The Senate will vote tomorrow on dueling health care plans: Democrats' proposal to extend enhanced Affordable Care Act subsidies for three years, and a plan from two Republican chairmen that would instead give enrollees funds in health savings accounts.

Why it matters: The move gives the GOP an alternative to point to if the ACA subsidies expire at the end of the year and health care costs spike for millions of people.

• But neither plan is expected to get the 60 votes to advance.

Driving the news: The plan from Finance Committee chair Mike Crapo (R-Idaho) and health committee Chair Bill Cassidy (R-La.) wouldn't extend the tax credits past their year-end expiration, instead providing $1,000 to $1,500 in health savings accounts to help certain marketplace enrollees with out-of-pocket costs.

• It's drawn sharp criticism from some Democrats for leaving working-class Americans saddled with high health costs.

Senate Majority Leader John Thune (S.D.) left open the possibility of talks after both votes fail on Thursday, though there is deep skepticism about the chances of reaching a bipartisan agreement.

• "If neither proposal gets 60 then we'll see where it goes from there," Thune said.
• President Trump, asked later about the Crapo-Cassidy bill and whether Republicans should vote for it, told reporters, "I like the concept. ... I love the idea of money going directly to the people."

Between the lines: On the House side, GOP leadership, committee chairs and leaders of House GOP factions met yesterday to discuss health proposals, with an eye toward a possible House vote this year.

• Members left the meeting tight-lipped, saying discussions are ongoing.
• The full House Republican conference is expected to discuss health proposals in its meeting this morning ahead of potential votes next week.

Lab testing companies including giants Quest Diagnostics and LabCorp are pressing Congress to stop hundreds of millions of dollars of Medicare cuts for diagnostic tests that are due to take effect at the end of January.

Why it matters: Their push could add to the health care issues piling up on lawmakers' plates as the calendar flips over.

• Congress has given the testing industry short-term reprieves for the past five years. But because of recent changes to how congressional scorekeepers analyze the sector, pushing off the scheduled cuts now would add to the deficit, instead of saving tax dollars.

The issue has stayed largely under the radar as Congress debates whether to extend enhanced Obamacare premium subsidies. But testing policy has big implications as precision medicine evolves and patients show up with more complicated cases.

• The testing industry and allied medical groups want a permanent fix, arguing that member companies' laboratory services influence 70% of clinical decisions.

Driving the news: A 15% reduction to Medicare payments for nearly 800 lab tests is set to take effect Jan. 31, followed by additional cuts in following years.

• The change stems from 2014 legislation that aimed to align Medicare reimbursements for lab tests more closely with commercial payments.
• Medicare cuts that previously went into effect from the legislation cost labs nearly $4 billion over three years. Since then, the diagnostics industry has successfully argued the cuts are based on incomplete and outdated pricing information.

What they're saying: Clinical lab companies say letting the cuts take effect will leave them with less money to spend on creating new diagnostics or technologies to generate quicker results.

• The cuts could also derail progress toward personalized medicine, which hinges on having a comprehensive understanding of the patient's molecular profile, said Susan Van Meter, president of the American Clinical Laboratory Association.

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Hospitals are closing unprofitable pediatric units and eliminating some surgical services for kids as they grapple with lower Medicaid reimbursements, staffing issues and more complicated cases, a 20-year review in the journal Pediatrics found.

Why it matters: The cuts can erect additional hurdles to getting care in already underserved communities and require families to travel longer distances to regional or urban health centers.

What they found: The review of nearly 4,000 facilities from 2003 to 2022 found the proportion of hospitals that researchers identified as having the lowest capabilities for pediatric care more than doubled.

• The most common services shed were appendectomies (50.5% fewer hospitals), hospitalizations for pneumonia (42.3%) and asthma hospitalizations (41.1%).
• In contrast, capabilities like organ transplantation and open-heart surgery for congenital defects showed little to no change.

The intrigue: Hospitalizations for children fell 26% from 2000 to 2019, prompting more hospital operators to take pediatric inpatient units offline, with little incentive to bring them back.

• The resulting regionalization of pediatric care "has not shown signs of slowing, and it remains to be seen whether there is a floor on pediatric capacity," they wrote.

Yes, but: The lack of pediatric inpatient beds doesn't mean that a hospital will not admit a child on an adult ward.

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Total enrollment in U.S. medical schools reached over 100,000 students for the first time during the 2025-2026 academic year, the Association of American Medical Colleges said yesterday.

Why it matters: The country is projected to face a shortage of 187,130 doctors by 2037.

• But while enrollment is up, many medical school students will feel a financial squeeze from caps on student loan borrowing and cuts to other assistance stemming from the Republican tax-and-spending bill.

By the numbers: Medical school applicants for 2025-2026 rose 5.3%, reversing a three-year decline and posting the biggest gain in a decade.

• First-year enrollees rose 1.2% from 2024-2025, with women comprising 55%.
• Among historically underrepresented groups, 8.4% identified as Black or African American, 11.5% were Hispanic or Latino, 0.9% identified as American Indian or Alaska Native and 0.4% were Native Hawaiian or Pacific Islander.

What we're watching: Higher enrollment could make the U.S. less dependent on immigrant physicians.

• But turnover could continue to plague the field, with significant numbers of doctors looking to leave their practice or reduce hours.

⚕️ ACA enrollment is slightly ahead of last year, initial federal data shows, even as expiring subsidies will make the coverage more expensive for many. (AP)

🔎 The FDA's probe of COVID-19 vaccines is expanding into adults, led by a critic of the shots. (Endpoints News)

💉 Democrat-led cities and states are balking at U.S. vaccine advisers' calls to no longer require all babies get hepatitis B shots at birth, portraying them as at odds with scientific consensus. (Bloomberg Law)

👤 Community health centers were created to serve as medical safety nets for people struggling to afford care. But some are suing patients and garnishing their paychecks. (ProPublica)