By Megan R. Wilson

Listen to this briefing

Not a subscriber? Sign up here to get this newsletter in your inbox.

• Cost concerns: A new poll reveals 47 percent of Americans are concerned they can’t afford care next year, putting fresh spotlight on costs as Congress debates enhanced Affordable Care Act subsidies.
• “Public charge”: The Trump administration’s revived “public charge” proposed rule that penalizes immigrants for using government assistance could push families out of Medicaid and routine care, risking a rise in uncompensated care as new polling already shows concerns among immigrants about access.
• Hims & Hers: The telehealth company best known for offering compounded weight loss drugs, hair loss treatments and medications to treat menopause and erectile dysfunction is bringing on its first chief policy officer, another step in its Washington influence expansion, as regulators put it under the microscope.

Hi there and welcome to Health Brief. The temps keep dropping as we wade into the cold-and-flu season. Check out this story from The Post’s Lindsey Bever, who dove into the myth that getting the flu shot gives you the flu.

→ Call for submissions: My colleague Shannon Najmabadi in the Washington Post newsroom wants to hear from readers about how they’re navigating elder care. Click here to submit your thoughts.

And make sure to send me your health policy tips and scoops. You can find me at megan.wilson@washpost.com, or you can message me securely 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.

Congress is seeking a solution to the looming expiration of the enhanced Affordable Care Act premium tax credit at year's end, but there hasn't been a unifying plan. (Joe Raedle/Getty Images)

	The Lead Brief

The debate in Congress over the enhanced Affordable Care Act tax credits has put the spotlight on affordability — or a lack thereof — in the health care system. It’s an issue that several national polls have shown is top of mind for most Americans, which could carry over to the midterm elections less than a year away.

A new poll shows that about half of U.S. adults say they’re worried they won’t be able to afford the health care they need next year — the highest level West Health and Gallup have recorded since they began tracking the metric in 2021.

→ The West Health-Gallup also issued a 50-state report that shows just how deep the cracks run throughout the country, asking people about their experiences with cost, quality and access. The results are bleak.

Washington has emerged from the federal government shutdown, which was triggered over deep disagreements on health policy that are still lingering. About 20 million Americans are about to see their health care costs increase dramatically as enhanced tax credits meant to offset premiums are about to expire.

Advertisement

President Donald Trump has thrown his weight behind the idea being circulated by some Republicans on Capitol Hill to give people money in health savings accounts to pay for their out-of-pocket costs. On Tuesday, Trump posted on social media that it is the only health reform policy he will support: “Congress, do not waste your time and energy on anything else,” Trump added.

→ However, the discussion over health care affordability goes beyond the individual health marketplace established under the Affordable Care Act. The cost of coverage is going up for nearly all Americans next year.

• Employers are looking at the largest health benefit cost increase in 15 years. This also impacts the more than 150 million Americans who have health insurance through their work.
• Medicare Part B premiums are increasing next year by about 10 percent, the Trump administration announced on Friday. It covers doctors’ visits, mental health care and outpatient services. The costs have been rising in recent years: According to a KFF, 12.5 million Medicare beneficiaries — or 21 percent — reported spending 8 percent or more of their annual income on Part B premiums.

→ Further, the West Health-Gallup poll found that 1 in 5 Americans said they or someone in their household couldn’t pay for a prescription in just the last three months, a record-high number since the poll began four years ago.

While the Trump administration has been trying to make headway on deals with large pharma companies, and has drafted guidance that regulators hope will spur the approval of more biosimilars — cheaper copies of biologic drugs — it’s unclear how much, and how quickly, people will be seeing any cost savings.

	Executive Health Brief

The Trump administration is moving to revive a stricter so-called “public charge” rule — a policy that could deny green cards to immigrants who use certain health or safety-net programs, including Medicaid and food assistance programs such as SNAP.

Advertisement

Similar policies were put in place during Trump’s first term but were rolled back under the Biden administration. The notice of proposed rulemaking released by the U.S. Citizenship and Immigration Services on Monday afternoon seeks to eliminate most of the prior administration’s “public charge” criteria.

It would replace the rules with new guidance — which is yet to be written, but would allow officers to have “broader discretion to evaluate all pertinent facts” about whether an immigrant could become a “public charge.” That is, a person who is dependent on government services.

The changes would “align with long-standing policy” that immigrants should be “self-reliant and government benefits should not incentivize immigration,” USCIS wrote in the notice of proposed rulemaking. The agency is accepting public comment until Dec. 19.

→ A new poll of immigrants from KFF and the New York Times released on Tuesday found that immigrants, including those in the country legally, are already more afraid to access health care or apply for government programs. During Trump’s first term, community health center directors and staff told KFF in a 2019 survey that many of their immigrant patients were no longer coming in for services like routine screenings.

