, this increase was largely driven by non-expansion states on the federal exchange, which saw its population of enrollees without claims rise from 24% to 41%, followed by expansion states on the federal exchange with an increase from 22% to 32%. State-based exchanges saw a much more modest increase in enrollees without claims, from 22% to 24%. The increases are an indication of healthier enrollees purchasing insurance after premium tax credits were enhanced in 2021.
The CMS data is available here.
Other Updates
KFF Finds Median ACA Premium Increase of 18%
On August 6th, the Peterson-Kaiser Family Foundation Health System Tracker released an analysis of rate filings for the 2026 plan year. Researchers found a median rate increase of 18%, 11 percentage points higher than last year, when analyzing proposed rates from 312 issuers in all 50 states. These findings align with an analysis of premium filings in 19 states, released last month, which found a median increase of 15%. Issuers cite several factors contributing to larger-than-usual increases, including general health care cost growth, increasing cost and utilization of high-priced pharmaceuticals, rising labor costs, increasing inflation, and an expected deterioration of risk pools due to the expiration of the enhanced premium tax credits (EPTCs). The proposed premium increases are the largest since 2018, the last time policy uncertainty drove up premiums. The increases are for gross premiums and not the net cost to those who will lose EPTCs in 2026. Net premium cost growth will be substantially higher.
The analysis is available here.
CBO Publishes Additional Distributional Effects of OBBBA Including SNAP Analysis
On August 11th, the Congressional Budget Office (CBO) published an analysis of the distributional effects of the One Big Beautiful Bill Act (OBBBA) on U.S. households. CBO estimates that, on average, U.S. households will experience an increase in resources as a result of the OBBBA but resource changes will not be evenly distributed across households. In general, resources will decrease for households toward the bottom of the income distribution and increase for households toward the top of the income distribution. Specifically, CBO estimates that resources for households in the lowest decile of income distribution will decrease by $1,200, or about 3.1% of annual income. These reductions are mainly attributable to decreases in in-kind transfers from Medicaid and the Supplemental Nutrition Assistance Program (SNAP). In contrast, resources for households in the highest decile are estimated to increase by $13,600, or 2.7% of income.
CBO’s analysis of OBBBA’s changes to SNAP include a Thrifty Food Plan (TFP) benefit reduction from a projected $227 per month in 2034 to $213 in the same year, and that Medicaid work requirements will reduce SNAP participation by approximately 2.4 million people in an average month during the 2025-2034 period. An additional 300,000 adults and 96,000 children are projected to have nutrition benefits reduced or eliminated due to matching funds requirements in OBBBA. Finally, SNAP benefit amounts will be further decreased for some recipients that qualify for energy assistance or an internet expense allowance.
CBO’s distributional effects estimates are available here and the SNAP analysis is available here.
Fitch Reports Non-Profit Hospital Ratings Improvements for 2025
On August 12th, Fitch Ratings reported improved non-profit hospital and health system credit ratings in the first half of 2025. During the first six months of the year, credit upgrades and downgrades were nearly even, with nine upgrades and eight downgrades. Most downgrades were attributed to operational issues. Fitch notes that though negative outlooks outpace positive, 80% of outlooks for the year are stable. However, changes to the health sector made by the One Big Beautiful Bill Act are not reflected in these ratings because the major changes have not yet taken effect and will take time to affect credit ratings.