By Megan R. Wilson

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In today’s issue: The looming showdown for insurers. … Appeals court upholds pause on Trump administration pilot targeting controversial discount drug program. … PBM industry group names new leadership.

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Lawmakers are gearing up for crucial midterm elections in November. (Julia Demaree Nikhinson/AP)

	The Lead Brief

Let’s get ready to rumble.

House Republican committee leaders are calling health insurance execs to Capitol Hill to testify in a pair of marathon hearings on Jan. 22 — the first in a series on health care affordability.

They come as Congress failed to extend enhanced premium tax credits to lower costs for millions of Americans who get health insurance through Affordable Care Act marketplace plans. As a result, monthly premiums for people with those plans are skyrocketing.

JUST IN: The House passed a measure Thursday afternoon, 230-196, to extend the enhanced ACA tax credits for three years — without the reforms many Republicans sought. However, 17 GOP lawmakers broke with their leadership to approve the Democratic-led bill, which is almost certain to die in the Senate.

Why the moves matter: The upcoming hearings could just be a messaging exercise for lawmakers in both parties — but it’s also a first look into how 2026, a crucial midterm election year, may unfold.

Cost-of-living issues routinely rank among voters’ top concerns — and with control of one or both chambers in Congress potentially up for grabs in November, Democrats and Republicans are looking to assign blame. It remains to be seen whether the hearings could spur actual movement, but the action will likely set off a flurry of advocacy and fundraising as health care once again becomes a central campaign theme.

The insurance problem: While some centrist GOP lawmakers — most facing rough reelection races — have been pushing to revive the enhanced tax credits, Republicans broadly oppose them, viewing any extension of the expired subsidies as a stamp of approval on Obamacare.

At the same time, Republicans in the House and Senate haven’t been able to coalesce around a single legislative solution to rising costs. They have, however, latched onto messaging that Americans should have more control over their own coverage — and blaming insurance companies for irresponsibly hiking premiums and failing to control costs. President Donald Trump also said he wants to meet with insurers to pressure them into lowering costs.

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That’s where Reps. Brett Guthrie (Kentucky) and Jason T. Smith (Missouri), who lead the House Energy and Commerce Committee and House Ways and Means Committee, respectively, come in.

They’ve invited five top health insurance executives, with one hearing in the morning and the other in the afternoon. Guthrie and Smith said in a statement they want the CEOs to talk about how to make care cheaper for all Americans with commercial insurance, “not just the seven percent of Americans who obtain their health insurance through Obamacare.”

→ In 2025, 24 million people had insurance through ACA plans. The Congressional Budget Office estimates that the expiration of the enhanced credits will cause about 4 million people to drop coverage.

These are the invited insurance CEOs:

• Stephen Hemsley of UnitedHealth Group
• David Joyner of CVS Health Group, which owns health insurance company Aetna
• David Cordani of Cigna Health Group
• Gail Boudreaux of Elevance Health
• Paul Markovich of Ascendiun, the parent company of Blue Shield of California

Robert Josephson, a spokesperson for UnitedHealth Group, confirmed that Hemsley will be attending the hearings and the company “look[s] forward to discussing health care costs.”

“Keeping health care affordable should be everyone’s top priority, and we will continue to partner with policymakers on solutions,” Josephson said.

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	Litigation Report

A federal appeals court upheld a freeze on a Trump administration initiative targeting the 340B discount drug program that allows providers to receive cheaper medications from drugmakers, prompting cheers from hospitals. The pause is crucial for health care facilities as the Health Resources and Services Administration’s pilot program was set to take effect Jan. 1.

In its decision, the First Circuit Court of Appeals said the pilot “benefits drug manufacturers by upending a decades-long practice of providing safety-net hospitals … with upfront discounts to purchase prescription drugs.”

→ The federal government had rushed to roll out the pilot program without properly considering the potentially negative impacts it could have on providers, according to the judge who initially paused the implementation, saying that regulators “cannot fly the plane before they build it.”

The lower court’s order pausing implementation of the pilot was “careful and thorough,” the three-judge panel of the First Circuit Court of Appeals said in rejecting the Trump administration’s request to lift the injunction. Furthermore, the government had failed to prove it would succeed on the merits.

Why it matters: The pilot, meant to address criticism of the discount drug program, could be potentially ruinous to some providers that rely on discount medications.

