Policy Updates: Hill Happenings and Administration Activities
Hill Happenings
FY2026 Appropriations & Budget Reconciliation
House committees are drafting spending proposals to include in the landmark domestic policy and spending bill that Republicans intend to pass through the budget reconciliation process. House Speaker Mike Johnson (R-LA-04) is aiming to pass the lower chamber’s version of the bill by Memorial Day, but internal disagreements on spending and policy priorities may delay the Speaker’s timeline. An increasingly bipartisan group of lawmakers have warned that many of the cuts proposed by the House go too far, including proposals to cut Medicaid funding and enrollment that are being considered by the Energy & Commerce Committee (E&C) and scheduled for a markup on May 13. If approved by Congress, Medicaid cuts would jeopardize coverage access for millions of beneficiaries who rely on the safety-net program, which ranks as the single-largest insurance payor for people living with HIV (PLWH). The budget resolution approved by Congress on April 10 tasks E&C Republicans with achieving spending reductions of at least $880 billion in the reconciliation package, which will likely require Medicaid cuts to accomplish. Democrats will have limited opportunities to block the reconciliation package if the Republican caucus can successfully leverage their slim bicameral majority to advance the mega-bill.
Additionally, appropriations subcommittees have scheduled a series of budget hearings to evaluate the President’s Budget Request to Congress for Fiscal Year 2026 (FY2026) which was released on May 2. The House Appropriations Labor, Health and Human Services, Education, and Related Agencies (LHHS) Subcommittee will hold a hearing on May 14 to review spending proposals for the Department of Health and Human Services (HHS) and its operating divisions, including the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA). Notably, the President’s budget for FY2026 would create a new HHS entity, the Administration for a Healthy America (AHA), by dismantling and consolidating entire HHS operating divisions, including HRSA and the Substance Abuse and Mental Health Services Administration (SAMHSA). The President’s budget would also merge hepatitis, STI, and TB prevention programs at the CDC National Center for HIV, Hepatitis, STI, and TB Prevention (NCHHSTP) into a single block grant program with increased implementation discretion for state and local health jurisdictions, which would threaten the ability HIV and hepatitis programs to sustain current programming.
NASTAD Calls on Senate to Support Resolution to Restore Public Notice and Comment Opportunities at HHS
On April 28, NASTAD joined a coalition of over 70 organizations and called on the Senate to support a Resolution that aims to reinstate a requirement for HHS offices and operating divisions to provide public participation opportunities in rulemaking and regulatory processes. The resolution, introduced by members of the Senate Finance Committee, would express the sense of the Senate that the HHS Secretary should withdraw a March 3 policy statement that limits the circumstances under which HHS agencies must publish proposed rules for public comment or otherwise seek public comment on federal rulemaking before those rules are finalized. This reduction in patient and stakeholder comment opportunities reverses 50 years of precedent established by the “Richardson Waiver,” which required HHS to safeguard transparency in the rulemaking process and consider the needs of all relevant consumers, communities, and stakeholders when developing rules and regulations that impact HHS agency management, grants, benefits, contracts, and loans.
House Energy & Commerce Committee Advances SUPPORT Act Reauthorization Bill
On April 29, the E&C Committee passed the SUPPORT for Patients and Communities Reauthorization Act of 2025 (H.R. 2483) out of committee (36-13) and referred the bill to the House floor. The 2025 update would renew the legislative authorization for the 2018 inaugural SUPPORT Act (H.R.6) that lapsed at the end of Fiscal Year 2023. The SUPPORT Act is an omnibus bill made up of 70 opioid-related bills that reformed opioid and substance use disorder (SUD) policies and created new programs to enhance and scale up the nation’s efforts to address the SUD and opioid overdose crisis. Although the SUPPORT Act recruited near unanimous bipartisan support in 2018, the 2025 reauthorization package secured less approval from E&C Democrats due to concerns about the diminished federal capacity to coordinate programs founded by the SUPPORT Act after widespread layoffs at HHS and SAMHSA, and the impact of dismantling SAMHSA’s agency structure and consolidating SUD treatment and prevention programs into the new HHS Administration for a Healthy America. Additionally, at a Committee markup on April 29, Ranking Member Frank Pallone (D-NJ-06) highlighted budget proposals under consideration by Committee Republicans that would weaken the national coverage network for behavioral healthcare through cuts to the Medicaid program, which is the nation’s largest payor for behavioral health services and insures as much as 40% of all people living with an opioid use disorder.
Administration Activities
Trump Administration Announces Personnel Changes for Surgeon General Nominee and Top HHS Spokesperson
On May 7, the White House announced that it rescinded the nomination of Janette Nesheiwat, a physician and Fox News medical contributor, for the role of US Surgeon General merely a day before she was scheduled to appear before the Senate Health, Education, Labor, and Pensions (HELP) Committee for a confirmation hearing. President Trump may have decided to rescind Nesheiwat’s nomination after Republican pundits discredited her qualifications and cast doubt on her commitment to the Make America Healthy Again (MAHA) agenda due to an op-ed she authored for Fox News in 2021 that supported some COVID vaccination measures. The White House nominated Casey Means, a physician by training and wellness influencer with connections to HHS Secretary Robert F. Kennedy, Jr, to replace Nesheiwat. The Surgeon General is a Cabinet-level role responsible for managing the US Public Health Commissioned Corps and serving as the country’s chief medical doctor and health promoter.
