June 25, 2025

Academy Joins HIV Advocates to Oppose Reconciliation Bill

The U.S. Senate is rushing to pass their budget bill this coming week before Congress breaks for the Fourth of July Recess, with Speaker Johnson hoping to then ram the bill through the House in the days following.

The Senate Finance Committee’s budget reconciliation draft, released June 16, further decimates Medicaid coverage through tighter eligibility rules, a reduction in provider tax limits and an expansion of work requirements for enrollees.

While this current budget bill strips access to care for vulnerable populations, a second big health care issue looms that could affect millions more unless Congress acts.

End of ACA Enhanced Subsidies

The ACA’s record enrollment over the past four years has been driven by a Biden-era enhancement for subsidies that lower the out-of-pocket cost of premiums for eligible people. Those enhanced subsidies are due to expire at the end of the year unless Congress extends them.

Of the more than 24 million Americans who signed up for insurance through the marketplace this year, nine in 10 receive a subsidy. Many are unaware that the enhanced subsidies are in place only through December 31.

Senate Bill Worsens Access to Care Threat

Instead of offering an improvement on the House version of the bill, Senate Republicans are proposing deeper and broader cuts to Medicaid than their counterparts in the House — heightening concerns among Academy members who were already warning of significant risks to patient access, insurance coverage and financial stability for providers.

Provider Tax Phase-down and Work Requirements 

Another contentious element of the Senate draft is a phased reduction of the maximum allowable provider tax rate from 6% to 3.5% in Medicaid expansion states. The Senate bill also expands work requirements beyond those in the House plan. While the House targeted childless adults, the Senate version would require adults with children over age 14 to work or volunteer at least 80 hours per month to remain eligible.

The Senate’s proposed additional Medicaid cuts will result in skyrocketing uncompensated care, compounding financial problems for physicians treating patients in underserved areas.

What is the Projected Impact of This Bill? 

The Congressional Budget Office estimates the combined measures could leave 11 million more Americans uninsured by 2034. If enacted, the Senate bill could trigger far-reaching changes to state Medicaid financing, accelerate coverage losses and deepen fiscal pressure on providers, particularly those serving vulnerable populations. This budget bill harms the most vulnerable while redistributing wealth upwards to the richest one percent.

Call To Action

Call your Senators today at 202-224-3121 and urge them to extend exchange ACA subsidies, maintain the provider tax rate, and reject cuts to Medicaid and HIV funding by voting no on reconciliation.

Don’t remember your senators’ names? The Capitol Switchboard operator at the number above will tell you and then connect you directly. Or you can find your Senators on the United States Senate website.

For further actions, visit the AIDS United policy action center. For more on the similarities and differences between the House bill and current Senate bill language, consider KFF’s comparison chart.

Additional Resources for Medicaid Actions

• Dashboard data that highlights Medicaid’s vital role in all 50 states and 435 Congressional districts: https://data.modernmedicaid.org/MMA/.
• Check out this resource for tips on how to leverage the new district-level data.
• Research America Resources LTE.
• Key messages on protecting Medicaid.
• More than 50% of surveyed Trump voters oppose cutting Medicaid to pay for tax cuts, and two-thirds of surveyed swing voters said they’re against slashing the safety-net program.

ACADEMY HAPPENINGS

Academy Scores Victory in Texas

Exciting news out of Texas. And a Huge THANK YOU to our Texas members for your advocacy efforts on this matter. The Texas Budget Conference Committee released a budget that included funds to support Long Acting Injectables (LAIs) for Texas ADAP. The Texas medication program was also able to receive an increase of $1 million per year, and these additional funds could also be used to cover LAIs, if needed.

Here is a link to the budget, page 66 contains details.

Academy Opposing Threats to HIV Prevention

On Friday, June 20, the Academy joined fellow AIDS United PPC Members by signing a letter to Congress opposing threats to domestic HIV prevention.

On June 5, the Academy joined advocates to speak out against attacks on HIV prevention for FY25 and FY26, noting the Administration has yet to release desperately needed HIV prevention funds that have already been authorized by Congress.

On June 17, the Academy joined HPAC in a letter campaign urging CDC and HHS to immediately release Year Two funding for PS-24-0047. Noting that the delay is disrupting HIV prevention efforts in all jurisdictions.

Academy Champions Medicaid

On June 13, AAHIVM, ANAC and HIVMA partnered to protect Medicaid for people with HIV by reaching out to our members in key states (Kansas, Maine, Nebraska, Utah, West Virginia, North Carolina and Missouri) where Senators could play a pivotal role in the Senate vote on the reconciliation/budget bill.

Also on June 13, the Academy signed on to the FAPP letter urging Congress to protect Medicaid in the reconciliation process.

Academy Champions HIV Funding 

On June 4, members of the Academy who practice in Richmond, Virginia, joined ABAC in a virtual meeting with Representative McClellan’s Health Legislative Assistant, Erica Eisenman, to discuss the effects of the recent federal cuts in funding on HIV clinicians. Rep. McClellan (D-VA-4) represents Richmond and areas south to the North Carolina border and east to the tidewater area. She is a member of the Energy and Commerce Committee and Congressional Black Caucus.

Monitoring Threats to Federal HIV Guidelines

The Academy is aware that starting in June 2026 the National Institutes of Health (NIH) will no longer support the HIV clinical practice guidelines that are supported through the NIH’s Office of AIDS Research. Federal HIV guidelines have been a mainstay to clinical practice and an essential tool for all providers, especially those who may have less experience with patients with HIV. We are monitoring the situation and will keep our members updated on any advocacy we can do on this matter.