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By Kelly Hooper and Sophie Gardner |
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With help from Amanda Chu, Simon J. Levien and Carmen Paun A Note to Our Readers Over the past week, you've been bombarded with dire warnings about AI's future, and a cacophony of voices insisting governments must take “some” action. But on what will actually be done, by whom and where — there are precious few voices offering clarity. That's where POLITICO comes in. On the most consequential story of our lifetimes — how governments around the world respond to the most powerful technology humans have ever built — clarity is our commitment to you. And it’s why we’re so proud to announce the launch of Decoded by POLITICO. Decoded draws on POLITICO's unmatched ability to reveal who holds power, how they're using it, and what happens next in this moment where technology, power and policy are all colliding, with reporting from Silicon Valley, Washington, Sacramento, London, Brussels and beyond. Drawing on nearly 50 journalists around the world with expertise covering tech policy, Decoded will provide essential intelligence on the people, power moves and policy fights shaping the AI era. Yesterday, we held our first Decoded Summit in Washington, with more Decoded Summits coming to other key capitals in the months ahead. A new daily newsletter and audio podcast, Decoded by POLITICO, launches Oct. 5. We hope you'll sign up for the newsletter here. The AI revolution is the biggest news story of our lifetimes. Thank you for your continued trust in POLITICO to cover this story with the precision and depth it deserves. — Goli Sheikholeslami, Jonathan Greenberger, Alex Burns, Chris Cadelago and Kate Day
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Large companies are calling for reforms to the No Surprise Act, which was enacted to protect patients from unexpected medical bills. | Jacquelyn Martin/AP Photo |
INDUSTRY CALLS FOR BILLING REFORM — Some of the largest U.S. companies are ramping up their lobbying efforts to reform the 2020 No Surprises Act, which protects patients from unexpected medical charges but costs millions more than anticipated, Amanda and Simon report. The ERISA Industry Committee, whose board includes executives from ExxonMobil, Lockheed Martin, PepsiCo and Walmart, says that absent reform, businesses will be forced to pass more of the cost on to their employees at a time when Americans are frustrated with the cost of living. “To the extent that Congress actually gives a damn about how much you pay for health insurance, here's the test,” said James Gelfand, head of the committee, which represents large employers that self-fund their health plans instead of contracting with insurers. Calls to reform the law have drawn in some of Washington’s largest lobbies, setting up an expensive policy battle among doctors, insurers and employers spanning U.S. industry. ERISA has doubled down on its lobbying effort this week, releasing a report on the No Surprises Act’s impact on businesses and hosting two briefings on Capitol Hill. Key context: The No Surprises Act created an arbitration system to protect patients from unexpected out-of-network bills in emergencies. Six years later, the system is flooded with millions more in disputes than Congress anticipated. A recent Georgetown University report found providers initiated 2.6 million disputes last year, far above the 22,000 in annual disputes initially predicted. Employers are calling on Congress to order arbitrators to abide by market-rate calculations for price benchmarks, a proposal doctor groups have called a “nonstarter.” Doctor groups, meanwhile, want lawmakers to penalize insurers who fail to pay up. Both House and Senate committees that shepherded the law and now oversee its implementation are considering next steps. This week, Senate Health Committee Chair Bill Cassidy (R-La.) convened roundtables to gather ideas from the interested parties. The cost of providing health benefits for the 165.6 million Americans who receive coverage through an employer is expected to rise 8.5% next year, its steepest hike in nearly a quarter of a century, according to consulting firm Mercer. WELCOME TO THURSDAY PULSE. The number of people ages 100 and older living in Japan has exceeded a record 100,000. Send your tips, scoops and feedback to khooper@politico.com and sgardner@politico.com, and follow along @kelhoops and @sophie_gardnerJ.
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A message from the Coalition to Strengthen America’s Healthcare: How many more cuts to care can patients take? Funding cuts can impact patient access to hospitals and health systems through longer waits, fewer services, and closures that could scale back the 24/7 care their communities rely on. Tell Congress to reject cuts and protect timely access to hospital care when patients need it most. Tell Congress: Protect America’s Patients |
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The House Ways and Means Committee voted to advance a bill from Rep. Vern Buchanan that would expand Medicare coverage to blood tests for Alzheimer's. | Rod Lamkey, Jr./AP Photo |
MEDICARE MARKUP — In its last business meeting before the midterms, the House Ways and Means Committee advanced three bills Wednesday that would expand Medicare coverage and require reporting additional data on the program’s expenses, Simon reports. Two bipartisan bills sailed through unanimously. One, from Rep. Vern Buchanan (R-Fla.), would allow the public insurance program to cover blood tests for Alzheimer’s disease. He argued that better access to early-detection tests would improve prognoses and lower costs for patients. Another bipartisan bill, from Reps. Jim McGovern (D-Mass.) and Nicole Malliotakis (R-N.Y.), would create a Medicare pilot program on medically tailored food for patients. The six-year pilot would allow hospitals to design nutrition programs for patients at high risk of hospital readmission, such as those with heart disease or diabetes. A third bill, from Rep. Aaron Bean (R-Fla.), would require Medicare to report additional data on program expenses and would instruct MedPAC, an independent agency that advises Congress on Medicare, to compare expenses between Medicare Advantage, run by private insurers, and traditional Medicare. The bill advanced along party lines. What’s missing: Some members had initially hoped to mark up a bill reforming the No Surprises Act before the midterms. That law created the now-controversial system to resolve payment disputes between insurers and doctors. It increasingly looks like fixing that dispute process is a task for the next Congress, according to two people familiar with the committee’s thinking granted anonymity to speak candidly. What’s next: The bills were advanced to the full House for consideration. The House won’t be back in session until after the midterms. MENOPAUSE HEARING — The Senate Special Committee on Aging held a hearing Wednesday to explore how the federal government can research and support menopause care — the first-ever hearing on menopause in Congress, the senators said. The Aging Committee doesn’t have authority to legislate, but the discussion signaled a policy alignment between the panel’s Democrats and Republicans. New York Sen. Kirsten Gillibrand, the ranking member, mentioned a bipartisan bill that would fund menopause research and public awareness programs. “This hearing is not about a one-size-fits-all solution,” said Florida Sen. Rick Scott, the committee chair. “It’s about ensuring that every woman in this country has access to good information, the right healthcare provider and treatment options.” The panel heard from a slate of women’s health experts who said that menopause research and care have been overlooked for too long. They expressed hope that increased federal resources could help train health care providers in menopause care, study hormonal therapies and explore links between menopause and cognitive function. Witnesses included Jean Wactawski-Wende, dean of the University at Buffalo’s School of Public Health and Health Professions; Lynne Coslett-Charlton, a gynecologist with the American College of Obstetricians and Gynecologists; Jennifer Weiss-Wolf of the New York University School of Law; and Suzanne Fenske of TārāMD, a women’s health practice in New York City.
