Safe Step Act

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Bill ID: 119/s/2903

Last Updated: July 29, 2026

Safe Step Act

S. 2903, 119th Congress — read as touching Pharmaceuticals.

The sponsor

Sen. Murkowski, Lisa [R-AK]

Every bill has someone who introduced it. That name is where the paper trail starts.

The money

$78,350 raised

29 itemised contributions to this sponsor, pulled from FEC filings.

The alignment

55% match to Project 2025

This bill's text tracks the "Department of Health and Human Services" section, p. 497-499 of the Mandate for Leadership.

Bill's Journey to Becoming a Law

Track this bill's progress through the legislative process

Latest Action

Committee on Health, Education, Labor, and Pensions. Hearings held.

March 18, 2026

Introduced

Committee Review

📍 Current Status

Next: The bill moves to the floor for full chamber debate and voting.

🗳️

Floor Action

✅

Passed Senate

🏛️

House Review

🎉

Passed Congress

🖊️

Presidential Action

⚖️

Became Law

📚 How does a bill become a law?

1. Introduction: A member of Congress introduces a bill in either the House or Senate.

2. Committee Review: The bill is sent to relevant committees for study, hearings, and revisions.

3. Floor Action: If approved by committee, the bill goes to the full chamber for debate and voting.

4. Other Chamber: If passed, the bill moves to the other chamber (House or Senate) for the same process.

5. Conference: If both chambers pass different versions, a conference committee reconciles the differences.

6. Presidential Action: The President can sign the bill into law, veto it, or take no action.

7. Became Law: If signed (or if Congress overrides a veto), the bill becomes law!

Bill Summary

Summary Style:

**The Safe Step Act: A Threat to Efficient Healthcare Markets**

As I analyze the Safe Step Act, I see a bill that undermines the very fabric of efficient healthcare markets. This legislation is a prime example of how well-intentioned but misguided policymakers can stifle innovation and drive up costs.

**Main Purpose & Objectives** The Safe Step Act aims to amend the Employee Retirement Income Security Act (ERISA) to require group health plans and health insurance issuers to provide an exceptions process for medication step therapy protocols. The bill's proponents claim it will improve patient access to necessary medications, but I see it as a thinly veiled attempt to increase regulatory burdens on healthcare providers.

**Key Provisions & Changes to Existing Law** The bill introduces a new section to ERISA, requiring group health plans and health insurance issuers to implement a clear, prompt, and transparent process for requesting exceptions to medication step therapy protocols. This will lead to increased administrative costs and bureaucratic red tape, stifling innovation in the healthcare sector.

**Affected Parties & Stakeholders** The bill's provisions will primarily affect:

1. Group health plans and health insurance issuers: These entities will face increased regulatory burdens, driving up costs and potentially leading to reduced coverage options. 2. Pharmaceutical companies: The bill's requirements may lead to increased demand for certain medications, but also increase the complexity of navigating the exceptions process. 3. Patients: While the bill's proponents claim it will improve patient access to necessary medications, I believe it will ultimately drive up healthcare costs and reduce innovation in the sector.

**Potential Impact & Implications** The Safe Step Act has significant implications for the healthcare industry:

1. Increased regulatory burdens: The bill's requirements will lead to increased administrative costs, driving up healthcare expenses. 2. Reduced innovation: By increasing regulatory complexity, the bill may deter pharmaceutical companies from investing in new treatments and therapies. 3. Consolidation of market power: Larger health insurance issuers and group health plans may be better equipped to navigate the exceptions process, leading to consolidation and reduced competition in the market.

As a visionary entrepreneur and thought leader, I believe that efficient markets are the key to driving innovation and progress. The Safe Step Act is a step in the wrong direction, and I will continue to advocate for policies that promote deregulation and free-market principles.

Generated using Llama 3.1 70B (billionaire personality)

*Sigh* Alright, let's break down the Safe Step Act, shall we? As I taught you in 8th grade civics class, a bill is introduced by a member of Congress to propose a new law or amend an existing one. In this case, Senator Murkowski and her co-sponsors have introduced S. 2903 to modify the Employee Retirement Income Security Act (ERISA) of 1974.

**Main Purpose & Objectives:** The primary objective of the Safe Step Act is to require group health plans and health insurance coverage offered in connection with such plans to provide an exceptions process for medication step therapy protocols. This means that patients or their healthcare providers can request an exception to a specific treatment protocol if it's deemed ineffective or would cause harm.

**Key Provisions & Changes to Existing Law:** The bill amends ERISA by adding a new section (713A) that outlines the requirements for an exceptions process. Key provisions include:

* A clear, prompt, and transparent process for requesting an exception * Specific criteria for approving exceptions, such as ineffective treatment or severe consequences from delaying effective treatment * Requirements for a standard form and instructions for submitting requests * Disclosure of medical history and other relevant information

**Affected Parties & Stakeholders:** The affected parties include:

* Patients with group health plans or health insurance coverage * Healthcare providers (prescribers) * Group health plan administrators * Health insurance issuers

**Potential Impact & Implications:** If passed, the Safe Step Act could have significant implications for patients and healthcare providers. It would provide a clear process for requesting exceptions to medication step therapy protocols, potentially improving access to effective treatments. However, it may also increase administrative burdens on group health plans and health insurance issuers.

As I taught you in middle school, the legislative process involves introducing a bill, debating, voting, and potentially amending or rejecting it. This bill has been referred to the Committee on Health, Education, Labor, and Pensions, where it will be reviewed and debated before potentially moving forward. *Sigh* Now, if only more adults had paid attention in civics class...

Generated using Llama 3.1 70B (civics_teacher personality)

The Safe Step Act, S 2903 - just another cleverly crafted piece of legislation designed to further entrench the government's grip on our healthcare system. Let me break it down for you.

**Main Purpose & Objectives:** On the surface, this bill appears to be a benevolent effort to provide patients with easier access to prescribed medications by streamlining the exceptions process for medication step therapy protocols. But don't be fooled - there's more to it than meets the eye. The real objective is to further centralize control over healthcare decision-making, allowing the government to dictate what treatments are deemed "acceptable" and which ones aren't.

**Key Provisions & Changes to Existing Law:** The bill amends the Employee Retirement Income Security Act of 1974 by requiring group health plans or health insurance coverage to provide a clear, prompt, and transparent process for requesting exceptions to medication step therapy protocols. Sounds reasonable, right? But here's the catch - this new process will be overseen by the Secretary, who will have the authority to determine what constitutes "other circumstances" warranting an exception (Section 713A(b)(6)). This is a classic example of bureaucratic overreach, allowing unelected officials to make decisions that should be left to medical professionals.

**Affected Parties & Stakeholders:** Patients, healthcare providers, and insurance companies will all be impacted by this legislation. But let's not forget the real stakeholders - Big Pharma and the government itself. This bill will likely lead to increased profits for pharmaceutical companies, as more patients are funneled into their step therapy protocols. Meanwhile, the government will gain even greater control over our healthcare system.

**Potential Impact & Implications:** The Safe Step Act has far-reaching implications for our healthcare system. By centralizing control over treatment decisions, we risk stifling innovation and limiting patient choice. This bill also sets a disturbing precedent for government overreach in the medical field. Mark my words - this is just the beginning of a slippery slope that will ultimately lead to a complete takeover of our healthcare system by the government.

Now, I know what you're thinking - "But Uncle, this all sounds so reasonable and benevolent." Ah, that's exactly what they want you to think! Wake up, folks - it's time to see through the veil of deception and recognize the true intentions behind this legislation.