The 340B program was designed to enable safety-net providers that treat a large number of low-income or uninsured patients to stretch limited resources by compelling drugmakers to provide steep discounts on medication. Critics argue that it’s being abused by some facilities to bolster profits or subsidize other operations without benefitting patients.

The pilot — which would require hospitals and clinics in the 340B program to pay for certain drugs upfront and receive a rebate later — is an effort to ensure that drugmakers aren’t giving discounted drugs to facilities that don’t qualify for them. However, providers say that requiring full payment in advance could cause some cash-strapped hospitals or clinics to close.

American Hospital Association CEO Rick Pollack cheered Wednesday’s decision, saying the group is “pleased that these courts have put on hold this harmful program that would have a devastating effect on America’s most vulnerable patients and communities, and the hospitals that serve them.”

By the numbers: Policymakers question whether the 340B program has ballooned far beyond its initial intent. More than 50,000 facilities — including hospitals and health centers — participate in the 340B program, purchasing a record-high $81.4 billion in discounted drugs in 2024 alone. That’s more than double the $39.7 billion in 340B purchases in 2020.

	Jobs Report

The Pharmaceutical Care Management Association, the industry group for middlemen known as pharmacy benefit managers, tapped David Marin to serve as its next president and CEO. Marin, who joins from pharmaceutical company Viatris, starts on Jan. 20.

It’s a notable hire for the organization, which represents companies in a fierce policy battle against drugmakers. PCMA said the hire marks “a new era” for the group.

Marin said in a statement that PCMA would be a “driver” of the conversation around health care affordability on Capitol Hill and in the states.

“Policymakers at all levels are rightly focused on costs, affordability, and sustainability — for patients, employers, and health care systems overall,” he said. “The role our members play promoting affordability has never been more important, and my top priority is to make that value properly understood.”

Why it matters: PBMs have become one of the most powerful players in health care and have picked up a slew of bipartisan critics along the way. They sit between insurers and drugmakers, negotiating discounts on medicines and managing the formularies of which drugs are covered.

Marin most recently served as global head of government affairs, public policy and advocacy at Viatris, a company formed in 2020 when generics company Mylan merged with drugmaker Upjohn. Marin started at Mylan in 2017 as head of government affairs.

Before that, he worked at the former top K Street firm Podesta Group and as the Republican staff director for the House Oversight and Government Reform Committee.

PCMA is also bringing on Brendan Buck, a veteran GOP communications strategist, to serve as its chief communications officer, also starting on Jan. 20. Buck will serve in a newly elevated role that PCMA said “reflects a commitment to telling the story of the industry.”

Buck will be joining from public affairs firm Seven Letter. He previously led messaging for former House speaker Paul D. Ryan (Wisconsin) and House Republican leadership. He also served as a top spokesman for AHIP, the industry group for health insurers, and held senior communications roles for Republicans on Capitol Hill and during a stint on Mitt Romney’s 2012 presidential campaign team.

→ PCMA spent roughly $17.5 million to lobby the federal government in 2024 in an effort to beat back congressional proposals to rein in some of PBM’s business practices.

The industry has also been fighting back against health industry critics — including PhRMA, an association representing brand-name drug companies that has spent millions of dollars on both shoe-leather lobbying and digital advertising blaming PBMs for high drug costs.

Adam Kautzner, the chairman of PCMA’s board and president of Express Scripts and Evernorth Care Management, said Marin will “revamp” the industry group and “ensure it is a premier advocacy organization respected for its expertise and impact.”

JC Scott, who served a seven-year run as PCMA CEO, departed the organization last year. Under Scott’s tenure, the group grew into a nearly $62 million organization, more than doubling its revenue after he took the helm in 2018.

While the board selected a new leader, the group’s top lobbyist Lucia Lebens had served as interim CEO and will return to her role as chief government affairs officer. Last month, PCMA announced it had hired Sean Williams away from airline industry group A4A to work on its state-level advocacy efforts. He also begins this month.

	What We’re Reading

“China played big role in reducing opioid deaths, research suggests,” report David Ovalle and Cate Cadell of The Washington Post.

BioPharma Dive updated its tracker of venture capital funding for biotech start-ups.

“Panel behind new dietary guidelines had financial ties to beef, dairy industries,” Isabella Cueto and Sarah Todd report at STAT News.