Health Calls Season 6, Episode 11 delivers an important Washington health policy update, as host Brian Reardon and Executive Producer Josh Matejka welcome Paulo Pontemayor, CHA’s Senior Director for Government Relations. Paulo breaks down federal health care policy developments, including the expiration of ACA premium tax credits and ongoing coalition advocacy through Keep Americans Covered.
Health Calls Season 6, Episode 11 delivers an important Washington health policy update, as host Brian Reardon and Executive Producer Josh Matejka welcome Paulo Pontemayor, CHA’s Senior Director for Government Relations. Paulo breaks down the latest federal health care policy developments impacting Catholic health care, including the expiration of ACA premium tax credits, rising insurance costs, and ongoing coalition advocacy through Keep Americans Covered.
The conversation also highlights key wins in recent appropriations bills, such as extensions for essential Medicare and Medicaid provisions, telehealth flexibilities, and delayed Medicaid DSH cuts. Looking ahead, Paulo previews 2026 priorities—Medicaid work requirements, maternal health initiatives, and immigration policies rooted in human dignity. As a pivotal election year shapes congressional action, listeners learn how CHA members and community partners can stay engaged through advocacy alerts, local outreach, and collaborative efforts that strengthen access to care and support whole‑person health across the country.
Brian Reardon (00:05):
Welcome to Health Calls, the podcast of the Catholic Health Association of the United States. I'm your host, Brian Reardon, and with me is Josh Matejka. Hey, Josh.
Josh Matejka (00:13):
Hey, Brian. How's it going?
Brian Reardon (00:15):
It's going good. This episode, we're going to do what we call a Washington update, and in just a moment, we're going to bring our colleague Paulo Pontemayor from our DC office. Paulo is CHA Senior Director for Government Relations. We'll bring him into the conversation in just a moment. But Josh, this episode, as you might imagine, is about recent policy decisions or legislation I should say, that passed in Congress. We want to get kind of a recap of what's been happening in Washington over the last month or so, and also look ahead here to the rest of 2026, but again, in the context of this season, United for Change, really, we also want to mention some of the coalition work we're doing as well.
Josh Matejka (00:56):
Yeah, I mean, folks who have been listening to Health Calls for the last few years will know that around this time every year as advocacy work is kicking back up in dc we try to check in with our advocacy team just so everyone can know what's going on. It's become an annual thing on the podcast, but I mean, just to give listeners a peek behind the screen, I think when we decided that this season was going to be titled United for Change, and this was going to be the theme, I think we reached out to our DC office right away to just say, Hey, this works so seamlessly because our DC team is kind of putting this out there every single day. They're always working with other coalitions, other nonprofits. The work of advocacy is so collaborative in nature. I mean, you're working with the different legislative partners from all parties in the United States, so you kind of can't do advocacy work without a level of collaboration, without a level of partnership.
(01:53)
So it made a lot of sense for us to make sure that our advocacy team got to speak out on everything that's going on in Washington DC and I mean, Paulo has been on the show before, so people who listen will recognize his voice and get to see his face Now since we're on video, but yeah, we're really excited to welcome Paulo to the show to talk about some recent developments wins and opportunities for more growth as we try to enable human flourishing for all of our members and all of our patients and everyone in the us.
Brian Reardon (02:22):
Well, let's bring Paulo into the conversation. Paulo Ponto Mayer. He's CHA, senior Director for Government relations. Paulo, welcome back to the show.
Paulo Pontemayor (02:30):
Hi. Thanks for having me. Very good to see our new setup here with this podcast.
Brian Reardon (02:36):
Pretty slick, huh?
Paulo Pontemayor (02:37):
Yep.
Brian Reardon (02:39):
All right. Well, we're going to, I guess start off with really looking at the most recent legislation. Of course, we go back to the summer of 2025, and we had legislation that wasn't so good for health care in general because of the massive cuts to Medicaid. We'll talk a little bit about Medicaid work requirements in a moment, but let's go to more recent history. There was some appropriations bills passed in January, and there were a lot of actually health care provisions tucked into that legislation. So I think maybe to start with kind of a good news, bad news scenario, I guess you could say with what happened in Congress in late January. Maybe start with what was the not so positive bad news that transpired?
Paulo Pontemayor (03:23):
Sure. Thanks Brian. So yes, the bad news that we have really been taking a while to get our heads around, especially because one of the big policy priorities that CHA has had really for most of last year was the extension of these enhanced premium tax credits or what we like to call the health care tax credits, which actually expired last December, and we really thought that there was some bipartisan movement this year to attach it to the appropriations bill, as you mentioned. But based on really the political realities, the timing, and really the challenges that many people have had with really supporting these enhanced premium tax credits, they still have not been extended and open enrollment actually closed last January, and so not only did these tax credits expire, but the open enrollment period also closed without these essential health care tax credits. So that's pretty sad and bad for our policy priority area, but we do have some good news, as you mentioned, which I'll talk about later.