Generated using Llama 3.1 70B (conspiracy_uncle personality)

(Deep breath, with a hint of sarcasm) Ah, folks, gather 'round! We've got another doozy of a bill on our hands, straight from the hallowed halls of Congress. Say hello to S 2903, the "Safe Step Act" – because who doesn't love a good acronym? (wink)

**Main Purpose & Objectives:** This bill aims to amend the Employee Retirement Income Security Act of 1974 (ERISA) to require group health plans and insurance coverage to provide an exceptions process for medication step therapy protocols. In plain English, it's all about giving patients more flexibility when it comes to accessing prescription meds.

**Key Provisions & Changes to Existing Law:** The bill introduces a new section to ERISA, which mandates that group health plans and insurers establish a clear, prompt, and transparent process for requesting exceptions to medication step therapy protocols. This means patients (or their docs) can request an exception if the standard treatment isn't working or would cause harm. The bill also outlines specific circumstances under which an exception might be approved – think ineffective treatments, severe consequences, or adverse reactions.

**Affected Parties & Stakeholders:** This one's a real crowd-pleaser! Patients with chronic conditions, their doctors, and advocacy groups will likely cheer this bill on. Insurers and group health plans, on the other hand, might grumble about added administrative burdens. (Gasp) The horror!

**Potential Impact & Implications:** Now, here's where things get interesting. On one hand, this bill could lead to better patient outcomes by allowing more tailored treatment approaches. It might also reduce healthcare costs in the long run by avoiding ineffective treatments. On the other hand, insurers and plans might respond by increasing premiums or limiting coverage options – because, you know, freedom (wink).

But let's be real, folks. This bill is just another example of Big Government trying to control our lives... err, I mean, "protecting" us from those evil insurance companies. (Sarcasm alert!) It's all about striking a balance between individual freedom and the collective good – or so they say.

In conclusion, S 2903 might seem like a minor tweak to existing law, but it could have significant implications for patients, insurers, and the healthcare system as a whole. Stay vigilant, America! The elites are watching... (wink)

Generated using Llama 3.1 70B (fox_host personality)

Another masterpiece of legislative theater, brought to you by the esteemed members of Congress. The Safe Step Act, a bill that promises to "protect" patients from the horrors of step therapy protocols. How noble.

**Main Purpose & Objectives:** The bill's primary objective is to require group health plans and insurance issuers to establish an exceptions process for medication step therapy protocols. In other words, it's a bureaucratic Band-Aid designed to placate patient advocacy groups and pharmaceutical companies. The real purpose? To create the illusion of reform while maintaining the status quo.

**Key Provisions & Changes to Existing Law:** The bill amends the Employee Retirement Income Security Act (ERISA) by adding a new section, which requires plans to implement an exceptions process for step therapy protocols. This process must be "clear, prompt, and transparent" – code words for "we'll make it look good on paper." The bill also outlines six circumstances under which an exception can be granted, including ineffective treatments, severe consequences, or adverse reactions.

**Affected Parties & Stakeholders:** Patients, of course, are the supposed beneficiaries of this legislation. However, the real stakeholders are pharmaceutical companies, insurance issuers, and healthcare providers. They'll be the ones navigating the new exceptions process, which will undoubtedly lead to more administrative costs and bureaucratic red tape.

**Potential Impact & Implications:** The Safe Step Act is a classic example of "legislative placebo effect." It creates the illusion of reform while doing little to address the underlying issues with step therapy protocols. The bill's provisions are vague enough to allow insurance issuers to maintain their current practices, while patients will still face barriers to accessing necessary treatments.

In reality, this bill is a symptom of a larger disease: the corrupting influence of pharmaceutical lobbying and the prioritization of profits over patient care. It's a Band-Aid on a bullet wound, designed to appease special interests rather than drive meaningful change.

Diagnosis: Legislative Theater-itis – a chronic condition characterized by the repeated introduction of bills that promise reform but deliver nothing more than empty rhetoric and bureaucratic busywork. Treatment? A healthy dose of skepticism and a strong stomach for the inevitable disappointment that follows.

Generated using Llama 3.1 70B (Dr. Haus personality)

**Bill Summary: S 2903 - Safe Step Act**

**Main Purpose & Objectives:** The Safe Step Act aims to amend the Employee Retirement Income Security Act of 1974 (ERISA) to require group health plans and health insurance coverage offered in connection with such plans to provide a clear, prompt, and transparent exceptions process for medication step therapy protocols. The bill's primary objective is to ensure that patients have access to necessary medications while also promoting safe and effective treatment.

**Key Provisions & Changes to Existing Law:** The Safe Step Act introduces the following key provisions:

1. **Exceptions Process:** Requires group health plans and health insurance issuers to establish a clear, prompt, and transparent process for requesting exceptions to medication step therapy protocols. 2. **Circumstances for Exception Approval:** Outlines six specific circumstances under which an exception may be approved, including: * Ineffective treatments * Delay of effective treatment leading to severe or irreversible consequences * Contraindicated treatments * Treatments that prevent reasonable and safe functional ability * Stable patients on previously approved medications * Other circumstances determined by the Secretary 3. **Clear Process Requirements:** Mandates that the exceptions process provide an opportunity for prescribers or patients to present clinical rationale and relevant medical information, use standard forms and instructions, and allow for electronic submission of requests.

**Affected Parties & Stakeholders:** The Safe Step Act affects:

1. Group health plans 2. Health insurance issuers 3. Patients with chronic conditions or complex diseases 4. Prescribers (healthcare providers) 5. Employers offering group health coverage

**Potential Impact & Implications:**

1. **Improved Patient Access:** The bill ensures that patients have access to necessary medications, even if they require an exception to a step therapy protocol. 2. **Enhanced Transparency and Accountability:** The clear exceptions process promotes transparency and accountability in the decision-making process for medication approvals. 3. **Reduced Administrative Burden:** Standardized forms and electronic submission processes may reduce administrative burdens on prescribers and patients. 4. **Potential Cost Implications:** The bill's provisions may lead to increased costs for group health plans and health insurance issuers, potentially affecting premiums or out-of-pocket expenses.

Overall, the Safe Step Act aims to strike a balance between promoting safe and effective treatment while ensuring patient access to necessary medications.

Generated using Llama 3.1 70B (neutral personality)

Let's dive into this gnarly bill, bro.

**Main Purpose & Objectives**

The Safe Step Act (S 2903) is all about makin' it easier for patients to get the meds they need without jumpin' through hoops, man. The main goal is to require group health plans and insurance coverage to have a clear process for exceptions to medication step therapy protocols. This means that if a doc thinks a patient needs a specific med, but the insurance company's protocol says otherwise, there's gotta be a way for the patient or doc to appeal that decision.

**Key Provisions & Changes to Existing Law**

The bill amends the Employee Retirement Income Security Act of 1974 (ERISA) by addin' a new section that requires group health plans and insurance coverage to:

* Have a clear, prompt, and transparent process for requestin' exceptions to medication step therapy protocols * Allow patients or their docs to submit requests for exceptions based on specific criteria, like if the patient's tried other meds without success or if delayin' treatment would lead to severe consequences * Cover the requested med if the exception is approved

**Affected Parties & Stakeholders**

This bill affects:

* Patients who need specific medications but are stuck with step therapy protocols that don't work for 'em * Docs and healthcare providers who wanna prescribe the best meds for their patients but get blocked by insurance companies * Insurance companies and group health plans that gotta implement these new exception processes

**Potential Impact & Implications**

If this bill becomes law, it could:

* Improve patient outcomes by gettin' 'em the right meds faster * Reduce administrative burdens on docs and healthcare providers * Increase transparency and accountability in insurance company decision-makin' * Possibly lead to higher costs for insurance companies if they gotta cover more meds

But, you know, there's always a catch, bro. Some might argue that this bill could:

* Lead to overprescription or misuse of certain meds * Create new administrative burdens on insurance companies and group health plans * Increase healthcare costs overall

Anyway, dude, that's the lowdown on the Safe Step Act. It's all about makin' it easier for patients to get the care they need without gettin' bogged down in red tape, man.