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AHRQ FUNDING — Deputy health secretary nominee Chris Klomp pledged to deliver to Sen. Tammy Baldwin (D-Wis.) an overview today of how the Department of Health and Human Services plans to spend down the funding for its Agency for Healthcare Research and Quality, Carmen reports. The pledge comes as Baldwin raised concerns during Klomp’s nomination hearing in the Senate Health Committee on Wednesday that millions of dollars remain to be spent at the agency before the end of the fiscal year on Sept. 30. Baldwin, the top Democrat on the Senate Appropriations Subcommittee on Labor, Health and Human Services, and Education, and Sen. Patty Murray (D-Wash.) also sent a letter to Health Secretary Robert F. Kennedy Jr. about the issue on Wednesday. AHRQ told Congress earlier this month that it plans to spend $100 million on agreements with other agencies, which Baldwin and Murray say would enable HHS to “siphon dollars away from AHRQ to support other initiatives, instead of funding the health care quality and delivery research that Congress specifically set aside resources for.” The two senators also wrote that AHRQ hasn’t provided any information on how the remaining $65 million Congress appropriated for the agency for 2026 would be spent. “It appears that AHRQ is being intentionally run into the ground through a combination of incompetence and disregard for the law, and something needs to change,” Baldwin told Klomp. This summer, the agency, which is charged with funding research to improve the quality and efficient delivery of health care, abruptly canceled grants for health research, career development and institutional training programs without much explanation. Klomp told Baldwin that he’d been told the agency was on track to spend 97% of its appropriated funding by the end of the fiscal year.
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A message from the Coalition to Strengthen America’s Healthcare:  
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MEDICAL DEBT’S GRIP — Nearly a third of Americans enrolled in private health insurance are paying off medical bills or debt, with many struggling to pay for their care, according to a new survey by The Commonwealth Fund, a progressive health care advocacy group. Among those with debt, 37% used all or part of their savings to pay their bills, 30% delayed or avoided needed health care and 30% cut back on basic necessities, including food, heat or rent, the survey found. The primary source of that medical debt is hospital care, at about 64%. Forty-three percent of privately insured Americans cited doctors’ office visits, while 38% attributed the debt to lab work or diagnostic tests. About 2 in 5 said their debt was tied to an ongoing or chronic condition, according to the survey. More than a third of Americans with private insurance also said they would be unable to pay an unexpected $1,000 medical bill within 30 days. Key context: Among the Americans with medical debt, about 64% blamed their insurance company, while 57% blamed the health care system. The Commonwealth Fund 2025 Affordability Survey was conducted nationwide by telephone and online from July 22 to October 27, 2025, among 6,353 adults ages 19 to 64 years living in the United States. Today’s report focuses on the 4,121 adults with private insurance at the time of the survey and for the previous 12 months.
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Josh Denny, CEO of the National Institutes of Health’s All of Us Research Program, will step down Oct. 31 to accept a new leadership post at the University of Chicago. U.K. drugmaker AstraZeneca hired Tholos Government Relations to lobby on issues related to pharmaceuticals, intellectual property and trade. Their lobbyists at Tholos Government Relations include founder Aleix Jarvis, a former legislative director for the late Sen. Lindsey Graham (R-S.C.); Matthew Schuck, former press secretary for the House Budget Committee under then-Chair Jason Smith (R-Mo.); and Michael Williams, who was a deputy assistant to President Donald Trump in his first term.
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POLITICO’s Ashley Ahn reports on White House chief of staff Susie Wiles announcing she is cancer-free after being treated for early-stage breast cancer.
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A message from the Coalition to Strengthen America’s Healthcare: How many more cuts to care can patients take?
Hospitals and health systems provide 24/7 quality care to everyone who needs it, but they're being forced to absorb billions in unpaid care while facing continued funding cuts from Washington.
More cuts don't just hurt balance sheets — they impact patients, in the form of longer wait times, reduced services, and hospital closures that could leave entire communities without nearby care.
Congress must reject cuts because America’s patients deserve 24/7 quality hospital care.
Tell Congress: Protect America’s Patients |
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