TROA Reintroduced,  Veterans Health Advances, Hep C Bill Introduced, and Senate Considers Medicaid Cuts

The House passed H.R. 1, the One Big, Beautiful Bill Act, sending the budget reconciliation package to the Senate.

Budget Reconciliation Process Underway – Medicaid Remains on Chopping Block

The House has officially achieved its goal of passing the One Big, Beautiful Bill Act by Memorial Day. While the House bill was developed through committee hearings, Senate Republicans are not expected to hold committee markups in the same way the House did, and a number of Senators are pushing back on key cuts made to programs such as Medicaid and SNAP. Instead, the Senate is negotiating directly with the House in coordination with the White House. These negotiations are already underway, and GLI has urged Congress to protect Medicaid. View more information here from our partners at Modern Medicaid Alliance. 

GLI is primarily concerned about the impact on reducing enrollment in Medicaid, eliminating optional benefits and increasing utilization management for prescription drugs due to reduced funding to states, as well as Exchange plans created by the Affordable Care Act. The Congressional Budget Office (CBO) estimates that at least 11 million people will go uninsured, with more than 7.8 million of those individuals getting kicked off of Medicaid and millions more losing coverage through the Affordable Care Act marketplace. CBO provided the following information:

• The expiration of the refundable tax credit under the Affordable Care Act (ACA) that assists eligible low to moderate-income individuals and families in affording health insurance purchased through the Health Insurance Marketplace (Exchange) will increase the number of people without health insurance by 4.2 million in 2034 relative to an estimate of a permanent extension of those credits. 
• Finalizing the 2025 Marketplace Integrity and Affordability Rule, as proposed to restrict enrollment timelines and verify incomes, will increase the number of people without health insurance by 1.8 million in 2034.
• The provisions related to Medicaid, as well as the marketplace provisions that extend beyond codifying the proposed rule, would increase the number of people without health insurance by at least 7.7 million in 2034. 

Key Medicaid provisions in the House-passed bill, now to be considered by the Senate, that are expected to reduce enrollment and tighten state budgets include:

• Community engagement requirements (known as “work requirements”): Beginning December 31, 2026, individuals would have to demonstrate compliance with community engagement activities as a condition of receiving Medicaid coverage, meaning in a month the individual: (1) works at least 80 hours; (2) completes at least 80 hours of community service; (3) participates in a work program for at least 80 hours; (4) is enrolled in an educational program for at least 40 hours; engages in any combination of these activities for at least 80 hours; or (5) the individual has a monthly income that is not less than $580 (the applicable minimum wage requirement multiplied by 80 hours). A State may only impose community engagement requirements on an individual who is: (1) aged 19-64, not pregnant, not eligible for or enrolled in Medicare, and not eligible for Medicaid under other mandatory groups; or (2) who is otherwise eligible to enroll in Medicaid under a waiver of the State plan that provides coverage equivalent to minimum essential coverage and who is aged 19-64, not pregnant, not eligible for or enrolled in Medicare, and is not otherwise eligible to enroll under the state plan or waiver.
• According to the Kaiser Family Foundation, of non-disabled adults under 65 who rely on Medicaid, 92% are either working, caring for a family member, managing an illness or disability, or attending school. Nearly half of Medicaid beneficiaries who are employed work for small companies and are not eligible for employer-sponsored health insurance at their job, leaving Medicaid as one of their only coverage options. 
• End Increased FMAP for New Expansion States: The enhanced federal match (adding 5%) for states providing Medicaid to the expansion population, enacted March 2021 in response to the COVID-19 epidemic, would end. 
• Moratorium on New or Increased Provider Taxes: Prohibits states from receiving federal Medicaid matching funds for any new or increased provider taxes enacted after the bill’s passage, unless already authorized. 
• Payment Limit for Certain State-Directed Payments: Directs HHS to revise a Medicaid managed care regulation so that state-directed payments to providers in Medicaid expansion states cannot exceed 100 percent of the equivalent Medicare published payment rate. Non-Medicaid expansion states would have a cap of 110 percent.
• Undocumented immigrants: The bill would reduce federal Medicaid funding for states that provide coverage to undocumented immigrants, as well as impose certain penalties. More information is here.
• Provisions to reduce fraud, verify enrollment: GLI is concerned that provisions to reduce fraud and ensure proper enrollment will create burdensome administrative requirements that make it difficult for eligible beneficiaries to achieve enrollment or increase state administrative costs, thereby forcing states to reduce benefits or slow down or deny enrollment to otherwise eligible beneficiaries. For example, the bill requires all 50 states and the District of Columbia to take steps to prevent individuals from being simultaneously enrolled in Medicaid and CHIP programs across multiple States, requires states to revalidate and screen providers more often, and to redetermine eligibility every 6 months (instead of 12 months).