Brian Reardon (04:36):
Yeah, let's just stick for a moment with the a. A premium tax subsidies. Obviously CHA has always allocated for increased expanded access to care, the Affordable Care Act not perfect, but it did set out to reduce the number of uninsured over the years that's happened. What are the effects of the tax credits, tax subsidies not being extended? What are we talking about in the way of how many people might be affected and what's the impact on the delivery of care in the country?
Paulo Pontemayor (05:08):
Yeah, so as we mentioned last year, the challenges with this is these health care task credits actually lower the cost of individual health care insurance premiums for those who qualify for this additional support. For some folks, this actually would reduce their health insurance premiums by up to 30%, some, depending on where you are with what types of support you get. Because of the federal poverty limit guidelines, some would actually have $0 payments for their health insurance premiums. And so what we're seeing, and based on some of the analysis coming from the Centers for Medicare and Medicaid services, because these health care tax credits have expired, more than a million people actually did not renew their health insurance or based on 2025 open enrollment period pieces, it really was close to the lowest on insurance rate that we've ever had with 24.2 million people selecting marketplace insurance and a large chunk of these getting their health care insurance tax credits supported with 2026.
(06:25)
Based on what they've released, it shows that more than a million people actually did not choose to renew. One of the things that we're watching very closely is while there wasn't a huge dropoff from official estimates, we know that throughout the year as people get their first health insurance bill in the mail and seeing the massive increase in how much they owe, we fear that a lot of people would actually just drop coverage. And so many analysts are looking to see what the consumer behavior will look like from February onwards, and whether or not this actually destabilizes health insurance marketplaces in some areas we're just saddened to see that individuals will be losing their access to affordable health insurance.
Brian Reardon (07:14):
And CHA was part of a coalition Keep America Covered that was really advocating for that. Where do you see that coalition going? Is their work going to shift now and maybe talk a little bit about the United Front that was among a lot of different health care associations and patient advocates that were pushing for these tax subsidies because like you said, the amount of people that were covered and now the amount of people who won't be covered is really significant.
Paulo Pontemayor (07:43):
So CHA was an active member of Keep Americans Covered. As you mentioned. This was really the broad-based coalition made up of health care providers, health insurers, health consumers, disease advocacy groups. It was really a broad swath of people and CHS work, especially to work in coalition to raise these larger health care issues on to that scale was really needed. I think based on a lot of the conversations and really the challenges faced for expanding these health care tax credits, it really did boil down to whether or not these plans would cover abortion. And so a's voice in this and expertise and really work throughout the last 15 years of the Affordable Care Act existence was really needed at the last moment. And so CHA and myself and many of my colleagues were on the hill really talking to some of these lead negotiators both in the Senate and the House, really raising and talking about how the law as is already contains strong protections for any of these plans covering abortion.
(08:52)
And so we provided as much technical assistance. The coalition really leaned on us to be deployed to some of these Republican offices and some of these Democrat offices as well who were negotiating a compromised piece of legislation, which up until last week was still very much live. And so we don't know what the future holds. Knowing that the January 30th deadline with the appropriations bill was another culminating event, I think Congress acts on a lot of culminating events, whether it is a year end bill, the expiration of a program, but because this appropriations bill funds government until September, there really isn't a quote must pass Bill that this must ride on. And based on the challenges of getting any kind of legislation in the Senate, we really are looking to another must pass piece of legislation. So the coalition is regrouping thinking about the strategy for the rest of the year. I think we're looking forward to again being that voice, especially on this issue about abortion coverage and preventing federal funds from funding abortions. And so the political climate calls us to really be that convener and to really help both parties understand current law and what can and should be done with these health care tax credits.
Brian Reardon (10:19):
And as I mentioned, there's some good news. The Congress and the president signed a series of appropriations bills, and I know that there were a lot of health care pieces to that. And so maybe just to start with, can you give us an overview of what some of these health care provisions are that we actually see as a positive development?
