Key Healthcare Legislation to Monitor in the Current Year

Healthcare Legislation to Watch in 2025

This year has brought significant changes to the healthcare industry, ushered in by recent policy shifts like the “One Big Beautiful Bill Act.” Providers, insurers, and health IT companies are bracing for Medicaid cuts, changes to the Affordable Care Act, and reduced funding for providers. Beyond these major shifts, numerous bills introduced in Congress hint at what stakeholders may face next.

Lawmakers are tackling reforms to Medicare Advantage, overhauling transgender healthcare, integrating artificial intelligence, curbing pharmacy benefit manager practices, and equalizing provider payments. Some bills aim to counter previous policy changes,safeguarding access to abortion and ACA funding,while others seek further cuts to government healthcare programs. Here’s a look at the top bills addressing core issues in healthcare:

340B

The 340B drug discount programme, designed to help providers treating vulnerable Americans afford expensive drugs, faces scrutiny. While its original intent enjoys broad support, critics question its scope and potential for misuse.

Current legislation largely preserves the program. Rep. Jack Bergman (R-Mich.) reintroduced a bill extending 340B discounts to rural emergency hospitals,and Rep. Doris Matsui (D-Calif.) and sen. Peter Welch (D-Vt.) introduced the 340B PATIENTS Act to shield providers’ use of contract pharmacies.

This is a point of contention: the number of pharmacies in 340B has skyrocketed from 1,300 in 2010 to over 30,000 in 2025. Investigations reveal that only half of contract pharmacies pass discounts to patients, and many are located in wealthier areas.

The 340B PATIENTS Act, supported by hospitals and several states, would conflict with court rulings limiting hospitals’ use of contract pharmacies.Prior bills proposed stricter guardrails – requiring savings to be passed to patients, increasing transparency, and limiting contract pharmacy use.

Pharmacy Benefit Managers

There’s bipartisan agreement that pharmacy benefit managers (PBMs) need oversight, but solutions diverge. PBM reform was cut from a recent spending package, but numerous bills seek to prevent the middlemen from profiting excessively.proposed legislation includes investigations into anticompetition,lowering patient co-pays,increasing transparency,and banning spread pricing (where PBMs bill more for drugs than they reimburse pharmacies). A Senate proposal sought to force PBMs to pass through 100% of rebates, but failed. Other bills aim to delink PBM compensation from rebates and stop discrimination against independent pharmacies.

Reforming PBM payments could lower national drug spending by almost $100 billion, according to analysis from the USC Schaeffer Center.

Medicare spending and Medicare Advantage

Medicare faces a looming solvency crisis as the population ages and the ratio of workers to beneficiaries declines. More seniors are choosing Medicare Advantage (MA) plans, which are more expensive for the government than conventional Medicare.

The program is projected to become insolvent in 2033. Democrats have proposed expanding Medicare benefits and guaranteeing coverage for all, while Republicans have focused on cost-cutting measures.

Recent bills aim to improve MA by preventing claim denials without physician consultation,streamlining pre-authorization processes,and cracking down on upcoding. One Republican bill would automatically enroll seniors in MA plans and lock them into those plans for three years.

Medicaid and the Affordable Care Act

Medicaid has been considerably impacted by the recent “One Big Beautiful Bill,” which introduces work requirements and restricts state funding arrangements. Democrats are proposing legislation to expand Medicaid benefits and broaden coverage.

Republicans continue to propose measures to roll back Medicaid expansion and tighten eligibility requirements. The ACA also faces ongoing challenges. Legislation aims to exempt plans from minimum essential coverage and expand option plans, while Democrats are working to enhance navigator programs and protect ACA enrollees from deceptive broker practices.

There may be bipartisan support for punishing brokers who change enrollees’ plans without consent.

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Key Healthcare Legislation to Monitor in 2025

As healthcare professionals and patients navigate an evolving landscape,staying informed about current and proposed healthcare legislation is crucial. This article, brought to you by Dr.Priya Deshmukh, outlines key bills and regulatory changes expected to impact the US healthcare system in 2025. We’ll cover areas like affordable care, prescription drug pricing, telehealth access, mental health parity, and healthcare reform.

1. Advancing the Lower Costs, Better Care act (Potential Revisions & Implementation)

Originally passed in 2022 as part of the Inflation Reduction Act, the Lower Costs, better care Act continues to be a focal point.In 2025, monitoring its full implementation and potential revisions is vital. This legislation directly addresses drug price negotiation with Medicare, a critically important step towards affordable medications.

Medicare Drug Price Negotiation: Phase-in of negotiated prices for high-cost drugs continues. Expect scrutiny regarding pharmaceutical company responses and potential legal challenges. This impacts patients with Medicare Part D and overall healthcare costs.

Insulin Cost Caps: The $35 monthly cap on insulin for medicare beneficiaries remains in effect. Expansion of this cap to private insurance plans is a continuing debate.