“If implemented, the proposed rule would force low-income immigrants to choose between accessing necessary support and maintaining their immigration status,” Renee M. Willis, the leader of the National Low Income Housing Coalition, said in a statement.

→ It comes on the heels of another recent directive by the Trump administration to allow the federal government to deny visas to people based on chronic health conditions that may be expensive to treat, including obesity, cancer and heart disease.

What it means: Immigrants — including those with U.S. citizenship living with noncitizens — are likely to drop out of Medicaid, the health insurance meant for low-income people, or simply stop showing up for doctors’ appointments. That could result in higher costs to providers due to uncompensated care — treating people unable to pay — in emergency rooms as people avoid basic health visits.

→ USCIS now estimates that federal and state governments would reap a windfall of nearly $9 billion each year — due solely to people dropping out of benefits programs or not signing up at all, including immigrants and “U.S. citizens who are members of mixed-status households.”

What’s next: The rulemaking is likely to draw legal challenges, as the Trump changes in 2019 did.

“This is yet another breach of trust that will push families back into the shadows and deter them from seeking health care,” said Sarah Grusin, a senior attorney at the National Health Law Program, in a statement. “NHeLP and our partners will fight to stop these harmful changes to public charge, just as we did during Trump’s first term.”

	Jobs Report

Telehealth company Hims & Hers Health is bringing on Deb Autor, a former pharmaceutical exec and federal regulator, as its first chief policy officer — a new position at the company that it says represents a move to increase its engagement with regulators and policymakers.

Autor will oversee the policy and lobbying operations, in addition to sparking conversations with others in the health care system — including other telehealth platforms, advocacy groups, medical associations, and pharmaceutical and health tech companies.

Why it matters: It’s a move to further elevate the company as it becomes a bigger player in the health system and patients are seeking alternate ways to get care. Hims & Hers has ramped up its lobbying operation, establishing an in-house team this year. It launched a political action committee in 2024, and donated $1 million to Trump’s inauguration.

→ The company is lobbying on top issues, including compounded drugs and the regulation of AI in health care. Autor tells me the company supports a “unified national framework for health care AI.”

Hims & Hers has come under scrutiny from the Food and Drug Administration for advertisements for the compounded GLP-1 medications it offers and sparred with drugmakers over the copycat weight loss drugs. Its offerings to patients also include at-home diagnostic testing, treatments for menopause, erectile dysfunction and hair loss, and mental health medications.

Autor, who has been a Hims & Hers board member since 2024, comes from serving as CEO of consulting firm Healthcare Innovation Catalysts and has worked at AstraZeneca and Mylan. Before that, she held top roles at the FDA, including a post running the agency’s worldwide inspections and enforcement efforts, and she also worked in the office charged with protecting Americans from poor quality or unsafe drugs.

She says the company will be “supporting clear, common sense rules that allow safe compounding to continue serving patients and building a policy environment where innovation benefits everyone, not just those already well served by the system.” As the FDA moves to regulate direct-to-consumer advertising, she told me “we are always happy to have conversations about how to best facilitate public health goals.”

	Health on the Hill

A new hearing added this week: The Senate Special Committee on Aging is meeting tomorrow afternoon to continue its discussion about America’s drug supply chain, with a hearing called “Made in America: Restoring Trust in Our Essential Medicines.”

What it’s about: It’s part of a series of hearings the committee is having on generic drug manufacturing. This installment is focused on companies involved in making medications in the U.S., and will examine the “regulatory hurdles, foreign price manipulation, and supply chain transparency issues” involved in domestic manufacturing.

	What We’re Reading

“Trump HIV prevention plan shuts out South Africa — the nation most affected,” Adam Taylor reports at The Washington Post.

“Medicaid Insurers Promise Lots of Doctors. Good Luck Seeing One,” reports Christopher Weaver, Anna Wilde Mathews and Tom McGinty at the Wall Street Journal.

“How RFK Jr., America’s celebrity health secretary, is steamrolling science,” Chelsea Cirruzzo, Casey Ross, and Sarah Todd report at Stat.

“Cheaper medicines, free beach trips: U.S. health plans tap prescriptions that feds say are illegal,” CNBC’s Scott Zamost, Paige Tortorelli and Melissa Lee report.

“Recycling Lead for U.S. Car Batteries Is Poisoning People,” a report by Peter S. Goodman, Will Fitzgibbon and Samuel Granados at the New York Times.

“Empathetic, Available, Cheap: When A.I. Offers What Doctors Don’t,” write Teddy Rosenbluth and Maggie Astor at the New York Times.