Policy Updates: Hill Happenings and Administration Activities
Hill Happenings
FY2026 Appropriations and Budget Reconciliation
Senate Republicans are pursuing an ambitious timeline to advance Fiscal Year 2026 (FY2026) budget and spending bills. On June 18, Senate Leader John Thune (R-SD) announced that he intends to bring the upper chamber’s version of the House-passed One Big Beautiful Bill Act (H.R.1), a landmark budget and domestic policy bill that Republicans are advancing through the budget reconciliation process, to the Senate floor on June 25 for an initial procedural vote. Additionally, Senator Leader Thune is aiming to pass the bill by the Independence Day Holiday, but several outstanding policy disputes are preventing the Congressional Republican caucus from securing the virtually unanimous, party-line vote in both chambers that is required for H.R.1. to become law.
On June 16, the Senate Finance Committee, which has jurisdiction over spending for mandatory programs like Medicare and Medicaid, released new bill text for H.R.1. The Committee introduced steeper cuts to the Medicaid program than those approved by the House, which approved the implementation of work requirements on Medicaid eligibility and cuts to core Medicaid and ACA funding, leading to complete coverage loss for as many as 7.8 million people. Additionally, fiscal hawks are growing increasingly vocal in their opposition to the bill, which the Congressional Budget Office estimated would increase the federal deficit by as much as $2.8 trillion. Despite these disagreements, it may be likely that the Republican caucus will coalesce behind a package once it receives approval from President Trump.
FY2026 Appropriations
Appropriators are advancing FY2026 spending bills behind the scenes while Republicans develop the One Big Beautiful Bill Act (H.R.1). On July 21, the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies (LHHS) will conduct a markup of the LHHS bill, which includes spending proposals for health programs. Additionally, the House Appropriations Committee scheduled a full committee markup of the LHHS bill on July 24.
Additionally, on June 17, House Energy & Commerce (E&C) Committee Chair Rep. Guthrie (R-KY-02) and Chair of the E&C Subcommittee on Health Rep. Carter (R-GA-01) announced that the Subcommittee will hold a hearing on June 24 to examine the HHS portion of the FY2026 Executive budget request to Congress. Notably, Health and Human Services (HHS) Secretary Kennedy will appear before the Subcommittee to defend the policy priorities and spending requests included in the budget request, which have drawn bipartisan scrutiny due to deep programmatic cuts and sprawling plans to restructure entire HHS agencies and operating divisions. Prior to the E&C hearing, Secretary Kennedy appeared before the Senate Appropriations LHHS Subcommittee on May 14, the House LHHS Subcommittee on May 20, and the Senate HELP Committee on May 20 to defend the budget.
Senate HELP Committee Schedules Confirmation Hearing for CDC Director Nominee
Susan Monarez, President Trump’s nominee for Director of the Centers for Disease Control and Prevention (CDC), will appear before the Senate HELP Committee on June 25 for a confirmation hearing. Notably, Monarez is the first-ever person to undergo Congressional vetting for the role of CDC Director, which requires Senate confirmation starting this year as a result of a provision included in the Fiscal Year 2023 (FY2023) spending package. Prior to CDC, Monarez served as Deputy Director of the HHS Advanced Research Projects Agency for Health (ARPA-H) and had roles in the Department of Homeland Security and White House Office of Science and Technology Policy.
NASTAD Calls on Senate to Reject House-Passed Big, Beautiful Bill Act
On June 13, NASTAD and the Federal AIDS Policy Partnership (FAPP) called on Senate leaders to reject the One Big Beautiful Bill Act (H.R.1), the landmark FY2026 spending and policy package that Republicans are advancing through the budget reconciliation process. The coalition urged Congress to prevent the anticipated decimation of safety-net insurance networks and infectious disease surveillance and prevention infrastructures as a result of the bill’s cuts to the Medicaid program and provisions that would weaken access to and the affordability of ACA marketplace coverage. Additionally, the coalition highlighted the disparate burden that historically impacted populations, such as people living with HIV, would face as a result of the destabilized public health infrastructure, ultimately undermining decades of progress made to end the HIV epidemic in the US.
Bipartisan Group of Senators Introduce Bill to Reauthorize SUPPORT Act
On June 18, a bipartisan group of Senators led by Senate HELP Committee Chair Bill Cassidy (R-LA) introduced legislation to reauthorize the Support for Patients and Communities Act (H.R.6). The SUPPORT Act, which first became law in 2018, established new programs and expanded federal efforts to combat the opioid overdose and substance use disorder (SUD) crisis. The House of Representatives passed its version of the reauthorizing bill on June 5 (H.R. 2483). Although the SUPPORT Act historically recruits bipartisan support, Congressional Democrats questioned whether HHS retained sufficient workforce capacity to fully implement programming authorized by the SUPPORT Act after the Administration’s agency-wide reduction in force and organizational restructuring campaign impacted programs coordinated by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the CDC National Center for Injury Prevention and Control.