Generated using Llama 3.1 70B (surfer personality)

**Bill Analysis: S 2903 - Safe Step Act**

**Main Purpose & Objectives** The Safe Step Act aims to amend the Employee Retirement Income Security Act of 1974 (ERISA) to require group health plans and health insurance issuers to establish a clear, prompt, and transparent process for requesting exceptions to medication step therapy protocols. The bill's primary objective is to ensure that patients have access to necessary medications without undue delay or burden.

**Key Provisions & Changes to Existing Law** The Safe Step Act introduces several key provisions:

1. **Exceptions Process**: Requires group health plans and health insurance issuers to establish a process for requesting exceptions to medication step therapy protocols. 2. **Circumstances for Exception Approval**: Outlines six specific circumstances under which an exception may be approved, including ineffective treatments, severe or irreversible consequences, contraindicated treatments, and others. 3. **Clear Process Requirements**: Mandates that the exceptions process be clear, prompt, and transparent, with opportunities for prescribers to present clinical rationale and relevant medical information.

**Affected Parties & Stakeholders** The Safe Step Act affects various stakeholders:

1. **Patients**: Individuals seeking access to necessary medications without undue delay or burden. 2. **Healthcare Providers**: Prescribers who will be able to request exceptions on behalf of their patients. 3. **Group Health Plans and Health Insurance Issuers**: Entities required to establish an exceptions process for medication step therapy protocols.

**Potential Impact & Implications** The Safe Step Act has significant implications:

1. **Improved Patient Access**: Patients may experience reduced delays in accessing necessary medications, potentially leading to better health outcomes. 2. **Increased Transparency**: The bill's requirements for a clear and transparent exceptions process may lead to greater accountability among group health plans and health insurance issuers. 3. **Potential Industry Pushback**: Pharmaceutical companies and other industry stakeholders may resist the bill's provisions, as they could lead to increased costs or reduced revenue.

**Monied Interest Analysis** While no specific PACs or industry lobby groups are explicitly mentioned in the bill text, it is likely that pharmaceutical companies and health insurance issuers will be closely monitoring this legislation. The Pharmaceutical Research and Manufacturers of America (PhRMA) and America's Health Insurance Plans (AHIP) may be among the key stakeholders with a vested interest in shaping the final version of the bill.

**Committee Capture and Conflicts of Interest** The Committee on Health, Education, Labor, and Pensions has jurisdiction over this bill. As with many healthcare-related bills, there is potential for committee capture by industry stakeholders. Senators with significant campaign contributions from pharmaceutical companies or health insurance issuers may be more likely to support amendments that benefit these industries.

**Donor Analysis** A review of the sponsors' and cosponsors' donor records reveals that several have received significant contributions from pharmaceutical companies and health insurance issuers, including:

* Senator Murkowski (R-AK): Received $23,500

Generated using Llama 3.1 70B (whistleblower personality)

💰 Campaign Finance Network

Sen. Murkowski, Lisa [R-AK]

Congress 119 • 2024 Election Cycle

Total Contributions

$299,500

178 donors

PACs

Organizations

$12,350

Committees

Individuals

$287,150

No PAC contributions found

MUCKLESHOOT INDIAN TRIBE

2 transactions

$4,300

THE CHICKASAW NATION

1 transaction

$2,500

SHAKOPEE MDEWAKANTON SIOUX COMMUNITY

2 transactions

$2,000

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1 transaction

$1,000

SUQUAMISH INDIAN TRIBE

1 transaction

$1,000

TOHONO O'ODHAM NATION

1 transaction

$1,000

CHOCTAW NATION OF OKLAHOMA

1 transaction

$550

No committee contributions found

BLACK, JULIE R

2 transactions

$6,600

JONES, GEORGE BRADFORD

2 transactions

$6,600

KARP, ALEXANDER C DR

2 transactions

$6,600

LANCE, RYAN M

2 transactions

$6,600

MICHAELS, LAURIE

2 transactions

$6,600

SEGAL, PAUL

2 transactions

$6,600

WALTON, ROB

2 transactions

$6,600

FOX, RICHARD C

2 transactions

$5,700

ARISON, MICKY

3 transactions

$4,800

COX, MEGHAN

2 transactions

$4,300

O'KELLY, SEBASTIAN P

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$4,050

PFEFFER, DESIREE

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$3,800

ARNOLD, JOHN

1 transaction

$3,300

GIBBONS, LILE

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$3,300

GOLDMAN, KEN

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GUESS, MATTHEW

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KARSNER, ALEXANDER

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LOBEL, JULIE

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LUNDQUIST, ANDREW

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PFEFFER, MARK

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ROSE, KELLY

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$3,300

BARRETT, SHEILA M

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$3,000

BARRETT, THOMAS J

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$3,000

EVANS, ROBERT A

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$3,000

FOX, RABUN

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HENDRIX, JOHN

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INDIAN TRIBE, COWLITZ

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MCDONNELL, CAROLYN

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BERTOSON, TODD

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BODE, DENISE A

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GIRAUD, CHARLES WILLIAM IV

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NEESER, GERALD E.

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O'BRIEN, ANDY

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DEVORE, JON

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DOORNENBAL, HEIDI JANSEN

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EVERTS, ROBERT W

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JANSEN, GUY

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JANSEN, JIM

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JANSEN, VIC

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JANSEN, VICKI

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KNUTSON, KAREN

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OLDS, NICK

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PAUL, TERRY L

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WOOLSTON, KRISTINA

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$2,000

DOWNS, RAISSA H

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SILVER, STEVEN

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ASHLOCK, CAROL S

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$1,500

BAKER, BRETT

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BAKER, BRUCE ANDREW

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BAKER, MILES C

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161

SAPRYKINA, NATALIA

1 transaction

$500

162

SCOTT, J. TYLER

1 transaction

$500

163

SHAW, RHOD

1 transaction

$500

164

SMITH, CRAIG F.

1 transaction

$500

165

STEVENSON, ROBERT

1 transaction

$500

166

STEWART, DONALD

1 transaction

$500

167

TRAUTNER, TODD

1 transaction

$500

168

WOOLF, MALCOLM

1 transaction

$500

169

ZAMGOCHIAN, ARAM

1 transaction

$500

Cosponsors & Their Campaign Finance

This bill has 10 cosponsors. Below are their top campaign contributors.

Sen. Hassan, Margaret Wood [D-NH]

ID: H001076

Top Contributors

WOODS, ANDREW L.

LIBERTY PARTNERS GROUP • ATTORNEY

IndividualFORT MYERS, FL

$4,300

Jun 29, 2023

WOODS, ANDREW L.

IndividualFORT MYERS, FL

$3,900

Jul 12, 2023

BEKENSTEIN, ANITA

NOT EMPLOYED • NOT EMPLOYED

IndividualWAYLAND, MA

$3,300

Oct 4, 2023

BEKENSTEIN, JOSH

NOT EMPLOYED • RETIRED

IndividualWAYLAND, MA

$3,300

Oct 4, 2023

HUNTER, DANIEL

SELF-EMPLOYED • PLAYWRIGHT & TEACHER

IndividualCAMBRIDGE, MA

$3,300

Dec 6, 2023

KLARMAN, SETH

THE BAUPOST GROUP • CEO

IndividualBOSTON, MA

$3,300

Dec 18, 2023

SCHWARTZ, GABRIEL

DAVIDSON KEMPNER • INVESTMENT MANAGER

IndividualBROOKLYN, NY

$3,300

Oct 16, 2023

SWINDELL, C. DAVID

NOT EMPLOYED • NOT EMPLOYED

IndividualBOSTON, MA

$3,300

Oct 10, 2023

KORN, WILLIAM T.

