Author: Matt Zavadsky

Interesting editorial and perspective from an EMS clinician in a well-respected healthcare publication.
 
State balance billing laws have been all over the map (literally and figuratively) and only apply to state-regulated plans.
 
The EMS profession should be paying closer attention to the continued call for federal action on surprise payments, and the status of the GAPB committee recommendations to Congress.
 
We should be advocating for our patients by encouraging Congress to adopt the GAPB committee recommendations, which can be found here: https://www.cms.gov/files/document/report-advisory-committee-ground-ambulance-and-patient-billing.pdf

Your Patients Are Getting Surprise Ambulance Bills. Federal Law Still Allows It.

— Excluding ground ambulances from the No Surprises Act has clinical consequences

by Emily James

April 19, 2026 

https://www.medpagetoday.com/opinion/second-opinions/120845

Your patient called 911. They had no say in which ambulance responded. The dispatcher chose, the system routed them, and a crew arrived. Care was delivered. Transport was completed, and weeks later, a bill arrived for $900, $1,500, $2,400, or some other absurd amount. Sure, their insurance covered part of it, but the rest landed on them. And under current federal law, every part of that scenario was entirely legal.

The No Surprises Act, which took effect in January 2022, was a landmark patient protection measure that eliminated surprise billing across most emergency and out-of-network settings. It covered air ambulances. It covered out-of-network emergency physicians, anesthesiologists, and radiologists. It explicitly did not cover ground ambulances, which are the most common form of emergency medical transport, leaving an estimated 1.5 million privately insured patients exposed to surprise bills each year.

As a paramedic who has worked within private emergency medical services (EMS) for nearly a decade, I have watched this gap widen in real time. Patients are stabilized and transported, and then they’re left to navigate a billing system that they don’t understand and that federal law has declined to regulate. This is a gap with direct clinical consequences that emergency and acute care providers should understand.

The Numbers

Approximately 85% of emergency ground ambulance rides are out-of-network. A 2020 Health Affairs analysis found that roughly half of emergency ground ambulance rides resulted in an out-of-network charge for privately insured patients, with a median surprise bill of $450. High-end cases routinely reach into the thousands.

The clinical consequence that tends to receive the least attention is that some patients are delaying or forgoing 911 calls because they fear the bill. This is not a hypothetical. It is a documented pattern of care avoidance driven by financial calculation rather than medical judgment, and it means that some of the patients not arriving in the emergency department are making that decision at home, alone, weighing the cost of the ambulance against the severity of their symptoms.

That calculation will not always go the right way.

Why the Gap Exists and Persists

The exclusion of ground ambulances from the No Surprises Act was deliberate. Congress cited the complexity of ambulance regulation, referring to the mix of private companies, municipal fire departments, hospital-based services, and volunteer squads, as a reason to defer action. The American Ambulance Association lobbied successfully for the carve-out, arguing that the No Surprises Act’s arbitration framework would be unworkable for ambulance providers. In its place, Congress created the Advisory Committee on Ground Ambulance and Patient Billing (GAPB committee) to study the issue and return with its recommendations.

The committee delivered its report in August 2024. Its recommendations were specific and actionable: prohibit balance billing for out-of-network ground ambulance services; cap patient cost-sharing at the lesser of $100 or 10% of the bill; require insurers to process payments within 30 days; and mandate billing transparency. On reimbursement rates, the committee recommended deferring to state and locally set rates with federal guardrails, which is a framework designed to protect rural and smaller agencies from rate compression while still shielding patients.

Congress has not acted on those recommendations.

Why State Solutions Aren’t Enough

Twenty-two states have enacted some form of ground ambulance billing protection. It sounds like meaningful progress, and in some cases it is. But state laws cannot reach self-funded employer-sponsored health plans, which are governed by the Employee Retirement Income Security Act of 1974 (ERISA) and explicitly preempted from state regulation. Approximately 63% of workers with employer-sponsored insurance are in self-funded plans. That means the majority of working Americans with job-based coverage remain unprotected regardless of what their state has done. A patient in a state with strong ambulance billing laws may still receive a surprise bill if their employer uses a self-funded plan, which is something that the largest employers almost uniformly do.

