Senate Republicans today served notice that they're preparing for a major fight next year over renewing enhanced Affordable Care Act subsidies — one that they say could spotlight major flaws in ACA marketplaces.

Why it matters: Hospitals, insurers and provider and patient groups already are mobilizing for what's shaping up to be a drawn-out debate over the subsidies and the possibility of a grand compromise if there's divided government, Peter reports.

What they're saying: Republicans on the Senate Finance Committee bashed the enhanced subsidies as expensive and wasteful at a hearing today, indicating that it won't be an easy sell to get their votes to renew the aid, which has largely benefited people in red states.

• "The IRA uses hardworking taxpayer funds to camouflage the ongoing flaws with the individual health insurance market," said Finance Committee Ranking Member Mike Crapo.
• He cited CBO estimates that permanently extending the enhanced subsidies would increase the deficit by more than $325 billion over a decade, plus billions more in interest outlays.
• Theo Merkel, a former Trump administration health official now at Paragon Health Institute, testified that extending the subsidies was a move to "simply paper over the poor quality of the plans themselves."

The big picture: Although Republicans would almost certainly let the subsidies expire if they sweep the election, a deal still could be struck in a divided government to temporarily extend them in exchange for renewing some expiring Trump tax cuts.

• Senate Finance Chair Ron Wyden made clear that the subsidies are a priority, saying he is "all in" on the effort and framing the issue as preventing a "giant premium spike."

Between the lines: As we reported last week, powerful industry groups are lining up to push for renewal of the subsidies, meaning the effort will be backed by months of strenuous lobbying.

• The Finance hearing also gave Democrats on the panel a chance to preview a new health care line of attack against the Trump-Vance ticket.
• Wyden pointed to comments Sen. JD Vance made on NBC's "Meet the Press" on Sunday calling for sick people to be in a separate risk pool. He said Vance's ideas are "a prescription for going back to the days when you can clobber people with a preexisting condition."

Sen. Bernie Sanders today predicted that covering GLP-1 drugs for weight loss could be financially ruinous for Medicare and private insurance, and said generic manufacturers told him they could make the drugs at a much lower cost, Victoria reports.

Why it matters: The Senate HELP Committee chair's comments at a roundtable he convened were a likely preview of arguments he'll make at next week's committee hearing with Novo Nordisk CEO Lars Fruergaard Jørgensen about the high costs of the drugmaker's Ozempic and Wegovy.

What he's saying: Sanders outlined specific concerns about the prices of Ozempic and Wegovy and how they could be remedied.

• "The outrageously high cost of these drugs could bankrupt Medicare, while radically increasing insurance premiums to absolutely unaffordable rates," Sanders said.
• "The HELP Committee has heard concerns from across the country," he continued. "One of the largest health insurance companies in the country has told me that they would have to double premiums for all of their policyholders if they covered Wegovy and Ozempic for all eligible patients."

Sanders said manufacturers of generics told him that they can sell an equivalent version of Ozempic in the U.S. for less than a $100 per month.

• He said that even with rebates, the price of Ozempic is much higher in the U.S. than in other countries — about $969 per month compared with $59 in Germany, $71 in France, $122 in Denmark and $155 in Canada.
• Medicare doesn't cover GLP-1 drugs for weight loss but does pay for their use in treating type 2 diabetes and cardiovascular disease.
• The roundtable included North Carolina state Treasurer Dale Folwell, physicians and a patient advocate.

Shawn Bishop, the chief health care adviser for Senate Finance Committee Democrats, is leaving her position, a committee spokesperson confirmed to Peter.

Why it matters: Bishop, a well-known figure in D.C. health policy circles, has helped craft legislation including the Affordable Care Act and the drug pricing provisions of the Inflation Reduction Act.

Between the lines: She has served multiple stints at the Finance Committee, most recently in a role that started in early 2021.

• She previously worked at the committee from 2005 to 2010, per her LinkedIn profile, including on the ACA.
• Stat first reported the news of her departure.
• There's no word yet on her successor.

1. Patent reforms: The Senate Judiciary Committee will mark up patent bills with big implications for drug developers, including the PREVAIL Act, which would limit who can challenge patents, and the Patent Eligibility Restoration Act, which would make it easier for certain scientific discoveries to be patented.

• It all begins Thursday at 10am ET. Background here.

2. E&C health bills: The House Energy and Commerce Committee is due to mark up 16 measures tomorrow at 10am ET, including one to extend certain Medicare telehealth flexibilities and a Congressional Review Act resolution disapproving of the Biden administration's staffing minimums for long-term care.

3. Contempt resolutions: The Senate HELP Committee meets Thursday at 10am ET to vote on holding Steward Health Care CEO Ralph de la Torre in contempt after he refused a subpoena to testify on the company's bankruptcy.

4. Chronic disease: The House Ways and Means health subcommittee has a hearing tomorrow at 2pm ET on chronic disease prevention and treatment.