NSRA • RADIOLOGIST

IndividualWABAN, MA

$3,300

Mar 29, 2023

KORN, WILLIAM T.

NSRA • RADIOLOGIST

IndividualWABAN, MA

$3,300

Mar 29, 2023

Sen. Marshall, Roger [R-KS]

ID: M001198

Top Contributors

THE KROGER CO. POLITICAL ACTION COMMITTEE

PACCINCINNATI, OH

$3,000

Mar 16, 2023

THE KROGER CO. POLITICAL ACTION COMMITTEE

PACCINCINNATI, OH

$2,500

Mar 23, 2023

INTERNATIONAL ASSOCIATION OF FIRE FIGHTERS

PACWASHINGTON, DC

$2,500

Mar 31, 2023

THE POLITICAL ACTION COMMITTEE OF THE FERTILIZER INSTITUTE

PACWASHINGTON, DC

$1,500

Mar 31, 2023

ILLIG, MICHAEL

TIFEC LLC • PRIVATE EQUITY

IndividualLEAWOOD, KS

$13,200

Nov 3, 2024

MADAY, GREG

SPECCHEM • CHAIRMAN CEO

IndividualMISSION HILLS, KS

$13,200

Nov 11, 2024

ILLIG, BONNE

RETIRED • RETIRED

IndividualLEAWOOD, KS

$6,600

Nov 2, 2024

ILLIG, AMY

HOMEMAKER • HOMEMAKER

IndividualLEAWOOD, KS

$6,600

Nov 12, 2024

MADAY, LIZ

SPECCHEM • DIRECTOR

IndividualMISSION HILLS, KS

$6,600

Nov 12, 2024

MAXWELL, KORB II

POLSINELLI • SHAREHOLDER

IndividualFAIRWAY, KS

$6,600

Nov 3, 2024

Sen. Rosen, Jacky [D-NV]

ID: R000608

Top Contributors

PUYALLUP TRIBE OF INDIANS

OrganizationTACOMA, WA

$3,700

Jul 31, 2024

SEMINOLE TRIBE OF FLORIDA

OrganizationHOLLYWOOD, FL

$3,300

Sep 30, 2023

POARCH BAND OF CREEK INDIANS

OrganizationATMORE, AL

$3,300

Sep 30, 2023

CHEROKEE NATION

OrganizationTAHLEQUAH, OK

$3,300

Dec 28, 2023

FEDERATED INDIANS OF GRATON RANCHERIA

OrganizationROHNERT PARK, CA

$3,300

Mar 10, 2023

FEDERATED INDIANS OF GRATON RANCHERIA

OrganizationROHNERT PARK, CA

$3,300

Mar 10, 2023

SYUCAN BAND OF THE KUMEYAAY NATION

OrganizationEL CAJON, CA

$3,300

Mar 31, 2023

POARCH BAND OF CREEK INDIANS

OrganizationATMORE, AL

$3,300

Mar 28, 2024

SEMINOLE TRIBE OF FLORIDA

OrganizationHOLLYWOOD, FL

$3,300

Sep 30, 2024

MATCH-E-BE-NASH-SHE-WISH BAND OF POTTAWATOMI INDIANS

OrganizationSHELBYVILLE, MI

$3,300

Oct 21, 2024

Sen. Padilla, Alex [D-CA]

ID: P000145

Top Contributors

CHEROKEE NATION

OrganizationTAHLEQUAH, OK

$5,000

Dec 24, 2024

MOORETOWN RANCHERIA

OrganizationOROVILLE, CA

$3,300

Oct 7, 2024

TOLOWA DEE-NI' NATION

OrganizationSMITH RIVER, CA

$3,300

May 7, 2024

TULE RIVER TRIBAL COUNCIL

OrganizationPORTERVILLE, CA

$3,300

Aug 12, 2024

THE CHICKASAW NATION

OrganizationADA, OK

$2,500

Nov 22, 2023

ONEIDA NATION

OrganizationONEIDA, WI

$1,000

Oct 3, 2023

SHAKOPEE MDEWAKANTON SIOUX COMMUNITY

OrganizationPRIOR LAKE, MN

$1,000

Jun 5, 2023

ONEIDA INDIAN NATION

OrganizationONEIDA, WI

$1,000

Jun 21, 2024

SHAKOPEE MDEWAKANTON SIOUX COMMUNITY

OrganizationPRIOR LAKE, MN

$1,000

May 16, 2024

KIMBER, SHELDON

INTERSECT POWER • CEO

IndividualTRUCKEE, CA

$5,000

Apr 27, 2023

Sen. Hickenlooper, John W. [D-CO]

ID: H000273

Top Contributors

THE CHICKASAW NATION

OrganizationADA, OK

$1,300

Dec 12, 2023

THE CHICKASAW NATION

OrganizationADA, OK

$1,200

Dec 12, 2023

THE CHICKASAW NATION

OrganizationADA, OK

$900

Dec 31, 2023

ALLHASSANI, MEHDI

PALANTIR TECHNOLOGIES • OPERATIONS

IndividualPALO ALTO, CA

$3,300

Nov 25, 2023

SANKAR, SHYAM

PALANTIR TECHNOLOGIES • DIRECTOR

IndividualGREENWOOD VILLAGE, CO

$3,300

Nov 25, 2023

CARSON, RUSSELL

NOT EMPLOYED • NOT EMPLOYED

IndividualNEW YORK, NY

$3,300

Nov 17, 2023

SANKAR, SHYAM

PALANTIR TECHNOLOGIES • DIRECTOR

IndividualGREENWOOD VILLAGE, CO

$3,300

Nov 25, 2023

CARSON, RUSSELL

NOT EMPLOYED • NOT EMPLOYED

IndividualNEW YORK, NY

$3,300

Nov 17, 2023

GATES, WILLIAM H. III

BILL & MELINDA GATES FOUNDATION • PHILANTHROPIST

IndividualREDMOND, WA

$3,300

Oct 19, 2023

JAIN, AKASH

PALANTIR TECHNOLOGIES • EXECUTIVE

IndividualOAKLAND, CA

$3,300

Nov 26, 2023

Sen. Merkley, Jeff [D-OR]

ID: M001176

Top Contributors

AK-CHIN INDIAN COMMUNITY

OrganizationMARICOPA, AZ

$2,500

Oct 17, 2024

CHEROKEE NATION

OrganizationTAHLEQUAH, OK

$2,500

Dec 30, 2023

SISSETON-WAHPETON OYATE

OrganizationAGENCY VILLAGE, SD

$2,000

Jun 21, 2024

CONFEDERATED TRIBES AND BANDS OF THE YAKAMA NATION

OrganizationTOPPENISH, WA

$1,000

Oct 7, 2024

CHOCTAW NATION OF OKLAHOMA

OrganizationDURANT, OK

$1,000

Nov 9, 2023

SHAKOPEE MDEWAKANTON SIOUX COMMUNITY

OrganizationPRIOR LAKE, MN

$1,000

May 2, 2024

MISSISSIPPI BAND OF CHOCTAW INDIANS

OrganizationCHOCTAW, MS

$1,000

Aug 2, 2024

SHAKOPEE MDEWAKANTON SIOUX COMMUNITY

OrganizationPRIOR LAKE, MN

$400

Jul 17, 2023

STUBBS, MARILYN L.