Paulo Pontemayor (10:38):
Sure. So we're really pleased to see these health care extenders. We like to use that as shorthand for many of the Medicare and Medicaid pieces that have been longstanding priorities, not only for CHA, but for the health care world in general. The issues around Medicaid, disproportionate share hospital or Medicaid dish, which is something that we have constantly been looking at. Each time Congress looks at them and delays them or cancels them. And so there's actually two years of relief under Medicaid dish in this that we're really pleased to see in the Medicare space. There are these things that are essentially called flexibilities. So telehealth, low volume hospital, Medicare dependent hospitals programs. Those actually got several years in terms of some of these provisions to get extended. And so I can talk about those more at length, but those are pieces that pretty much usually always get extended at the end of the year. So for it to be extended up until September, that actually frees us up for doing a lot more legislation and supporting legislation that CHA is really concerned about. There are also some pieces related to maternal health and of course funding for the Department of Health and Human Services up until September 30th with really no cuts based on what we had been seeing. So that whole department had either been flat funded or has some increases for some pieces and priority areas that CHA is looking at
Brian Reardon (12:24):
And with these extenders, and again, letting waivers continue. I know they used to use the saying that Congress likes to kick the can down the road and we'll do these sort of one year patchwork on a lot of these different policies and legislation, but I would imagine this provides a little bit more predictability for those delivering health care to know that some of this funding, it's not just going to expire in another year and you're going to have to go back to Capitol Hill and continue this sort of process every year of asking for these to be extended. So that is a positive, right? There's the more predictability around the financing that's coming.
Paulo Pontemayor (13:01):
Yes. And with the issue of acute hospital care at home, that actually has been extended for five years up until 2030. And so we have reprieve for five years not to go back to Capitol Hill and ask for that. Sadly, there's one, the Medicare Dependent Hospital and low volume hospital adjustments that have only been extended for a year. And so that's something that we'll probably have to go to Congress on. But the largest piece, and something that has been such a priority for CHA for a long time is the Medicaid disproportionate share hospital piece, which essentially don't come back into effect until fiscal year 2028. So we have two years there. And so again, Congress has set itself up for several more deadlines. And so in terms of the health care space, we're taken care of one place that we're closely watching, and something that was raised to us by really the larger Catholic world was funding for the Department of Homeland Security.
(13:59)
And so because of many of the incidents that happened in Minneapolis and really the challenges and unfortunate events there, that there was a challenge to actually pass the labor HHS, labor Health and Human Services education bill out because they were all packaged together. And so Congress in their negotiations were actually able to take out a lot of those HHS funding pieces, including the health care extenders. And so DHS is really the only agency not funded for the rest of the year. And I think the Catholic response has always been for us to have an immigration enforcement policy and immigration policy that was really based on human dignity. And so CHA being able to also share that message and carry that message to members of Congress was a very powerful thing because we also cared about the health and human Services pieces, but we also care about immigration as well.
Brian Reardon (15:00):
And actually, we've got a podcast coming up. I think it's going to be the next one where we're going to talk to the Conference of Bishops about their program. So more to come on that. But real quick, sticking with Homeland Security, I think one area that we've been concerned about is protected status. That was a change about a year ago, and we want to make sure that, I'm guessing that is one area that will be a pushing for advocating for to return protected status into the immigration enforcement.
Paulo Pontemayor (15:30):
Yes, and that's an issue that I think Congress is ripe to address. And so based on really what Congress would like to do and some of the negotiations happening here in Washington dc, we don't think protected status is going to be an issue that ties up the Department of Homeland Security bill, but there are pieces of legislation floating out there and also engagement from Congress to encourage this administration to uphold protected status, especially in health care settings.
Brian Reardon (16:03):
Looking ahead to the rest of the year, we're here in February, so quite a bit left in the calendar year for legislation. I know I mentioned the bill that was passed in July that cut Medicaid. Part of that is around work requirements. So I imagine that's an area of focus for us in the coming months, is to help our members and others really understand how these work requirements are going to be put into effect. Can you talk a little bit about that, and maybe it's in the way of a preview and any other issues out there that we're going to be focused on here in the months ahead?
Paulo Pontemayor (16:35):
Sure. So thanks again for really asking about the Medicaid community engagement slash work requirements. And so as part of our continuing evolution of Medicaid makes it possible, our resources for this year are going to be focused on how our members, the advocates, the Catholic health community and Catholic community in general, can really capitalize on working with their state health officials as well as the Centers for Medicare and Medicaid services to craft requirements and policies that prevent coverage loss. And so we have worked very closely again with our leadership in the partnership for Medicaid, which the Catholic Health Association is the chair of this year, to actually talk to senior leaders at the Centers for Medicare and Medicaid services earlier last month to raise some issues that the provider community, the plan world really have raised around how do we prevent and mitigate large scale coverage loss.
