A proposal aimed at reducing overpayments to Medicare Advantage insurers is gaining momentum with backing from key committee leaders.

Why it matters: A crackdown on "upcoding" by MA plans could save the government tens of billions of dollars and serve as a bipartisan rallying point, though industry pushback is likely to be fierce.

Driving the news: Senate HELP Chair Bill Cassidy's No UPCODE Act seeks to address some MA plans' practice of classifying patients as sicker in order to receive higher payments. His office, citing past CBO estimates, says it could save as much as $124 billion over 10 years.

• The proposal received a burst of attention when it was considered for the GOP reconciliation bill.
• Backers are now eyeing other vehicles, including a year-end health package, if one materializes.

Senate Finance Chair Mike Crapo told reporters yesterday that he backs the bill. "I was hopeful we could do it in the reconciliation bill; we weren't able to put it in," he said. He did not specify a path forward.

• At a hearing yesterday, House Ways and Means Chair Jason Smith, without mentioning specific legislation, also called out "concerns about MA plans inflating a patient's level of sickness, resulting in higher reimbursements for the plan at taxpayer expense."

Between the lines: Savings from MA have bipartisan appeal, unlike the changes to Medicaid that the GOP pursued in reconciliation.

• Leading Democrats urged their GOP counterparts during the reconciliation debate to target MA practices like upcoding rather than Medicaid.
• Senate Finance Ranking Member Ron Wyden told Axios yesterday that he thinks upcoding is a "blatant rip-off" and that he will "look at all the possible vehicles to get it done."

Yes, but: Changes to MA can be characterized as "Medicare cuts" and prove politically incendiary heading into the midterms.

• That could be too much for lawmakers still bruised by the bitter reconciliation debate, who'd also open themselves up to attacks from the insurance industry.
• There is also the real prospect of legislative gridlock that results in just a bare-bones health extender package.

What they're saying: "The president and congressional leaders made a promise to seniors that there would be no cuts to Medicare," said Chris Bond, a spokesperson for America's Health Insurance Plans.

• "The No UPCODE Act would break that promise and lead to higher costs and reduced benefits for nearly 35 million seniors and individuals with disabilities who rely on the program."
• The Better Medicare Alliance, a pro-MA advocacy group, pushed back on the upcoding bill by saying that "stable, predictable payments are critical to sustaining Medicare Advantage's investments in coordinated care, supplemental benefits, and chronic disease management."

What's next: "I think we'll have a package of health care bills by the end of the year, and that should be one of them," said Sen. Roger Marshall, referring to the Cassidy bill.

• "There's no guarantee," Cassidy told Axios of the inclusion of his bill in a health package. "But it's bipartisan."

A coalition pushing to renew enhanced Affordable Care Act subsidies is arguing that allowing the tax credits to expire would more than cancel out many families' tax savings under the GOP domestic policy law.

Why it matters: ACA backers are trying to convince Republicans that they could lose a major political selling point in the midterms.

Driving the news: The group Keep Americans Covered is sending a chart to GOP offices comparing the increased premium costs for 22 million people on the ACA marketplaces with the savings those people would get from the tax cuts.

• A hypothetical family of four with a median income of $80,160 would gain $1,700 in tax cuts from the reconciliation bill but absorb a $2,947 premium increase if the ACA subsidies expire. That would result in a net $1,247 loss.
• There will be state-specific figures for all 50 states.
• Keep Americans Covered comprises patient groups, insurers, doctors, hospitals and other health groups pushing for the subsidy renewal.

The big picture: Renewing enhanced ACA subsidies has always been an uphill climb with GOP majorities in both houses, largely because of concerns about the $300 billion-plus cost over 10 years.

• Still, in recent weeks more GOP lawmakers have expressed some openness to an extension, perhaps wary of the political risk of allowing premium costs to rise in an election year.

1. Flu vaccine: HHS accepted recommendations from Secretary Robert F. Kennedy Jr.'s vaccine advisers to remove from influenza shots a preservative that anti-vaccine activists have suggested is linked to autism, endorsing a discredited belief that it's harmful at the level at which it's included in vaccines.
2. Hospital funds: Sen. Josh Hawley told an Axios News Shapers event that he doesn't want to "experiment" with hospital funding in the aftermath of the GOP tax and spending law.
3. Surprise billing: Rep. Greg Murphy today is due to introduce bipartisan follow-on legislation to the No Surprises Act that would increase penalties for payers who don't comply after losing billing disputes.