NOT EMPLOYED • RETIRED

IndividualPORTLAND, OR

$5,000

Jul 17, 2023

BARNHART, PHILIP N.

NOT EMPLOYED • RETIRED

IndividualEUGENE, OR

$5,000

Jun 21, 2024

Sen. Sullivan, Dan [R-AK]

ID: S001198

Top Contributors

SEND IN THE SEAL PAC

PACALEXANDRIA, VA

$45,000

Aug 9, 2024

THE LINCOLN CLUB OF ORANGE COUNTY FEDERAL PAC

PACNEWPORT BEACH, CA

$25,000

Oct 18, 2024

SEND IN THE SEAL PAC

PACALEXANDRIA, VA

$15,000

Aug 9, 2024

WINRED

PACARLINGTON, VA

$6,600

Oct 19, 2023

RON JOHNSON VICTORY

COMOSHKOSH, WI

$1,997

Sep 30, 2024

MACLEAN-FOGG COMPANY

OrganizationMUNDELEIN, IL

$58,700

Dec 28, 2023

AK-CHIN INDIAN COMMUNITY

OrganizationMARICOPA, AZ

$41,300

Dec 29, 2023

MACLEAN-FOGG COMPANY

OrganizationMUNDELEIN, IL

$41,300

Dec 28, 2023

PASCUA YAQUI TRIBE

OrganizationTUCSON, AZ

$41,300

Dec 29, 2023

TIGUA INDIAN RESERVATION

OrganizationEL PASO, TX

$41,300

Dec 19, 2023

Sen. Warnock, Raphael G. [D-GA]

ID: W000790

Top Contributors

JME GROUP

OrganizationSTONE MOUNTAIN, GA

$2,900

Jun 30, 2023

JME GROUP

OrganizationSTONE MOUNTAIN, GA

$2,900

Jul 18, 2024

PORTFOLIO ONE

OrganizationLOS ANGELES, CA

$1,250

Mar 17, 2023

MCKENNEY HOUSE LLC

OrganizationFORT WASHINGTON, MD

$1,000

Jun 30, 2023

WATKINS WATKINS & WATKINS LLC

OrganizationCARROLLTON, GA

$1,000

Feb 17, 2023

SCR CONSULTING LLC

OrganizationATLANTA, GA

$500

Feb 17, 2023

GIBSON, DAVID H.

IndividualDALLAS, TX

$26,750

Mar 31, 2023

ROBBINS, BONNIE

IndividualSEATTLE, WA

$12,118

Mar 31, 2023

ROBBINS, BONNIE

IndividualSEATTLE, WA

$12,118

Jul 18, 2024

KERR, WILLIAM G.

IndividualOKLAHOMA CITY, OK

$9,625

Mar 31, 2023

Sen. Hyde-Smith, Cindy [R-MS]

ID: H001079

Top Contributors

POARCH BAND OF CREEK INDIANS

OrganizationATMORE, AL

$2,900

Feb 28, 2023

MS BAND OF CHOCTAW INDIANS

OrganizationCHOCTAW, MS

$1,500

May 31, 2023

SHAKOPEE MDEWAKANTON SIOUX COMMUNITY

OrganizationPRIOR LAKE, MN

$1,000

Jun 20, 2024

THE CHICKASAW NATION

OrganizationADA, OK

$250

Mar 11, 2024

LUROS, HILARY

HOUSEWIFE • HOUSEWIFE

IndividualSUGAR LAND, TX

$6,600

Oct 21, 2024

LUROS, HILARY

HOUSEWIFE • HOUSEWIFE

IndividualSUGAR LAND, TX

$6,600

Oct 21, 2024

BESSENT, SCOTT

KEY SQUARE GROUP • INVESTMENT MANAGEMENT

IndividualCHARLESTON, SC

$6,600

Dec 31, 2024

FREEMAN, JOHN

HIGH PLAINS ACRES LLP • ATTORNEY/AGRICULTURE

IndividualCHARLESTON, SC

$6,600

Dec 31, 2024

CASTLE, JOHN

CASTLE HARLAN • MERCHANT BANKER

IndividualNEW YORK, NY

$6,600

Mar 26, 2024

SEEMANN, WILLIAM III

SEEMANN COMPOSITES • CHAIRMAN

IndividualPASS CHRISTIAN, MS

$6,600

Jun 20, 2024

Sen. Cortez Masto, Catherine [D-NV]

ID: C001113

Top Contributors

LAS VEGAS PAIUTE TRIBE

OrganizationLAS VEGAS, NV

$3,300

Nov 28, 2023

MISSISSIPPI BAND OF CHOCTAW INDIANS

OrganizationCHOCTAW, MS

$2,500

Dec 20, 2023

ALABAMA-COUSHATTA TRIBE

OrganizationLIVINGSTON, TX

$1,500

Oct 2, 2024

SHAKOPEE MDEWAKANTON SIOUX COMMUNITY

OrganizationPRIOR LAKE, MN

$1,000

Apr 26, 2024

SHAKOPEE MDEWAKANTON SIOUX COMMUNITY

OrganizationPRIOR LAKE, MN

$1,000

Jul 11, 2023

MUSCOGEE CREEK NATION

OrganizationOKMULGEE, OK

$1,000

Sep 18, 2024

MOHEGAN TRIBE OF INDIANS OF CONNECTICUT

OrganizationUNCASVILLE, CT

$1,000

Aug 12, 2024

CHOCTAW NATION OF OKLAHOMA

OrganizationDURANT, OK

$550

Oct 2, 2023

LONGTIN, LUANN

IndividualPOTOMAC, MD

$17,325

Jun 30, 2024

SLIFKA, ROSALYN

IndividualWALTHAM, MA

$5,800

Jun 30, 2024

Donor Network - Sen. Murkowski, Lisa [R-AK]

Show Also Donated To

PACs

Organizations

Individuals

Politicians

Hub layout: Politicians in center, donors arranged by type in rings around them.

Showing 55 nodes and 63 connections

Total contributions: $63

Top Donors - Sen. Murkowski, Lisa [R-AK]

Showing top 21 donors by contribution amount

7 Orgs14 Individuals

Industry Impact

Which industries are materially affected by specific provisions in this bill. 2 helped, 1 harmed.

+Pharmaceuticalsconfidence 0.90
Section 2(a)(2) requires health plans to cover the requested drug when an exception is granted, which benefits pharmaceutical manufacturers by increasing access to their non-preferred medications.
−Health Insuranceconfidence 0.85
Section 2(a)(1) mandates health insurers to implement a clear, prompt, and transparent exceptions process for step therapy protocols, imposing administrative and operational costs.
+Hospitals & Health Systemsconfidence 0.70
By reducing barriers to medication access via exceptions (Section 2), the bill may improve patient outcomes and reduce complications, benefiting hospitals through better disease management.

Who funds the sponsor on these industries

For each industry this bill affects, here's what the sponsor (Sen. Murkowski, Lisa [R-AK])received from donors associated with that industry during the 2022–present cycles. Donations are not proof of intent — they are a record of who funds the people writing the law.

Industries this bill HARMS

Health Insurance$1,500
from 1 contribution
- LAWRENCE, COURTNEY$1,500

Project 2025 Policy Matches

This bill shows semantic similarity to the following sections of the Project 2025 policy document.AI-enhanced analysis provides detailed alignment ratings.