This is not a gap that more state legislation can close. It requires federal action.

What the Clinical Community Can Do

Physicians and other acute care providers are positioned to move this issue in ways that EMS providers alone cannot. Emergency medicine, hospital medicine, and primary care organizations carry legislative influence that individual paramedics do not. When professional societies weigh in on patient safety issues — and care avoidance driven by billing fear is a patient safety issue — Congress listens differently than when it hears only from industry stakeholders and patient advocates.

The GAPB committee has done the analytical work. The report is on Congress’s desk. What has been missing is urgency from the clinical community. This refers to the providers who see the patients who waited too long, or the family members who explain that their loved one didn’t call because they were worried about the bill.

Every month without federal action is another cycle of patients absorbing costs they had no power to prevent, for a service they had no power to choose. The No Surprises Act was a genuine achievement with one significant exception baked into it.

That exception was always meant to be temporary.

It has not been.

Related:

Expanding the No Surprises Act to Protect Consumers from Surprise Ambulance Bills: Map of State Laws

February 5, 2026https://www.commonwealthfund.org/publications/maps-and-interactives/expanding-no-surprises-act-protect-consumers-surprise-ambulance

Ambulance theft is no longer a rare or isolated event—it is a predictable and growing operational risk.  Industry data suggests that an ambulance is stolen approximately every two weeks in the United States, most often from hospital ambulance bays, but increasingly from active scenes. What was once considered an anomaly is now presenting serious and escalating consequences—including police pursuits, spike strip deployments, vehicle crashes, and situations where patients and crews are placed in harm’s way.

The uncomfortable truth is this: many of these incidents are preventable.  This timely and practical webinar brings together operational leadership, regulatory insight, and legal expertise to examine ambulance security from every angle—what’s happening, why it matters, and what you can do about it now.  The Academy of International Mobile Healthcare Integration (AIMHI), Pro EMS and Page Wolfberg & Wirth Advisory Group (PWWAG) are teaming up to help you address this issue.

When:  Tuesday, April 28, 2026, 12n ET

Panel

Rob Lawrence – Pro EMS/AIMHI
President of the Academy of International Mobile Healthcare Integration (AIMHI) and Executive Director of the California Ambulance Association, bringing national perspective and frontline insight into EMS operations and risk.

Bill Mergendahl, Pro EMS
President of ProEMS, offering real-world operational experience on balancing rapid response with vehicle and crew security.

Mark Postma, SVP, Government Relations, Patient Care EMS Solutions
Experienced EMS leader offering insight into standards, compliance expectations, and the evolving role of vehicle security in modern EMS systems.

Doug Wolfberg, Esq. – PWWAG
Nationally-recognized EMS attorney with Page, Wolfberg & Wirth, providing clarity on liability, foreseeability, and the legal consequences of preventable ambulance theft.

Matt Zavadsky – PWWAG, Moderator
A nationally recognized EMS leader and strategist, guiding the discussion and drawing out practical insights across operations, regulation, and law.

Register Here: https://prodigyems.zoom.us/webinar/register/5417760399888/WN_kWrSTW3GTQWoYZRUKUlH6g

The go-to data base for conducting analysis of EMS trends ranging from finance and reimbursement to crashes and thefts – EMSIntel has now passed 4,000 news items and continues to grow.

What began as a simple weekly spreadsheet collated during the pandemic, tracking news reports about EMS, has grown into one of the most influential intelligence resources in Emergency Medical Services. EMSIntel, publicly accessible at www.emsintel.org, has surpassed 4,000 curated profession wide news stories, marking a significant milestone in its evolution from informal briefing tool to a nationally recognized platform for insight, analysis, and understanding.