GLI supports provisions in the House-passed budget reconciliation to address physician Medicare payments and to exclude Orphan drugs from the Medicare Drug Negotiation Program, as was originally intended by Congress. 

GLI will continue to urge the Senate to strike House-passed provisions that reduce access to health insurance and squeeze state Medicaid budgets.

GLI Works With Congress to Protect and Advance Veterans’ Health

As part of GLI’s Beyond the Biopsy initiative, GLI and its partners sent a letter to the VA. GLI and AASLD also sent a follow-up letter to the VA calling for coverage consistent with clinical guidelines. Most recently, GLI sent letters to commercial payers whose policies restricted access to care based on flawed criteria.

We continue to encourage signatures here on a petition to all payers calling for coverage without biopsy for steatotic liver disease (SLD). GLI also urges advocates to contact their legislators to request the VA take steps to increase efforts to screen, diagnose, and treat veterans with MASH/NASH using non-invasive diagnostics and FDA-approved treatments, similar to Tricare, the Department of Defense’s (DoD) health program for active duty military members, their families, and retirees, and provide a briefing to the Committee on these efforts.

GLI Hosts a Policy Event on the Sidelines of WHA78, Featuring Representatives from 5 Health Ministries Across the World (Egypt, India, Mexico, Philippines, and Qatar), Geneva, Switzerland

This policy event, co-hosted by Global Liver Institute (GLI), the European Association for the Study of the Liver (EASL), and the American Association for the Study of Liver Diseases (AASLD) and endorsed by over 20 international medical societies and organizations, served as a Call to Action for Member States and the World Health Organization (WHO) to:

• Formally recognize Steatotic Liver Disease (SLD) as a core Non-communicable Disease (NCD), ensuring it is included alongside cardiovascular diseases, diabetes, obesity, and other major NCDs.
• Expand public awareness campaigns to educate individuals on SLD risk factors and the importance of early detection and treatment.
• Integrate SLD into NCD prevention programs, aligning efforts with existing public health initiatives that target obesity, lifestyle interventions, and metabolic health.
• Support research and data collection to advance understanding of SLD’s epidemiology, prevention, and treatment.

Additionally, during the event, the second edition of the Best Practices in Liver Health Policy report was released. This new edition features five new case studies from Brazil, Japan, Mexico, Spain, and Qatar that demonstrate the integration of liver health into clinical pathways and broader health frameworks.

U.S. Administrative Budget Cuts Health Programs

The White House released its preliminary fiscal year (FY) 2026 budget request outlining deep cuts to health and other non-defense discretionary programs and more information about the reorganization of the Department of Health and Human Services (HHS). The request proposes to cut HHS by 26.2% to $93.8 billion from FY 2025 levels. Congress will next review the proposal and determine next steps as part of the appropriations process. 

The proposed budget requests $27 billion for research at the National Institutes of Health (NIH), a decrease of nearly $18 billion. Additionally, the budget “proposes to reform NIH and focus NIH research activities in line with the President’s commitment to MAHA, including consolidating multiple overlapping ill-focused programs into five new focus areas with associated spending reforms”. It specifically mentions a new National Institute on Body Systems Research, which the recently leaked FY 2026 pass back budget (not the formally submitted budget) clarified to combine the National Institute of Diabetes and Digestive and Kidney Diseases, the National Heart, Lung, and Blood Institute, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and a National Institute on Behavioral Health, which will combine the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse and the National Institute of Mental Health. It did not provide details on funding levels for these new institutes or the existing institutes and centers that will be retained. 

Additionally, the budget proposes a $77 million cut to consolidate funding for infectious disease and opioids, viral hepatitis, sexually transmitted infections, and tuberculosis programs into one grant program, which would be funded at $300 million, at the Centers for Disease Control and Prevention (CDC).  For the CDC, the President requests $5.6 billion, a 18.3% decrease below current funding levels. Also of note, the budget includes $500 million to build on the work of the President’s Make America Healthy Again Commission.

View additional details from AASLD here. GLI will fight for liver disease programs to remain intact and fully funded. 

Senator Cassidy and Van Hollen Introduce the Cure Hepatitis C Act
GLI proudly supports legislation (S. 1941) introduced by Senators Bill Cassidy (R-LA) and Chris Van Hollen (D-MD) aiming to implement a nationwide elimination program for the hepatitis C virus (HCV) in the United States. The bipartisan bill prioritizes patient health and safety, advances a national plan to eliminate hepatitis C, and seizes an opportunity to end a global health crisis through screening, diagnosis and treatment. Since curative treatments became available over a decade ago, GLI has advocated for a national strategy to eliminate this now treatable infectious disease. We look forward to working closely with Congress and the current administration to get it over the finish line. 

GLI’s statement can be found here.