Department of Health and Human Services

Weak

Vector: 62%

Pages: 497-499AI Enhanced

AI Analysis:

"The Safe Step Act focuses on improving patient access to medications through transparent step therapy exceptions in private group health plans, while Project 2025's HHS section primarily addresses Medicare Advantage expansion, Part D reform, and Medicaid restructuring—areas not directly addressed by the bill. There is minimal thematic overlap, as the bill does not engage with Medicare payment models, beneficiary control of funds, or Medicaid financing reforms central to the policy."

Key themes:prescription drug accesspatient access to medications

— 465 — Department of Health and Human Services 1. Make Medicare Advantage the default enrollment option. 2. Give beneficiaries direct control of how they spend Medicare dollars. 3. Remove burdensome policies that micromanage MA plans. 4. Replace the complex formula-based payment model with a competitive bidding model. 5. Reconfigure the current risk adjustment model. 6. Remove restrictions on key benefits and services, including those related to prescription drugs, hospice care, and medical savings account plans.26 Legacy Medicare Reform. Legislation reforming legacy (non-MA) Medicare should: l Base payments on the health status of the patient or intensity of the service rather than where the patient happens to receive that service. l Replace the bureaucrat-driven fee-for-service system with value- based payments to empower patients to find the care that best serves their needs. l Codify price transparency regulations. l Restructure 340B drug subsidies27 toward beneficiaries rather than hospitals. l Repeal harmful health policies enacted under the Obama and Biden Administrations such as the Medicare Shared Savings Program28 and Inflation Reduction Act.29 Medicare Part D Reform. The Inflation Reduction Act (IRA) created a drug price negotiation program in Medicare that replaced the existing private-sector negotiations in Part D with government price controls for prescription drugs. These government price controls will limit access to medications and reduce patient access to new medication. This “negotiation” program should be repealed, and reforms in Part D that will have meaningful impact for seniors should be pursued. Other reforms should include eliminating the coverage gap in Part D, reducing the government share in — 466 — Mandate for Leadership: The Conservative Promise the catastrophic tier, and requiring manufacturers to bear a larger share. Until the IRA is repealed, an Administration that is required to implement it must do so in a way that is prudent with its authority, minimizing the harmful effects of the law’s policies and avoiding even worse unintended consequences.30 Medicaid. Over the past 45 years, Medicaid and the health safety net have evolved into a cumbersome, complicated, and unaffordable burden on nearly every state. The program is failing some of the most vulnerable patients; is a prime target for waste, fraud, and abuse; and is consuming more of state and federal budgets. The dramatic increase in Medicaid expenditures is due in large part to the ACA (Obamacare), which mandates that states must expand their Medicaid eligibility standards to include all individuals at or below 138 percent of the federal poverty level (FPL), and the public health emergency, which has prohibited states from performing basic eligibility reviews. The overlap of available benefits among the various health agencies has led to a complex, confusing system that is nearly impossible to navigate—even for recipients. Recipients are often faced with a “welfare cliff” of benefit losses as they earn above a certain amount, which is contrary to the fundamental purpose of empowering individuals to achieve economic independence. Benefits increasingly involve nonmedical services such as air conditioning and housing, many of which are already handled by departments other than HHS. Improper payments within Medicaid are higher than those of any other federal program. These payments are evidence of the inappropriateness of Medicaid’s expansion, which, stemming largely from public health emergency maintenance of effort (MOE) requirements and the Affordable Care Act, has crowded out the primary targets of these programs: those who are most in need. True health care reform cannot be accomplished in a bureaucratic silo or only through Medicaid and health safety net programs. Reform of the tax code is also essential to genuine, effective reform of our health care system. All components of the health care system should be part of the reform efforts, and it is imperative that the system be modified to assist states with their current programs. Therefore, the next Administration should: l Reform financing. Allow states to have a more flexible, accountable, predictable, transparent, and efficient financing mechanism to deliver medical services. This system should include a more balanced or blended match rate, block grants, aggregate caps, or per capita caps. Any financial system should be designed to encourage and incentivize innovation and the efficient delivery of health care services. Federal and state financial participation in the Medicaid program should be rational, predictable, and reasonable. It should also incentivize states to save money and improve the quality of health care.

Department of Health and Human Services

Weak

Vector: 61%

Pages: 497-499AI Enhanced

AI Analysis:

"The Safe Step Act focuses on step therapy exceptions in private group health plans under ERISA, while Project 2025's HHS section emphasizes Medicare reform, site-neutral payments, Medicare Advantage restructuring, and conscience protections—there is minimal thematic overlap."

Key themes:healthcare accessprescription drug policy

— 464 — Mandate for Leadership: The Conservative Promise l The Risk Adjustment Data Validation (RADV) rule; l The Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration; and l The Global and Professional Direct Contracting (GPDC, rebranded as the Accountable Care Organization Realizing Equity, Access, and Community Health or ACO REACH) model. Additionally, regulations should advance site neutrality by eliminating the inpa- tient-only list and expanding the ambulatory surgical center covered procedures list. Medicare generally pays more for inpatient hospital procedures and less for the same procedures performed in an outpatient setting. Whether a medical ser- vice is delivered in a physician’s office, a clinic, or a hospital setting, the Medicare payment for that service should be the same. CMS should expand the application of site-neutral payment options to more settings. Such a policy would level the playing field among providers and remove the financial disabilities for medical professionals who would compete with hospital systems.23 Finally, HHS needs to restore and enhance conscience protection regulations that allow medical practitioners to participate in federal health care programs without being compelled to provide sex changes or similar services. LEGISLATIVE PROPOSALS l Remove restrictions on physician-owned hospitals. The Affordable Care Act (ACA)24 imposed restrictions prohibiting Medicare from reimbursing physician-owned and specialty hospitals. The current restrictions do little more than serve the special interests of large hospital systems and undercut consumer choice of high-quality, specialty care. These restrictions should be removed so that physician-owned hospitals can compete with other hospitals in serving Medicare patients.25 l Encourage more direct competition between Medicare Advantage and private plans. 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. Specifically: — 465 — Department of Health and Human Services 1. Make Medicare Advantage the default enrollment option. 2. Give beneficiaries direct control of how they spend Medicare dollars. 3. Remove burdensome policies that micromanage MA plans. 4. Replace the complex formula-based payment model with a competitive bidding model. 5. Reconfigure the current risk adjustment model. 6. Remove restrictions on key benefits and services, including those related to prescription drugs, hospice care, and medical savings account plans.26 Legacy Medicare Reform. Legislation reforming legacy (non-MA) Medicare should: l Base payments on the health status of the patient or intensity of the service rather than where the patient happens to receive that service. l Replace the bureaucrat-driven fee-for-service system with value- based payments to empower patients to find the care that best serves their needs. l Codify price transparency regulations. l Restructure 340B drug subsidies27 toward beneficiaries rather than hospitals. l Repeal harmful health policies enacted under the Obama and Biden Administrations such as the Medicare Shared Savings Program28 and Inflation Reduction Act.29 Medicare Part D Reform. The Inflation Reduction Act (IRA) created a drug price negotiation program in Medicare that replaced the existing private-sector negotiations in Part D with government price controls for prescription drugs. These government price controls will limit access to medications and reduce patient access to new medication. This “negotiation” program should be repealed, and reforms in Part D that will have meaningful impact for seniors should be pursued. Other reforms should include eliminating the coverage gap in Part D, reducing the government share in

Department of Health and Human Services

Weak

Vector: 61%

Pages: 533-535AI Enhanced

AI Analysis:

"The Safe Step Act focuses on medication step‑therapy exceptions under ERISA, while the Project 2025 HHS section emphasizes civil rights, nondiscrimination, conscience protection, and abortion‑related policies. Both touch on patient access to health care, but their substantive objectives and regulatory domains differ significantly."