The origins of EMSIntel are deliberately modest. Developed by Rob Lawrence (Pro EMS), while serving as the American Ambulance Association’s (AAA) Communications Chair, as a weekly compilation of notable EMS developments, the early version was shared with a small network of colleagues seeking clarity in an increasingly noisy information environment.

Recognizing both the value of the content and the opportunity to scale its impact, the AAA provided generous funding and support to transform EMSIntel from a static, spreadsheet-based product into the interactive and searchable platform it is today. This transition marked a pivotal moment, enabling not just collection, but structured collation and accessible analysis at scale.

As the platform matured, the Academy of International Mobile Healthcare Integration joined the collaboration, reinforcing EMSIntel’s role as a shared industry asset and ensuring its continued growth through coordinated collection, curation, and collaboration. Together, these partnerships have anchored EMSIntel firmly within the EMS ecosystem, both reflective of and responsive to its evolving needs.

From its earliest days, EMSIntel has been guided by a disciplined approach to curation and interpretation. Rodney Dyche (Patient Care EMS Solutions) serves as Chief Curator, overseeing the identification and classification of developments from across the United States and internationally. Matt Zavadsky (PWW|AG / Executive Director AIMHI) provides analytical leadership, translating thousands of individual entries into thematic insights that reveal the pressures, trends, and opportunities shaping EMS systems. Rob Lawrence shapes the input into briefings and articles to inform of issues, concerns and alerts.

An analytical summary of EMSIntel and a downloadable Excel file of the EMSIntel log, complete with source references, is updated each month on AIMHI’s News site.
 

This structure and support allows EMSIntel to move decisively beyond aggregation. With more than 4,000 curated entries, the platform now supports meaningful thematic analysis across workforce challenges, reimbursement reform, ambulance patient offload times (APOT), mobile integrated healthcare, and system resilience. It offers not just a snapshot of events, but a longitudinal understanding of how the EMS landscape is changing.

That insight is increasingly being put to use. EMSIntel analysis has supported briefings for policymakers at both state and federal levels, providing evidence and context to inform legislative and regulatory discussions. It has also been cited in journalistic reporting, helping frame EMS issues within a broader, data-informed narrative.
“EMS has no shortage of information, but it often lacks shared understanding,” said Rob Lawrence. “EMSIntel was created to bridge that gap, turning noise into insight, and insight into something that can inform decisions, policy, and public awareness.”

As EMSIntel enters its next phase, the focus will remain on expanding its analytical capability while maintaining the disciplined curation that underpins its value. The milestone of 4,000 entries is not simply a measure of scale, but a signal that EMS now has a growing intelligence function, one capable of tracking, interpreting, and communicating the realities of a complex and evolving system.

About www.EMSIntel.org
EMSIntel is a curated intelligence platform focused on tracking and analyzing developments across the Emergency Medical Services sector. Created by Rob Lawrence and supported by Chief Curator Rodney Dyche and Analyst Matt Zavadsky. EMSIntel provides thematic insight into emerging trends and issues affecting EMS systems, policy, and practice. Learn more at www.emsintel.org

Published analysis derived from EMS Intel
Leading into 2026: The four actions every EMS leader must take: Leading into 2026: The four actions every EMS leader must take
EMS at the edge: Inside a year of reckoning and redesign: EMS at the edge: Inside a year of reckoning and redesign
Funding on fire: Communities are saying the quiet part out loud: Rethinking EMS funding: New models for ambulance service sustainability
Fast & spurious: America keeps losing ambulances and the fix is cheap: Prevent ambulance thefts: Keep paramedics, patients and the public safe

Two news reports last week that could impact EMS reimbursement should catch the attention of EMS leaders.
 
The first report signals that Medicare is considering making enrollment in Medicare Advantage (MA) the ‘default’ enrollment option.
 
