By Megan R. Wilson

Listen to this briefing

• MAGA support for ACA: Most Republicans support — and benefit from — an extension of the Obamacare subsidies, according to KFF.
• Pharma feeling the heat: The Trump administration is continuing its pursuit of drug pricing proposals.
• WIC funding: The program that helps low-income women and babies with food assistance and breastfeeding trainings has less than two weeks of funding left.

Welcome to the Health Brief newsletter. I’m Megan Wilson, and I’m your host. The Senate once again rejected the two dueling measures that could have reopened the government, so it looks like we’re headed into another week of a government shutdown.

But I also bring some good news: The National Zoo will be open until Oct. 11, even if the government stays shut down next week.

Do you have any tips, scoops or intel? It’s also Feedback Friday. Got any comments or concerns? Let’s chat. You can reach me at megan.wilson@washpost.com or on Signal at megan.434.

This newsletter is published by WP Intelligence, The Washington Post’s subscription service for professionals that provides business, policy and thought leaders with actionable insights. WP Intelligence operates independently from the Washington Post newsroom. Learn more about WP Intelligence.

Senate Majority Leader John Thune (R-South Dakota) before the Senate rejected two bills to restore government funding. (Mariam Zuhaib/AP)

	The Lead Brief

As most Republicans on Capitol Hill push back against extending subsidies that help Americans buy coverage from Obamacare marketplace exchanges in the government funding fight, their voters mostly support the policy — and largely benefit from it.

A new poll released by KFF, a health research foundation, found that 59 percent of Republicans — and 57 percent of people who identify as “Make American Great Again” supporters — support extending the subsidies.

→ Insurance premiums will double, on average, for people with these plans if Congress doesn’t step in. That means a person making $45,000 per year will pay an average of $1,836 more per year for insurance, according to updated calculations from KFF.

Meanwhile, the Congressional Budget Office estimates that 4 million Americans will lose health coverage entirely if the premium subsidies aren’t extended.

Although the subsidies expire at the end of the year, experts warn that plans are already setting rates for 2026 ahead of the start of open enrollment, which begins Nov. 1. If people see that rates are exponentially higher, the argument goes, they might opt out of buying insurance entirely.

→ A lapse in the Affordable Care Act subsidies will disproportionally impact people living in conservative areas.

More people in Republican-controlled congressional districts have health insurance purchased through the Affordable Care Act marketplace exchanges, Bloomberg reported using KFF data: There are 12 million Americans living in congressional districts represented by Republicans who are enrolled in these plans, compared to 9 million Americans in Democratic districts.

Further, Republicans represent 47 of the 75 congressional districts where at least 10 percent of the residents purchased health insurance through the Affordable Care Act marketplaces, according to KFF data.

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→ This could put additional pressure on members of Congress in those districts, which include ones in Texas and Florida. Florida Republican Reps. Carlos Giménez and Maria Elvira Salazar are among the members working on a bipartisan compromise for a short-term extension of the subsidies.

	Industry Rx

The Trump administration is continuing the pressure on drugmakers to lower prices on medicines, moving forward with rules that could impose so-called most favored nation pricing on products in Medicare’s drug program.

The Centers for Medicare and Medicaid Services sent a proposed rule to the White House for review that would create a program called the Guarding U.S. Medicare Against Rising Drug Costs (GUARD) model, according to disclosures released this morning.

There is no text of the proposal or further details about it — but pharmaceutical lobbyists expect this to be a narrow pilot program for requiring most-favored-nation pricing in Medicare Part D, the prescription drug benefit for older Americans. My Washington Post colleague Dan Diamond has also been told this is the case, but the Department of Health and Human Services and CMS didn’t respond to my requests for clarification.

→ President Donald Trump has told 17 pharmaceutical giants that he wants them to lower the price of their products to align them with what other wealthy countries pay, often referred to as most-favored-nation pricing. The administration has been threatening tariffs on companies that don’t comply.

In an announcement on drug pricing with Pfizer this week, FDA leader Marty Makary also dangled accelerated drug approvals as a potential reward for lowering prices or moving more manufacturing to the U.S.

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“If you equalize your price [with other wealthy countries], then we're going to put your future applications at the front of the line,” he said in Tuesday’s Oval Office briefing.

→ The Wall Street Journal had a behind-the-curtain story last night about the White House’s deal with Pfizer, which reportedly irked other industry leaders.

Last week, CMS sent plans on another most favored nation pilot program to the White House for review, called the Global Benchmark for Efficient Drug Pricing (GLOBE) model. Sources tell Dan that this would apply to physician-administered drugs in Medicare.