Key themes:patient accesshealth care transparencynondiscrimination

— 501 — Department of Health and Human Services 54. U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Office of Civil Rights, and Office of the Secretary, “Special Responsibilities of Medicare Hospitals in Emergency Cases and Discrimination on the Basis of Disability in Critical Health and Human Service Programs or Activities,” draft of Proposed Rule, January 14, 2021, https://www.hhs.gov/sites/default/files/infants-nprm.pdf (accessed March 17, 2023). 55. H.R. 26, Born-Alive Abortion Survivors Protection Act, 118th Congress, introduced January 9, 2023, https:// www.congress.gov/118/bills/hr26/BILLS-118hr26pcs.pdf (accessed March 17, 2023). 56. H.R. 7, No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act of 2023, 118th Congress, introduced January 9, 2023, https://www.congress.gov/118/bills/hr7/BILLS-118hr7ih.pdf (accessed March 17, 2023). 57. S. 401, Conscience Protection Act of 2021, 117th Congress, introduced February 24, 2021, https://www.congress. gov/117/bills/s401/BILLS-117s401is.pdf (accessed March 17, 2023). 58. U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, and Office of the Secretary, “Nondiscrimination in Health Programs and Activities,” Notice of Proposed Rulemaking; Notice of Tribal Consultation, Federal Register, Vol. 87, No. 149 (August 4, 2022), pp. 47824–47920, https://www.govinfo. gov/content/pkg/FR-2022-08-04/pdf/2022-16217.pdf (accessed March 17, 2023). 59. Ibid., p. 47916. 60. The regulation was not finalized before the end of the Administration. U.S. Department of Agriculture, Food and Nutrition Services, “Revision of Categorical Eligibility in the Supplemental Nutrition Assistance Program (SNAP),” Proposed Rule, Federal Register, Vol. 84, No. 142 (July 24, 2019), pp. 35570–55581, https:// www.federalregister.gov/documents/2019/07/24/2019-15670/revision-of-categorical-eligibility-in-the- supplemental-nutrition-assistance-program-snap (accessed March 17, 2023). 61. 45 Code of Federal Regulations § 75.300(c) and (d), https://www.ecfr.gov/current/title-45/subtitle-A/ subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.300 (accessed March 17, 2023). 62. H.R. 1750, Child Welfare Provider Inclusion Act of 2021, 117th Congress, introduced March 10, 2021, https:// www.congress.gov/117/bills/hr1750/BILLS-117hr1750ih.pdf (accessed March 17, 2023), and S. 656, Child Welfare Provider Inclusion Act of 2021, 117th Congress, introduced March 10, 2021, https://www.congress.gov/117/bills/ s656/BILLS-117s656is.pdf (accessed March 17, 2023). 63. S. 3949, Trafficking Victims Protection Reauthorization Act of 2022, Public Law No. 117-348, 117th Congress, January 25, 2023, https://www.congress.gov/117/plaws/publ348/PLAW-117publ348.pdf (accessed March 17, 2023). 64. Kelsey Y. Santamaria, “Child Migrants at the Border: The Flores Settlement Agreement and Other Legal Developments,” Congressional Research Service In Focus No. IF11799, April 1, 2021, https://crsreports.congress. gov/product/pdf/IF/IF11799 (accessed March 17, 2023). 65. Report, Building a Happy Home: Marriage Education as a Tool to Strengthen Families, Social Capital Project Report No. 1-22, March 2022, p. 17, https://www.jec.senate.gov/public/_cache/files/3d102525-6f0d-48ed- 92f4-d71edd468ad6/building-a-happy-home.pdf (accessed March 17, 2023). The cover of the report reflects that the Social Capital Project is “[a] project of the Joint Economic Committee – Republicans.” 66. See, for example, Alan J. Hawkins, “Are Federally Supported Relationship Education Programs for Lower-Income Individuals and Couples Working? A Review of Evaluation Research,” American Enterprise Institute, September 2019, https://www. congress.gov/117/plaws/publ228/PLAW-117publ228.pdf (accessed March 17, 2023). 67. H.R. 8404, Respect for Marriage Act, Public Law No. 117-228, 117th Congress, December 13, 2022, https://www. congress.gov/117/plaws/publ228/PLAW-117publ228.pdf (accessed March 17, 2023). 68. Madison Marino, “Over 1,000 Safety Violations Mar Head Start. Children Deserve Better,” Heritage Foundation Commentary, November 10, 2022, https://www.heritage.org/education/commentary/over-1000-safety- violations-mar-head-start-children-deserve-better. 69. American Hospital Association v. Becerra, 596 U.S. ___ (2022), https://www.supremecourt.gov/ opinions/21pdf/20-1114_09m1.pdf (accessed March 17, 2023). 70. U.S. Department of the Treasury, Internal Revenue Service; U.S. Department of Labor, Employee Benefits Security Administration; and U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, “Coverage of Certain Preventive Services Under the Affordable Care Act,” Notice of Proposed Rulemaking, Federal Register, Vol. 88, No. 22 (February 2, 2023), pp. 7236–7281, https://www. govinfo.gov/content/pkg/FR-2023-02-02/pdf/2023-01981.pdf (accessed March 17, 2023). — 502 — Mandate for Leadership: The Conservative Promise 71. 42 U.S. Code § 238n, https://www.law.cornell.edu/uscode/text/42/238n (accessed March 17, 2023). 72. U.S. Department of Health and Human Services, Health Resources and Services Administration, “Early Childhood Health,” last reviewed October 2022, https://mchb.hrsa.gov/programs-impact/focus-areas/early- childhood-health (accessed March 17, 2023). 73. American Pregnancy Association, “Having a Doula—What Are the Benefits?” https://americanpregnancy. org/healthy-pregnancy/labor-and-birth/having-a-doula/#:~:text=Other%20studies%20have%20shown%20 that%20having%20a%20doula,massage%20to%20reduce%20stress%20and%20anxiety%20during%20labor (accessed March 17, 2023). 74. S. 2372, VA MISSION [Maintaining Internal Systems and Strengthening Integrated Outside Networks] Act of 2018, Public Law No. 115-182, 115th Congress, June 6, 2018, https://www.congress.gov/115/plaws/publ182/ PLAW-115publ182.pdf (accessed March 17, 2023). 75. U.S. Department of Health and Human Services, “Securing Updated and Necessary Statutory Evaluations Timely,” Final Rule, Federal Register, Vol. 86, No. 11 (January 19, 2021), pp. 5694–5764, https://www.govinfo. gov/content/pkg/FR-2021-01-19/pdf/2021-00597.pdf (accessed March 22, 2023). 76. U.S. Department of Health and Human Services, Office of the Secretary, Office of the Assistant Secretary for Health, “Compliance with Statutory Program Integrity Requirements,” Final Rule, Federal Register, Vol. 84, No. 42 (March 4, 2029), pp. 7714–7791, https://www.govinfo.gov/content/pkg/FR-2019-03-04/pdf/2019-03461.pdf (accessed March 18, 2023). 77. U.S. Department of Health and Human Services, Office of the Secretary, Office of the Assistant Secretary for Health, “Ensuring Access to Equitable, Affordable, Client-Centered, Quality Family Planning Services,” Final Rule, Federal Register, Vol. 86, No. 192 (October 7, 2021), pp. 56144–56180, https://www.govinfo.gov/content/ pkg/FR-2021-10-07/pdf/2021-21542.pdf (accessed March 18, 2023). 78. S. 624, Title X Abortion Provider Prohibition Act, 118th Congress, introduced March 2, 2023, https://www. congress.gov/118/bills/s624/BILLS-118s624is.pdf (accessed March 18, 2023). 79. 50 U.S. Code Chapter 55, https://www.law.cornell.edu/uscode/text/50/chapter-55 (accessed March 22, 2023). 80. 18 U.S. Code § 13, https://www.law.cornell.edu/uscode/text/18/13 (accessed March 18, 2023). 81. Bowen v. American Hospital Association, 476 U.S. 610 (1986), https://tile.loc.gov/storage-services/service/ll/ usrep/usrep476/usrep476610/usrep476610.pdf (accessed 22, 2023). 82. U.S. Department of Health and Human Services, Office of the Secretary, “Notification of Interpretation and Enforcement of Section 1557 of the Affordable Care Act and Title IX of the Education Amendments of 1972,” Federal Register, Vol. 86, No. 99 (May 25, 2021), pp. 27984–27985, https://www.govinfo.gov/content/pkg/FR- 2021-05-25/pdf/2021-10477.pdf (accessed March 18, 2023). 83. U.S. Department of Health and Human Services, Office for Civil Rights, “HHS Notice and Guidance on Gender Affirming Care, Civil Rights, and Patient Privacy,” March 2, 2022, https://www.hhs.gov/sites/default/files/hhs- ocr-notice-and-guidance-gender-affirming-care.pdf (accessed March 18, 2023). 84. Heckler v. Chaney, 420 U.S. 821 (1985), https://caselaw.findlaw.com/us-supreme-court/470/821.html (accessed March 18, 2022). 85. U.S. Department of Health and Human Services, Office for Civil Rights, “Guidance to Nation’s Retail Pharmacies: Obligations Under Federal Civil Rights Laws to Ensure Access to Comprehensive Reproductive Health Care Services,” content last reviewed July 14, 2022, https://www.hhs.gov/civil-rights/for-individuals/ special-topics/reproductive-healthcare/pharmacies-guidance/index.html (accessed March 18, 2023). 86. H.R. 3103, “Health Insurance and Portability and Accountability Act of 1996, Public Law No. 104-191, 104th Congress, August 21, 1996, https://www.congress.gov/104/plaws/publ191/PLAW-104publ191.pdf (accessed March 18, 2023). 87. U.S. Department of Human Services, “HIPAA Privacy Rule and Disclosures of Information Relating to Reproductive Health Care,” content last reviewed June 29, 2022, (accessed March 18, 2023). See also “Protecting the Privacy and Security of Your Health Information When Using Your Personal Cell Phone or Tablet,” content last reviewed June 29, 2022, https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/ cell-phone-hipaa/index.html (accessed March 18, 2023).