As reported in the August 2025 PWW|AG EMS Financial Index Report, MA claims represent 56.9% of all ambulance claims, with Medicare Part B representing 43.1% of claims. The average reimbursement from MA plans is $25 lower than Medicare Part B. Additional enrollees in MA plans could have a negative impact on EMS reimbursement.

The second report reveals that the average out-of-pocket premiums for Affordable Care Act (ACA) enrollees rose 58% this year after the expiration of enhanced subsidies. Also, 1.2 million fewer people enrolled in ACA plans in 2026 compared to 2025. 
 
This possibility was discussed in our summer Pulse of EMS Finance webinar series, explaining that reduced ACA enrollment due to provisions contained in the OBBBA could shift commercially insured patients to uninsured, or Medicaid programs.
 
We strong encourage EMS leaders to closely monitor these types of developments, and consider modeling what these changes may mean for their revenue cycle.

—————

CMS considering automatic enrollment in a Medicare Advantage plan

The idea is part of the conservative Project 2025 policy.

By Susan Morse

March 24, 2026

https://www.healthcarefinancenews.com/news/cms-considering-automatic-enrollment-medicare-advantage-plan

The Centers for Medicare & Medicaid Services is considering a policy to automatically enroll seniors in a Medicare Advantage plan, according to STAT.

Chris Klomp, director of Medicare and deputy administrator for CMS, told STAT his team is mulling the feasibility of models that would either automatically enroll beneficiaries into a private Medicare Advantage plan or an accountable care organization that participates in the Medicare Shared Savings Program or similar program. 

Klomp said either choice would be better than enrolling beneficiaries in a fee-for-service arrangement, which is Medicare. Individuals could still opt into a different insurance arrangement, he said. 

Klomp is senior advisor to Health and Human Services Secretary Robert F. Kennedy, Jr. 

In February, Kennedy announced in an email to staff that he was remaking his leadership team, putting Klomp in charge of overseeing all HHS operations, according to Politico.

Currently, original Medicare is the default option for seniors who don’t make a choice. Over half of seniors enrolled in a Medicare plan choose a Medicare Advantage plan.

Moving to MA as the default option is part of the conservative Project 2025 policy blueprint, which has made other recommendations that HHS has initiated such as Medicaid work requirements. 

Medicare Advantage (MA), a system of competing private health plans, is the major alternative to traditional Medicare for America’s large and growing cohort of seniors. The program provides beneficiaries with a wide range of competitive health plan choices—a richer set of benefits than traditional Medicare provides and at a reasonable cost. Equally as important, the MA program has been registering consistently high marks for superior performance in delivering high-quality care. Critical reforms are still needed to strengthen and improve the program for the future.”

————

ACA premium costs up after subsidies expire

By Peter Sullivan

March 30, 2026

https://www.axios.com/newsletters/axios-vitals-f319f390-2b23-11f1-8489-774d2aecabb5.html

Average out-of-pocket premiums for Obamacare enrollees rose 58%, or $65 per month, this year after the expiration of enhanced subsidies, new federal data shows.

Why it matters: The data helps quantify the effects of the fierce partisan battle in Congress over whether to extend the subsidies, which ended in no action.

By the numbers: The average Affordable Care Act out-of-pocket premium rose from $113 per month in 2025 to $178 per month in 2026, according to the CMS report.

• There are also more enrollees in “bronze” plans with higher deductibles this year: 40% of enrollees compared with 30% last year.
• Larry Levitt, executive vice president of health policy at KFF, wrote on X that the average premium increase would have been higher if some people had not switched into bronze plans with higher deductibles to try to keep their premiums down.

The big picture: 23.1 million people signed up for 2026 coverage, down 1.2 million from 2025.

• CMS touted its enforcement actions, which it said removed coverage or subsidies from nearly 1.5 million people found to be ineligible.

The study referenced in this news report found that 400+ hospitals are at risk of closing or cutting services due to Medicaid funding reductions, particularly affecting essential services like maternity and mental health. And, most hospitals affected are in urban, not rural areas.