Administration Activities
FDA Approves Gilead Science’s Yeztugo (lenacapavir) for PrEP
On June 18, Gilead Sciences, Inc. announced that the US Food & Drug Administration (FDA) approved Yeztugo (lenacapavir), an injectable HIV-1 capsid inhibitor, for use as HIV pre-exposure prophylaxis (PrEP). Notably, lenacapavir is the first and only twice-yearly injectable option for PrEP and marks the second injectable PrEP option available on the market. FDA approved ViiV Healthcare’s Apretude (cabotegravir), the first-ever injectable PrEP product, in 2021, which is administered every two months. FDA first approved lenacapavir for use in adults to treat HIV-1 in 2023, under the label Sunlenca. Public health advocates noted that, while Yeztugo could boost PrEP access and improve treatment adherence for certain consumers, cuts to HIV programs proposed by Congress and the Administration’s overhaul of the CDC Division of HIV Prevention (DHP) may pre-empt wide-scale uptake of the new PrEP option.
Resources
Building Healthy Online Communities: National HIV Testing Day Campaign 2025
“In honor of National HIV Testing Day on Friday, June 27, 2025, Building Healthy Online Communities (BHOC) has created social media materials to increase awareness of and access to free HIV self-testing.”
ANEA: EHE Readiness Assessment
“Act Now: End AIDS (ANEA) Coalition is proud to release our latest EHE Assessment Report, offering critical insights into how local jurisdictions are advancing toward the goals of the Ending the HIV Epidemic (EHE) initiative”
CDC MMWR: Mpox on Cruise Ships
- Clade II Mpox Infections Among Cruise Ship Passengers and Crew Members
- “In 2024, CDC was notified of eight mpox cases on four cruise ships: four among crew members and four among passengers. All cases occurred among men who had sex with men; five of eight patients had not been vaccinated against mpox.”
- Clade Ib Mpox Outbreak
- “48 clade Ib mpox cases were diagnosed in Kenya July 2024–February 2025, many among people who worked along a highway linking Kenya to other East and Central African countries with ongoing clade Ib mpox outbreaks, including truck drivers and sex workers.”
- Use of JYNNEOS (Smallpox and Mpox Vaccine, Live, Nonreplicating) for Persons Aged ≥18 Years at Risk for Mpox During an Mpox Outbreak: Recommendations of the Advisory Committee on Immunization Practices
- “In 2023, the Advisory Committee on Immunization Practices (ACIP) recommended the 2-dose JYNNEOS vaccine series for people 18 and older at risk for mpox during any mpox outbreak. ACIP also voted to recommend the vaccine series for people 18 and older at risk for acquiring mpox during the ongoing U.S. clade IIb outbreak that began in 2022, including but not limited to men who have sex with men who, during the past 6 months, have had or anticipate experiencing a new diagnosis of one or more sexually transmitted infections, more than one sex partner, sex at a commercial sex venue, or sex in association with a large public event in a geographic area where mpox transmission is occurring.”
News Bulletin
“In the wake of Robert F. Kennedy Jr.’s abrupt revamp of the CDC’s Advisory Committee on Immunization Practices, details from the panel’s planned meeting next week are confirming many industry watcher’s concerns about potential vaccine meddling by the Trump administration.”
“Despite a lot of fanfare about its ability to change the HIV prevention landscape, Apretude sales have been fairly anemic since its launch. This likely reflects the many barriers to PrEP access, including provider willingness to prescribe PrEP, individual awareness about HIV risk, and complicated procurement and financing considerations for provider-administered products. Whether the fact that lenacapavir requires far fewer provider visits than Apretude will make it a better option for people remains to be seen. But regardless of whether lenacapavir truly disrupts the PrEP landscape, it provides another important tool in the HIV prevention toolbox and an option that could help anyone who might struggle with adherence to a daily pill regimen.”
Purdue Pharma, Sacklers reach new $7.4 billion opioid settlement
“All 50 states as well as the District of Columbia and U.S. territories have approved a $7.4 billion settlement with Purdue Pharma, maker of Oxycontin, over the company's improper marketing of opioids.…If finalized, this settlement will add to more than $50 billion in opioid pay-outs by corporations that profited from manufacture, distribution and retail of opioid painkillers at a time when overdoses and drug deaths were skyrocketing in the U.S.”
Judge deems Trump's cuts to National Institutes of Health illegal
“A federal judge in Boston said Monday the termination of National Institutes of Health grants for research on diversity-related topics by the Trump administration was “void and illegal” and accused the government of discriminating against racial minorities and LGBTQ people. U.S. District Judge William Young said during a nonjury trial that the NIH violated federal law by arbitrarily canceling more than $1 billion in research grants because of their perceived connection to diversity, equity and inclusion initiatives.”