When Rep. Jason Smith became the Ways and Means chair in January, health analysts and lobbyists felt that he wasn't exactly a known quantity on health care.

The big picture: They now understand his style a little better — that his agenda is going to be set by what he hears from people around the country rather than D.C. insiders. But they're still looking for signs of what that means for them, Victoria reports.

• Health industry groups are definitely worried about how the GOP budget could affect their bottom lines and are watching what Ways and Means does, with providers and health plans worried about potential cuts.
• "If you're not cutting beneficiaries' benefits, there's really only one way to save money, if you want to make it more solvent, and that's provider cuts," said one of the lobbyists who spoke to Victoria.

Zoom in: Health care seems to have had a slow start for Ways and Means in the new Congress, where much of the discussion has centered on the debt ceiling and Medicaid (an Energy and Commerce issue), while the committee has focused more on the IRS and trade.

• Part of that slow start can be attributed to the committee still hiring staff, plus the fact that the chairman's vote was pushed to January.
• Still, in Smith's first few months, there's already been a tamping down of talks about cutting Medicare in the budget and a battle around Medicare Advantage, which have resulted in some outlines of what the new chairman's leadership might look like.

What they're saying: Smith has made it clear he wants to hear from people outside of the D.C. bubble, as he did by holding the committee's first two hearings of the new Congress in the field in West Virginia and Oklahoma.

• That pattern continued in Thursday's health hearing (held in D.C.), where the chairman called a small-business owner up to talk about how difficult it is to offer health insurance for employees and a nurse practitioner to discuss how inflation has made running his practice more difficult.
• Having average citizens and small-business owners — not typically traditional witnesses — helping to dictate the hearing discussion has added "a little bit of element of surprise to the downtown community," one GOP health lobbyist told Victoria.
• That's in part because trade associations are often heavily relied upon by chairs when trying to figure out topics of hearings, the lobbyist added.

Between the lines: Kevin Brady, who was the top Republican on the committee for the last seven years, had good relationships with the CEOs of big health industry groups and trade associations.

• That meant K Street was accustomed to Brady's leadership style and good communication with downtown, whereas Smith seems to care more about his constituents and colleagues than K Street, another GOP health lobbyist said.
• But lobbyists say Smith and his team at Ways and Means were very active in talking to K Street about the controversy over the Medicare Advantage payment rate changes. And in general, as a team they win good marks for openness about communicating with downtown.

Sen. Raphael Warnock introduced a bill today to cap insulin costs at $35 per month, but with an important addition: GOP Sen. John Kennedy is now cosponsoring, Peter reports.

Why it matters: The GOP sponsor could give a boost to Warnock's effort, which he pushed last year as well.

• Democrats were able to cap monthly costs at $35 per person on Medicare last year. This bill would extend the protection to people on private insurance and the uninsured.

Between the lines: Kennedy's support is not a complete surprise, given that he was one of seven GOP senators to vote for the effort last year during the IRA debate.

• But insulin legislation faces a tough path. There is now a GOP House, which has not been welcoming. House Energy and Commerce Committee Chair Cathy McMorris Rodgers called President Biden's call for a $35 cap in the State of the Union "socialist."
• Insulin makers have recently voluntarily lowered their prices, but backers say there is more to do to enshrine lower prices in law.

What's next: Warnock indicated to reporters today that Senate leaders haven't decided whether the measure would get a standalone floor vote or be in a larger package, saying his constituents don't care how it's done as long as it passes.

• He said he's having "ongoing" conversations with other GOP senators.

What they're saying: Senate Majority Leader Chuck Schumer said this month that "it is my hope" bipartisan insulin legislation can pass, without providing details on the path forward.

Usually we spotlight one bill at a time, but it’s been a big week for health care legislation introductions! Here’s a roundup of the bills Maya is keeping tabs on.

1) The Better Mental Health Care for Americans Act, sponsored by Sens. Ron Wyden and Michael Bennet, would require parity for mental and behavioral health services in Medicare and Medicaid and boost mental health reimbursement rates for Medicare and Medicaid providers.

• It's not bipartisan and would likely come with a hefty price tag. But policymakers across the aisle and in the White House want to improve mental health care. Plus Wyden leads the Finance committee agenda, so we expect this bill to at least get some discussion time.

2) The Ensuring Patient Access to Critical Breakthrough Products Act, reintroduced by Reps. Suzan DelBene, Brad Wenstrup and six other lawmakers, would make sure Medicare covers FDA-designated breakthrough products for four years while regulators make a permanent coverage decision.

• The bill is coming back up as CMS prepares to propose a reimagined rule on transitional coverage for breakthrough medical technology. It could add some urgency to CMS’ regulatory timeline and may get more serious play if the CMS rule differs substantially from the bill, which has industry backing.

3) The Health Care Affordability Act, led by Rep. Lauren Underwood, would make permanent the enhanced premium tax credits for ACA exchange plans.

• Thanks to the Inflation Reduction Act, the tax credits currently extend into 2025. Many Democrats want to make the credits permanent, but we’re curious to see how much traction this policy gets in the current Congress.

4) The Healthcare Ownership Transparency Act, introduced this morning by Rep. Pramila Jayapal, would require disclosures of private equity investment in health care. It would also give HHS the authority to stop private equity firms from controlling health care businesses until the effects of PE ownership on health care are known.

• Health care costs, and how hospital ownership contributes to them, are top of mind for Congress’ health brains this session. We’ll be watching to see who else signs onto Jayapal’s bill.

And a bonus for the true nerds:

5) Sens. Bill Cassidy and Bob Casey introduced a bill this week that would direct MedPAC and MACPAC to jointly issue policy recommendations on care for dual-eligible beneficiaries.

• This may be discussed in a bipartisan working group on dual eligibles, and Cassidy wants to do more work in this space, an aide to the senator said in an email.