Why this matters to EMS
As we have shared in recent articles and webinars, for EMS, this could mean:

• Fewer destination options
• Longer transport times
• Loss of specialty care access
• Increased APOT times
• Reduced unit availability
• Increased reliance on 911 as the safety net
• Greater use of EMS for non-emergent but unmet needs

What EMS agencies should do

• Map at-risk hospitals and identify alternate destinations now
• Develop dynamic patient navigation protocols (e.g., bypass rules, specialty routing)
• Consider dispatch triage programs
• Expand sustainable MIH/CP programs
• Expand Treatment in Place (TIP) and Transport to Alternate Destination (TAD) programs
• Plan for cross-jurisdictional, regional coordination

This isn’t just a hospital problem; it’s a system transformation moment that EMS agencies can leverage for system sustainability.

EMS agencies should continue to shift from “transport providers” to “mobile healthcare agencies”.

Medicaid cuts threaten hundreds of hospitals, new report finds

Together, the hospitals provide care for nearly 7 million patients across the U.S., according to the analysis.

By Berkeley Lovelace Jr.

March 31, 2026

https://www.nbcnews.com/health/health-news/medicaid-cuts-threaten-hundreds-hospitals-new-report-finds-rcna265789

More than 400 hospitals across the United States are at high risk of closing or cutting services because of the Medicaid cuts in President Donald Trump’s “big, beautiful bill,” according to an analysis from the progressive watchdog group Public Citizen.

The fallout could make it harder for millions of people to get care and put thousands of health care workers’ jobs at risk as hospitals lose a key source of federal funding. Medicaid covers about a fifth of all hospital spending.

The Medicaid cuts come in phases, with more significant changes, including work requirements, in 2027 and limits on how states raise funds in 2028. Overall, the law is expected to reduce federal Medicaid funding by roughly $1 trillion over the next decade.

“We’re seeing hospitals that are already under severe financial strain having to make decisions about how to stay financially solvent,” said Eileen O’Grady, a researcher in Public Citizen’s Congress Watch division and the report’s author. “That has pretty clear implications for people who live in that community. It also has ripple effects on other hospitals in those communities.”

The analysis draws on hospital financial data from the Centers for Medicare and Medicaid Services from 2022 through 2024, covering about 95% of U.S. hospitals. The group defined at-risk hospitals as those in which Medicaid and other low-income government programs made up at least 20% of revenue and that have been operating at a loss in recent years.

The report doesn’t estimate when hospitals could close or cut services.

“Closure is the worst-case scenario, but it also doesn’t preclude hospitals from having to make really tough decisions about cutting services that might be essential to those communities but are just no longer financially viable,” O’Grady said.

Across the country, hospitals have already made statements warning they may need to lay off staff or scale back care, including maternity and mental health care, because of the Medicaid cuts.

For many patients, hospitals are the last place to turn when there are few or no other options for care.

“When hospitals close, patients have less access to the care that they need,” said Gideon Lukens, director of research and data analysis on the health policy team at the Center on Budget and Policy Priorities, a nonpartisan research group. “They have to travel further or wait longer in other hospitals that become overcrowded. That additional time can be the difference between success and failure of time-sensitive, potentially life-saving treatments.”

The closures also add strain to the hospitals that take on the extra patients.O’Grady said doctors end up having “less patience, less time, less capacity to provide the highest quality care.”

“It can be very dangerous for hospitals to be under this kind of strain,” she said.

The analysis found a total of 446 at-risk hospitals, with at least one at-risk hospital in 44 states and Washington, D.C.

About 60% of the at-risk hospitals — 267 facilities — are in urban areas, even as much of the debate around Medicaid cuts has focused on rural hospitals. Black and Latino people stand to be the most affected by the cuts.

The hospitals span both Democratic and Republican-led states, though the states with the largest number of at-risk hospitals are California, New York, Illinois and Washington.