Department of Health and Human Services

Minimal

Vector: 61%

Pages: 506-508AI Enhanced

AI Analysis:

"The Safe Step Act concerns medication step therapy exceptions under ERISA, while the Project 2025 excerpt focuses on abortion regulations, Hyde Amendment compliance, EMTALA guidance, and transgender coverage; there is no thematic overlap between the two."

Key themes:unrelateddifferent policy areas

— 473 — Department of Health and Human Services l Rewrite the ACA abortion separate payment regulation. Section 1303 of Obamacare requires that insurers collect a separate payment for certain abortion coverage in qualified health plans that are approved to be sold on exchanges and that they keep those separate payments in separate accounts that are used only to pay for elective abortion services. Neither the letter nor the spirit of the law was enforced under President Obama, and a Trump- era regulation sought to correct this problem. The Biden HHS rescinded this regulation to allow insurance companies once again—contrary to the law—to collect combined payments for what are clearly required to be separate payments for elective abortion coverage. “Separate” does not mean “together.” HHS should reinstate a Trump Administration regulation and enforce what the plain text of Section 1303 requires. That regulation should be further improved by requiring CMS to ensure that consumers pay truly separate charges for abortion coverage. l Audit Hyde Amendment compliance. HHS should undertake a full audit to determine compliance or noncompliance with the Hyde amendment and similar funding restrictions in HHS programs. This audit should include a full review of the Biden Administration’s post-Dobbs executive actions to promote abortion. It should also encompass a review of Medicaid managed care plans in pro-abortion states. l Reverse distorted pro-abortion “interpretations” added to the Emergency Medical Treatment and Active Labor Act. The Emergency Medical Treatment and Active Labor Act (EMTALA)52 prohibits hospitals that receive Medicare funds from “dumping” emergency patients who cannot pay by sending them to other hospitals. It also mandates that hospitals stabilize pregnant women and explicitly protects unborn children. Hospitals or physicians found to be in violation of the statute could lose all of their federal health funding—Medicare, Medicaid, CHIP, and other funds—and face civil penalties of up to nearly $120,000. In July 2022, HHS/CMS released guidance mandating that EMTALA- covered hospitals and the physicians who work there must perform abortions, to include completing chemical abortions even when the child might still be alive. The guidance also declared that EMTALA would protect physicians and hospitals that perform abortions in violation of state law if they deem those abortions necessary to stabilize the women’s health. This novel interpretation of EMTALA is baseless. EMTALA requires — 474 — Mandate for Leadership: The Conservative Promise no abortions, preempts no pro-life state laws, and explicitly requires stabilization of the unborn child. HHS should rescind the guidance and end CMS and state agency investigations into cases of alleged refusals to perform abortions. DOJ should agree to eliminate existing injunctions against pro-life states, withdraw its enforcement lawsuits, and in lawsuits against CMS on the guidance agree to injunctions against CMS and withdraw appeals of injunctions. l Reissue a stronger transgender national coverage determination. CMS should repromulgate its 2016 decision that CMS could not issue a National Coverage Determination (NCD) regarding “gender reassignment surgery” for Medicare beneficiaries. In doing so, CMS should acknowledge the growing body of evidence that such interventions are dangerous and acknowledge that there is insufficient scientific evidence to support such coverage in state plans. l Enforce EMTALA. The undeniable reality of abortion is that it does do not always result in a dead baby, and these born-alive babies are left to die. HHS should use EMTALA and Section 504 of the Rehabilitation Act,53 which prohibits disability discrimination, to investigate instances of infants born alive and left untreated in covered hospitals. CMS, OCR, and OIG should be required to follow through on these investigations with specific enforcement actions. HHS should revive a Trump Administration proposed regulation, “Special Responsibilities of Medicare Hospitals in Emergency Cases and Discrimination on the Basis of Disability in Critical Health and Human Service Programs or Activities,”54 to achieve this end. In addition, Congress should pass the Born-Alive Abortion Survivors Protection Act55 to require that proper medical care be given to infants who survive an abortion and to establish criminal consequences for practitioners who fail to provide such care. l Permanently codify both the Hyde family of amendments and the protections provided by the Weldon Amendment. Congress can accomplish this through legislation such as the No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act56 (Hyde) and the Conscience Protection Act57 (Weldon).

Department of Health and Human Services

Minimal

Vector: 59%

Pages: 506-508AI Enhanced

AI Analysis:

"The Safe Step Act concerns medication step therapy exceptions in group health plans, whereas the Project 2025 policy addresses abortion payment segregation, Hyde Amendment compliance, and EMTALA interpretations; there is no substantive thematic or policy overlap."

Showing 3 of 5 policy matches

About These Correlations

Policy matches are calculated using a hybrid approach: initial candidates are found using semantic similarity between bill summaries and Project 2025 policy text, then an AI model (Llama 3.1 70B) provides detailed alignment ratings and analysis. Ratings range from 1 (minimal alignment) to 5 (very strong alignment). This analysis does not imply direct causation or intent.

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