Senator Cassidy Reintroduces TROA

GLI applauds the reintroduction of the bipartisan Treat and Reduce Obesity Act, which was recently introduced by Senators Bill Cassidy (R-LA) and Ben Ray Luján (D-NM). Within both the political and scientific realms, there is growing recognition of obesity as a chronic disease and the need to address and treat obesity like any other chronic disease. A robust body of research demonstrates the connection between obesity and serious liver diseases, such as nonalcoholic steatohepatitis (NASH), making access to treatment a top priority for GLI and patients. 

This bipartisan legislation would expand coverage of new health care specialists and chronic weight management medications for Medicare recipients. It will also work to mitigate the obesity epidemic by providing regular screenings.

GLI’s statement can be found here.

Administration Releases MAHA Report

The President issued an Executive Order to create the Make America Healthy Again Commission, identifying the challenge of increasing rates of fatty liver disease among children. The resulting report, issued in May 2025, reiterated concerns about fatty liver disease, or MASLD. It identifies “four potential drivers behind the rise in childhood chronic disease that present the clearest opportunities for progress:

• Poor Diet: The American diet has shifted dramatically toward ultra-processed foods (UPFs), leading to nutrient depletion, increased caloric intake, and exposure to harmful additives. Nearly 70% of children’s calories now come from UPFs, contributing to obesity, diabetes, and other chronic conditions.
• Aggregation of Environmental Chemicals: Children are exposed to an increasing number of synthetic chemicals, some of which have been linked to developmental issues and chronic disease. The current regulatory framework should be continually evaluated to ensure that chemicals and other exposures do not interact to pose a threat to the health of our children.
• Lack of Physical Activity and Chronic Stress: American children are experiencing unprecedented levels of inactivity, screen use, sleep deprivation, and chronic stress. These 5 factors significantly contribute to the rise in chronic diseases and mental health challenges. Overmedicalization: There is a concerning trend of overprescribing medications to children, often driven by conflicts of interest in medical research, regulation, and practice. This has led to unnecessary treatments and long-term health risks.”

View the report here.

GLI Asks Congress to Increase CDMRP Funding

Alongside the Defense Health Research Consortium (DHRC) and affiliated organizations, GLI sent a letter to the House and Senate Appropriations Committees, asking Congress to increase funding for the Congressionally Directed Medical Research Program (CDMRP) at the Department of Defense (DoD) by at least 5 percent plus inflation in fiscal year 2026.

The letter also asks Congress to “work expeditiously to restore through supplemental appropriations the $859 million in FY 2025 funding that was cut from the Congressionally Directed Medical Research Program (CDMRP) through the enactment of the Full-Year Continuing Appropriations and Extensions Act”.  The Continuing Resolution cut funding for CDMRP by 57 percent, and because these cuts were not evenly distributed across the program, many programs vital to warfighter health, such as cancer, received no funding for research grants in FY 2025.

Additional Bills GLI is Engaged With

GLI is closely monitoring the reintroduction of legislation that helps patients access and afford the health care they need. We will continue to update this list. A few bills reintroduced so far include:

• Medicare Multi-Cancer Early Detection and Screening Act (H.R.842/S.339) 
• Allows Medicare to cover simple blood tests to screen patients for cancer, leading to early diagnosis and treatment.
• HELP Copays Act (S.864)
• Requires health care insurers and pharmacy benefit managers (PBMs) to count payments they receive on a patient’s behalf – including payments from nonprofit organizations or drug manufacturers – toward the patient’s annual deductibles and out-of-pocket limit.
• Seniors’ Access to Critical Medications Act (H.R.2484)
• Allows Medicare patients to receive essential medications by mail or have caregivers and family members pick them up on their behalf. Reported favorably out of committee on April 29 in House Energy and Commerce Committee.
• Pharmacy Benefit Manager (PBM) Transparency Act (S.526)
• Bans deceptive and unfair pricing schemes, prohibits arbitrary clawbacks of payments made to pharmacies, and requires PBMs to report to the FTC on how much money they make through spread pricing and pharmacy fees.
• ORPHAN Cures Act (H.R. 946)
• Expands the Orphan Drug Exclusion in the Medicare Drug Negotiation Program to allow for the research and development of existing products that could help find treatments for the more than 95 percent of rare diseases without approved therapies. Learn more here.
• Charlotte Woodward Organ Transplant Discrimination Prevention Act (H.R.1520, S. 1782) 
• Reported favorably out of committee April 29 in House Energy and Commerce Committee – take action to support full passage here!
• Living Donor Protection Act (S.1552)
• Ensures living donors do not face discrimination from insurance companies, codifies Department of Labor (DOL) guidance that covers living donors under the Family Medical Leave Act (FMLA) in the private and civil service, removes barriers to organ donation, etc.
• Accelerating Kids’ Access to Care (S. 742, H.R. 1509)
• Improves children’s access to needed out-of-state health care by streamlining the Medicaid provider screening and enrollment process.

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