Republicans also represent several congressional districts with the highest number of at-risk hospitals. House Republicans who voted for the Medicaid cuts have 196 at-risk hospitals in their districts, while Senate Republicans — all of whom back the cuts — represent 146 at-risk hospitals in their states, according to the analysis.

The cuts could lead to a worsening crisis, especially for rural hospitals, said Zachary Levinson, the project director of the KFF Project on Hospital Costs.

He said that by his estimates, Trump’s law sets aside $50 billion to support rural communities, but could reduce federal Medicaid spending in rural areas by far more — about $137 billion over a decade.

James Jackson, the CEO of Alameda Health System in Oakland, California, said the Medicaid cuts represent an “existential threat.”

Alameda Health System, which gets 60% of its revenue from Medicaid payments, announced in December that it would lay off nearly 300 employees and lose more than $100 million annually by 2030. (The health network was not included on Public Citizen’s at-risk list, though the report notes its financial troubles.) The layoffs, set to take effect in March, have since been delayed.

Proposed cuts included mental health services, care for patients with chronic conditions and an ambulatory plastic surgery program. Jackson said closing hospitals is not on the table, but the system has continued to look at scaling back services.

“I don’t think the impact is going to be a positive one,” he said. “We are often the provider of last recourse, so if we’re not able to provide a service, there will be a delay in receiving care at one of the other systems in the area or they may not provide it at all.”

Trinity Health, a Michigan-based hospital system with facilities in other states, said it’s projected to lose $1.5 billion due to “recent and future government policy changes.”

In January, it said it was laying off 10.5% of its billing staff. One of its hospitals, St. Mary’s Sacred Heart Hospital in rural northeast Georgia, announced last October it was closing its maternity unit.

In a statement, a Trinity Health spokesperson shared a previous statement that said in part that “more reductions” are being considered by the federal government and it’s “not possible to simply absorb such a significant financial impact without making thoughtful, forward-thinking changes.”

EMS agency leaders should stay abreast of potential further changes to HHS, its agencies, and federal grant programs.

————————–

Trump budget targets $15.8B in HHS cuts: 9 things to know

By: Madeline Scheetz, Andrew Cass, and Alan Condon

April 3, 3036

https://www.beckershospitalreview.com/hospital-management-administration/trump-budget-targets-15-8b-in-hhs-cuts-9-things-to-know

The Trump administration’s fiscal year 2027 budget released April 3 proposes a $15.8 billion cut to HHS, while requesting $1.5 trillion for defense, a 44% increase. The budget would dramatically reshape federal spending priorities across healthcare and national security.

It would also restructure the federal health bureaucracy, eliminating familiar agencies, cutting $5 billion in programs deemed wasteful and replacing them with a new entity called the Administration for a Healthy America.

Below are nine notes on the fiscal year 2027 budget: 

1. HHS faces a $15.8 billion cut. The budget requests $111.1 billion for HHS in fiscal 2027, representing a 12.5% reduction from 2026. The administration framed the cut as a move to eliminate “bloated, woke and inefficient programs” and refocus on core priorities. 

The budget comes nine months after President Donald Trump signed into law the One Big Beautiful Bill Act, which outlined nearly $1 trillion in Medicaid cuts and restructured several key healthcare programs. Among the most contentious aspects of the OBBBA were its cuts to Medicaid; the legislation adds work requirements, more frequent redeterminations, and adds new limits on state-directed Medicaid managed care payments and oversight.  

President Trump has also signaled a broader shift in how the federal government approaches healthcare funding. Speaking at an April 1 White House event, he said it is “not possible” for the federal government to fund Medicare, Medicaid and childcare, arguing this responsibility should be on individual states while federal resources focus on priorities such as national defense, NBC News reported April 2. 

2. NIH loses $5 billion; 3 institutes eliminated. The administration alleges that the National Institutes of Health “broke trust of the American people with wasteful spending, misleading information, risky research, and the promotion of dangerous ideologies that undermine public health.” At the program level, the budget requests $41 million in funding for NIH research, a roughly $5 billion cut over 2026 funding. The proposal calls for the elimination of the National Institute on Minority Health and Health Disparities, Fogarty International Center and the National Center for Complementary and Integrative Health.