ACA Subsidies: Enhanced Affordable Care Act (ACA) subsidies,extended through 2025,are critical for maintaining health insurance coverage for millions. The future of these subsidies beyond 2025 is a major legislative question.

Real-World example: The Veterans Affairs (VA) has successfully negotiated drug prices for years, demonstrating the potential for savings. the Lower Costs,Better Care Act aims to replicate this success within Medicare.

2. Telehealth Expansion & Permanent Access

The COVID-19 pandemic dramatically accelerated the adoption of telehealth. Many temporary waivers allowing for broader telehealth services are expiring. 2025 will be pivotal in determining the future of remote patient monitoring and virtual care.

Telehealth Extension Act: Several bills propose making certain telehealth waivers permanent,particularly for Medicare beneficiaries.key areas include coverage for behavioral health services and remote physiological monitoring.

State-Level Legislation: States are enacting their own telehealth laws, creating a patchwork of regulations. Monitoring these state-level changes is essential for providers operating across state lines.

Payment Parity: Achieving payment parity between telehealth and in-person services remains a challenge. Advocacy efforts are focused on ensuring fair reimbursement rates for virtual care. Digital health is a growing field.

Benefits of Permanent Telehealth Access: Increased access to care, particularly for rural and underserved populations; reduced healthcare costs; improved patient convenience.

3. Mental Health Parity & Access Improvements

Despite the Mental Health Parity and addiction Equity Act (MHPAEA) of 2008, significant gaps remain in access to mental healthcare. Legislation in 2025 focuses on strengthening parity enforcement and expanding access.

Strengthening MHPAEA Enforcement: Bills aim to improve clarity and accountability in how insurers cover mental health and substance use disorder services. This includes stricter requirements for demonstrating compliance with parity laws.

Expanding Mental Health Workforce: Addressing the shortage of mental health professionals is a priority.Legislation proposes funding for training programs and loan repayment assistance.

Integrating Mental Health into Primary Care: Promoting the integration of mental health services into primary care settings is seen as a way to improve access and reduce stigma. Behavioral health integration is key.

Case Study: The 988 Suicide & Crisis Lifeline, launched in 2022, demonstrates the growing recognition of the importance of mental health services. Continued funding and expansion of this lifeline are crucial.

4.Hospital Price Transparency & Enforcement

The Hospital Price Transparency Rule, requiring hospitals to publicly disclose their standard charges, has faced challenges with compliance. 2025 will see increased enforcement efforts and potential revisions to the rule.

Increased CMS Enforcement: The Centers for Medicare & Medicaid Services (CMS) is expected to increase penalties for hospitals that fail to comply with the price transparency rule.

Standardized Data Formats: Efforts are underway to standardize the data formats used for price transparency disclosures, making it easier for patients to compare costs.

Patient-Pleasant Tools: Development of patient-friendly tools and resources to help consumers understand and utilize hospital price transparency data. Healthcare transparency is a growing demand.

5. Addressing Healthcare Disparities & Social Determinants of Health

Legislation increasingly recognizes the impact of social determinants of health (SDOH) – factors like housing, food security, and transportation – on health outcomes.

Investing in SDOH Programs: Bills propose funding for programs that address SDOH, such as housing assistance, food banks, and transportation services.

Expanding medicaid Coverage: Expanding Medicaid eligibility can improve access to care for vulnerable populations and address health disparities.

Data Collection & Analysis: Improving data collection and analysis on SDOH is essential for identifying and addressing health inequities.Health equity is a central focus.

6. Potential for Comprehensive Healthcare Reform (Long-Term Outlook)

While a complete overhaul of the healthcare system is unlikely in the near term, discussions around potential reforms continue.

Public Option: Proposals for a public health insurance option, competing with private insurers, remain on the table.

Medicare for All: The concept of a single-payer healthcare system, often referred to as “Medicare for All,” continues to be debated.

Value-Based Care: Shifting from a fee-for-service model to a value-based care model, rewarding providers for quality and outcomes, is gaining momentum.

Practical Tips for Staying Informed:

Follow CMS Updates: regularly check the CMS website for updates on regulations and guidance.

Monitor Congressional Activity: Track bills and legislative debates through Congress.gov.

Engage with Professional Organizations: Join relevant professional organizations to stay informed about policy changes affecting your field.

Subscribe to Healthcare Newsletters: Sign up for newsletters from reputable healthcare news sources. Healthcare policy is constantly changing.

Keywords: healthcare legislation, affordable care, prescription drug pricing, telehealth access, mental health parity, healthcare reform, US healthcare system, Medicare Part D, health insurance coverage, remote patient monitoring, digital health, behavioral health, healthcare costs, healthcare transparency, health equity, value-based care, social determinants of health, CMS, MHPAEA.