(17:38)
When we looked at work requirements back that were actually in effect, we like to think of the Arkansas experience, which in 2018 imposed new work requirements for certain populations in Medicaid. And what happened was 18,000 people lost coverage, and a lot of that was based on paperwork issues, confusion around what the requirements were. And so we want to prevent that from happening in this sense, especially now that we have these new nationwide mandatory requirements in effect. And so we're working to develop policy papers that our members can use to engage with their state health official or their Medicaid director. We also know that continued engagement with the Centers for Medicare and Medicaid services around their rulemaking, which they have to come up with an interim final rule at the middle of this year, so around June or July. We're hoping to see that language of what states can be doing to implement these because these actually all come into effect in less than a year. January 1st, 2027 is when they come on live. December 31st, 2026 is when states need to be ready. So we're in February now. I think that it is a large challenge, especially to stand something up very quickly in less than a year. And so continuous engagement with the administration with state health officials because Medicaid is a state federal run program is what we're going to be developing with our work.
Brian Reardon (19:15):
Definitely. Yeah. And it's about ensuring that as many people have access to health care as possible. Josh, you've been listening in on the conversation As we wrap things up, anything you want to ask or add?
Josh Matejka (19:27):
Yeah, Brian. Paulo, thanks. It's always good to get an update. I know we have these a lot internally, but it's good I think for everybody to hear all the good great work that's happening out in Washington DC. One thing I'm acutely aware of, and I'm sure a lot of people are, is that 2026 is an election year. We're coming up on the midterm elections, and so as you've said on the show before election years can kind of slow down the legislative processes in Washington DC a lot of our representatives are really focused on either winning elections or supporting their colleagues in winning elections. And so as we look toward this year and all of the critical things that are happening that you just talked about, how do folks who are listening be they members or individuals, continue to collaborate and partner with us and maybe with their communities to enact the change that we're working to see in our health care system and in the country as a whole?
Paulo Pontemayor (20:23):
That's a really good question. As you are aware, election years are what we like to call in DC silly season because once a certain threshold of legislating is done, everyone pivots to going back to their districts to run for reelection, and 2026 is no different. We are seeing that health care continues to be a very, very popular, very important issue for not just our members, obviously, because we are in that world, but for voters at large. And so I really would welcome listeners to go to our advocacy resources. We have what's known as advocacy alerts, and these are our very dynamic, very nimble ways of talking about what's moving in Congress. We don't have a crystal ball to see what Congress will come up with. There's always this idea that when a health care issue comes up, messaging bills pop up here and there, and we like to think of messaging bills as ways to essentially frame an issue just so that it's ready for election year coverage.
(21:35)
And so we will take positions on larger long-term care issues like palliative care is always going to be one that we really hope Congress acts on this year. We're also looking at ways that we can strengthen caring for the elderly or aging population, which always never gets the front and center attention that it truly deserves. And so I welcome our listeners and hope that they visit our website to see our action alerts where we're paying very close attention to what Congress does. There might be a bill that no one has paid attention to that we would like listeners to weigh in on. And it's really easy, a lot of the times you just put in your zip code and depending on what state you are, sometimes a little bit of your address because of congressional districts, and it pops up a form letter that you can send.
(22:26)
It also gives you a sense of where your members stand on certain issues because our resources are tailored in a way to show whether or not a member has co-sponsored or sponsored a piece of legislation. And so we're hoping that people will look at that. We also have some advocacy days coming up and hoping that that is something that our listeners can put on their calendars, whether or not they can come to DC a lot of the time, you can engage with your members of Congress in their district offices. One big piece that we do every year is our partnership with the March of Dimes on issues related to infant child and maternal health. And we are again, partnering with them for what's known as March for Change, which is in March, a whole set of advocacy at the local and federal level on pieces of legislation or congressional action or executive action that really uplifts care for moms and babies. And so we're hoping please look at our advocacy resources for resources on how to be part of that.
Brian Reardon (23:33):
Well, Paulo, as Josh said, it's always good to hear from you, appreciate you providing updates, and again, appreciate the work you and the team in DC do to advocate for positions that we feel strongly about that really are important to Catholic health care in the us. So again, thanks for your efforts. Keep up the good work, and it is always good to chat with you.
Paulo Pontemayor (23:52):
Always a pleasure. So happy whenever you guys invite me on. So if there's any other issue, please let me know how I can be helpful.
Brian Reardon (23:59):
We know how to find you. Again, that was Paul Pontemayor. He's the Senior Director for Government Relations for CHA. I'm your host, Brian Reardon, our executive producer Josh Matejka. Our scheduling producer is Sarah Marchant. Health Calls is engineered and produced at Once Films in St. Louis, Missouri, and you can access all the episodes of Health Calls at the CHA website, which is chausa.org. Just go to the news and publications tab at the top. And as Paulo mentioned, we've got a lot of resources under advocacy, and we've got a dedicated advocacy tab at the top of the homepage. Again, chha usa.org. You can also access Health Calls on all of your favorite streaming services. When you do so, be sure to give us a rating. We'd love to hear from you. We'd love to get your feedback. And as always, thanks for listening.