The proposed cut is significantly smaller than the administration sought in its 2026 budget. That plan proposed cutting NIH’s funding by $18 billion. That proposal was ultimately rejected by Congress. Last year the administration also proposed consolidating a significant number of the NIH’s 27 institutions and centers, which lawmakers also rejected.

3. A new agency replaces several familiar ones: the Administration for a Healthy America. The budget establishes the Administration for a Healthy America as part of a “major reorganization” of HHS. 

AHA would consolidate functions previously spread across the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration, the CDC, and the Office of the Assistant Secretary for Health. The goal is to bring nutrition services, food safety, chronic disease prevention, and behavioral health under one roof, cutting $5 billion in programs the budget described as duplicative, inefficient, or misaligned with the Trump administration’s policies. It also creates a new $4.1 billion Behavioral Health Innovation Block Grant to replace several existing behavioral health funding streams, which the administration criticized for funding programs including transgender health services and DEI initiatives.

4. Global health funding cut by $4.3 billion — PEPFAR restructured. The budget cuts $4.3 billion from global health programs, leaving $5.1 billion in total. The Trump administration framed this as a shift from “Beltway Bandit” contracts toward an “America First Global Health Strategy.” The budget said roughly 40% of the President’s Emergency Plan for AIDS Relief funds under the Biden administration supported actual service delivery like medications, testing, commodities and healthcare workers, with the remainder consumed by duplicated administrative costs and supply chain overhead. PEPFAR would operate through unified bilateral compacts moving forward designed to improve efficiency. The budget eliminates funding for certain reproductive health services, circumcision programs and LGBTQ-related health services under this restructuring.

5. The Hospital Preparedness Program would be eliminated. The $240 million Hospital Preparedness Program — housed within the Administration for Strategic Preparedness and Response — is slated for elimination. The budget argues its activities can be absorbed by CDC’s Public Health Emergency Preparedness Program and stronger state efforts. HPP has been the main federal platform through which hospitals fund surge capacity planning, disaster response infrastructure and healthcare coalition development. Its potential elimination comes as hospitals are still processing the operational and financial lessons of the COVID-19 pandemic, and as preparedness leaders have warned about the sector’s vulnerability to future events. 

6. VA healthcare investment spikes. Not all healthcare news in the budget is a cut. The VA would receive a $1.5 billion, or 9%, funding boost to $144.9 billion, including $4.2 billion for EHR modernization and $130 million for AI and automation investments in veterans claims processing. The department’s Oracle Health EHR implementation — which could cost nearly $50 billion — and its growing investment in AI-driven revenue cycle functions follows trends playing out across the broader healthcare landscape. The VA is set to install the EHR at 13 medical centers this year, beginning with four hospitals in Michigan, and could finish the program by 2031. The project was put on hold in 2023 as the agency and Oracle worked out technical and patient safety concerns.

7. AHRQ is effectively eliminated. The Agency for Healthcare Research and Quality would see a proposed $129 million cut, eliminating most of the agency’s current operations. The administration characterizes much of AHRQ’s research portfolio as duplicative of work already conducted at NIH and proposes moving select statistical functions into a newly created HHS Office of Strategy.

8. LIHEAP scrapped — again. For the sixth time, the administration is proposing to end the Low Income Home Energy Assistance Program. The administration argues that the $4 billion program is unnecessary because states have policies preventing utility disconnection for low-income households.  

9. WHO and Pan-American Health Organization would be defunded entirely. The budget provides zero funding for the World Health Organization, after the U.S. withdrew in late January. It also cuts funding for the Pan-American Health Organization. 

“These corrupt organizations have shown no independence from inappropriate political influences, such as when the WHO aided in the COVID-19 coverup,” the budget said. 

The 92-page budget proposal is available here.