Additionally, on May 8, reports emerged that Secretary Kennedy intends to appoint Rich Danker, a bank executive and former Treasury official in the Trump-Pence Administration, to the role of Assistant Secretary for Public Affairs. Danker would be the second person to fill the role since the start of the Trump-Vance Administration in January 2025. Danker replaces Tom Corry, who resigned from the role on March 3 just two weeks into the job due to personal disagreements with the Administration’s response to the growing measles outbreak. As the top HHS spokesperson, Danker will play an instrumental role in defending the Administration’s mass layoffs across HHS and the sprawling agency reorganization plan, and promoting the MAHA ethos.
CDC Updates Guidelines for Use of HIV nPEP
On May 8, the Centers for Disease Control and Prevention (CDC) published a Morbidity and Mortality Weekly Report (MMWR) that updates guidelines for nonoccupational postexposure prophylaxis (nPEP) for HIV. The 2025 guidelines update recommendations and considerations for use of nPEP last issued in 2016 to include new treatment formulations, the latest evidence on clinical indications for nPEP among people who take PrEP for HIV, and emerging implementation strategies. CDC now recommends a regimen of either: 1) bictegravir (BIC)/emtricitabine (FTC)/tenofovir alafenamide (TAF), or 2) dolutegravir (DTG) plus TAF, or 3) tenofovir disoproxil fumarate (TDF) plus FTC, or 4) lamivudine (3TC) for most adults and adolescents indicated for nPEP, based on the patient’s health history and comorbid conditions.
Resources
CDC MMWR: Medetomidine Overdoses, Medetomidine Withdrawal Syndrome, and more
- Overdoses Involving Medetomidine Mixed with Opioids
- During May 11–17, 2024, investigators identified 12 confirmed, 26 probable, and 140 suspected overdoses in Chicago involving medetomidine mixed with opioids among people treated at three hospitals on Chicago’s West Side.
- Notes from the Field: Suspected Medetomidine Withdrawal Syndrome Among Fentanyl-Exposed Patients
- From September 1, 2024–January 31, 2025, 165 patients in Philadelphia across three hospital systems were identified as having a clinically distinct withdrawal symptom after exposure to medetomidine and fentanyl. Bradycardia (slow heart rate) and lack of response to naloxone were defining clinical features.
- Notes from the Field: Severe Medetomidine Withdrawal Syndrome in Patients Using Illegally Manufactured Opioids
- Twenty-three patients at two hospitals in Pittsburgh who sought care between October 2024-March 2025 for severe withdrawal symptoms from illegally manufactured opioids experienced a new severe withdrawal syndrome that includes symptoms such as restlessness, agitation, high blood pressure, increased heart rate, vomiting, and altered mental status.
“Emergency department visit rates for fentanyl-involved nonfatal overdoses increased from October 2020 to mid-2023, followed by an 11% quarterly decline from mid-2023 to Quarter 1 of 2024 (January-March).”
NHRC/Building Healthy Online communities: Chemsex Awareness Week
When: May 12-18, 2025
“National Harm Reduction Coalition (NHRC) and Building Healthy Online Communities have put together the first-ever Chemsex Awareness Week campaign to promote sexual health and harm reduction strategies for queer and trans people engaging in chemsex.”
Job Postings
Executive Director of Programs – New York City, NY
The New York City Health Department is seeking an Executive Director of Programs to join its Bureau of Hepatitis, HIV, and STIs (BHHS). The Executive Director of Programs will provide day-to-day oversight and operational support to BHHS’s HIV Care and Treatment Program, HIV Epidemiology Program, HIV Prevention Program, STI Program, and Viral Hepatitis Program, which comprise the majority of the bureau’s staff. The Executive Director of Programs will report to BHHS’s Assistant Commissioner and work alongside the Assistant Commissioner and BHHS leadership to ensure these Programs are supported to function optimally and collaboratively, and that BHHS is well-positioned to implement its strategic priorities and achieve its mission to improve the lives of New Yorkers by ending transmission, illness, stigma, and inequities related to viral hepatitis, HIV, and STIs. For more information or to apply for the position, visit the job posting on NYC Jobs, here.
Communicable Disease Epidemiologist – Cheyenne, Wyoming
This position will serve as the Communicable Disease AIDS Drug Assistance Program (ADAP) Coordinator, Wyoming TB Controller, and Disease Intervention Specialist (DIS) for the Communicable Disease (CD) Treatment Program. Assist in outbreak response to ensure the safety of Wyoming residents; by interviewing cases for exposure information, updating news outlets on the progress of outbreak control, analyzing exposure data utilizing epidemiological and statistical methods.
News Bulletin
“The directors of other community-based groups in Mississippi, Alabama, Louisiana, and Tennessee told KFF Health News they too had reduced their spending on HIV testing and outreach because of delayed or slashed federal funds — or they were making plans to do so, anticipating cuts to come…President Trump, in his first term, promised to end America's HIV epidemic — and he put the resources of the federal government behind the effort. This time, he has deployed the powers of his office to gut funding, abandoning those communities at highest risk of HIV.”
In battle against transgender rights, Trump targets HUD’s housing policies
“In the months since President Donald Trump took back the White House and installed a loyalist to lead the federal housing department, HUD Secretary Scott Turner and his team have moved swiftly and strategically to undo, uproot and remake the agency’s decades of work and priorities. In the crosshairs is an intense focus on transgender people, as HUD retreats from long-established fair-housing protections by closing their discrimination complaints and, more broadly, moving to undo the Obama-era Equal Access Rule that cemented transgender people’s rights to discrimination protection in housing.”
States loosen vaccine rules — even as measles outbreak rages
“Public health experts fear that skepticism and the rising “medical freedom” movement — which has dovetailed with Kennedy’s “Make America Healthy Again” mantle — will lead to more cases of vaccine-preventable illnesses in children, many of which can cause serious complications and even death…Some public health experts are now puzzling over who might be “trusted messengers” to promote vaccination as scientific institutions are falling out of favor.”