The administration is also expected to propose a third model that targets drugs in the Medicaid program for low-income Americans.

→ The amount of damage these new policies could do to drugmakers’ bottom lines depends on how they’re written, including how many drugs would apply in each of the models. CMS uses pilot programs to narrowly enact policies, rather than applying them nationwide, but it’s not yet clear how far the administration will go.

During his first term, Trump tried to impose most-favored-nation pricing policies on the top 50 most costly Medicare Part B drugs, which are administered by a doctor, such as cancer medications and infusions for certain conditions. The effort was blocked by three separate courts.

However, this time appears different: The administration seems to be going through the official notice-and-comment process as it proposes the new models. Courts rejected the previous attempt because the administration skipped that step.

	From our notebook

My colleagues Matthew Choi and Mariana Alfaro in the Washington Post newsroom highlighted the dire state of a federal program that helps roughly 6 million of low-income women and children with food assistance and trainings.

→ They report the Special Supplemental Nutrition Program for Women, Infants, and Children, often called the WIC program, has less than two weeks of federal funding left amid the government shutdown. After that, if the federal government isn’t funded, states will have to fill in the gap. The fear is that some states won’t.

Nell Menefee-Libey, senior public policy manager at the National WIC Association, which advocates for WIC recipients, said once the estimated two weeks of funding are up, families could be put in a “really terrible position about having to figure out how to feed their kids.”

→ The program is still afloat for now, and states have been urging participants not to skip appointments or meals. But if some of the programs are forced to wind down without funds, it could cause long-lasting damage: Menefee-Libey said that when families stop using WIC, often “we don’t get those families back.”

Agency Alert

The Food and Drug Administration on Thursday approved a second generic version of mifepristone, one of the drugs used in medication abortions. The move has angered conservatives and antiabortion groups, who expressed feelings of betrayal by the administration.

“The FDA approving one more tool to kill babies is a betrayal,” Sen. Bill Cassidy (R-Louisiana) wrote on social media last night. “This is not what Commissioner Makary and Secretary [Robert F.] Kennedy indicated they would do in their confirmation hearings.”

Cassidy leads the Senate Health, Education, Labor and Pensions Committee, which oversees the FDA.

Kennedy took to social media on Thursday to defend the approval, saying “federal law requires approval when an application proves the generic is identical to the brand-name drug.”

In the post, Kennedy tried to show the administration is committed to questioning the safety of the drug, highlighting a letter he and Makary sent to Republican state attorneys general earlier this year that promised to take another look at whether mifepristone is safe.

→ Read the full report on the approval — and how it’s angered antiabortion groups — from my Washington Post colleagues, Natalie Allison and Paige Winfield Cunningham.

They note that federal regulators have the ability to slow approvals of generic drugs, including prolonging the process by making drugmakers provide more data. The agency took 10 years to approve the first generic version of mifepristone, made by GenBioPro.

Notable quotable from the story: “It’s a total goat rodeo,” said Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, in a dig at how the Trump administration has handled the drug approval. “‘Powerless’ is an adjective no one uses to describe this administration when facing trouble,” Dannenfelser said.

The approval means there are now three versions of the drug available on the market. The original was approved in 2000 and the GenBioPro generic copy gained FDA approval in during Trump’s first term, in 2019.

Sen. Josh Hawley (R-Missouri) expressed disappointment in the decision and said he has “lost confidence in the leadership at FDA.” Former vice president Mike Pence said the decision was “a complete betrayal of the pro-life movement that elected President Trump” and called on Kennedy to be fired.

	What We’re Reading

“UnitedHealthcare, Humana, Aetna scale back Medicare Advantage plans for 2026,” according to Rebecca Pifer at Healthcare Dive.

“She’s leading NIH’s push to reduce the use of animals in biomedical research,” from Sara Talpos at Stat.

“States Seize on Planned Parenthood as Medicaid Cuts Take Effect,” reports Celine Castronuovo at Bloomberg Law.

“Half of Merck’s sales are in jeopardy. Can Keytruda’s sequel save the day?” writes Michael Gibney at Biopharma Dive.

“Nuclear Missile Workers Are Contracting Cancer. They Blame the Bases,” according to Patricia Kime at KFF Health News.

Lena S. Wen, an emergency physician and Washington Post contributing columnist, writes: “Am I taking Tylenol safely? Answering your questions about the drug.”

“Doctor groups grapple with ‘bonkers’ spending on pricey skin substitutes,” according to Robert King at Politico.