| |  | The Lead Brief | The expiration of the Affordable Care Act tax credits could not just cost 4 million people their health insurance — and jack up rates for 20 million more. One GOP pollster sees it as Republicans’ biggest midterm threat. Democrats are demanding an extension of the subsidies in exchange for their votes on a GOP funding plan ahead of a Sept. 30 fiscal-year deadline, and Democratic votes are needed to pass the Senate. Some Republicans, particularly those in vulnerable House races, are on board. A group of 10 frontline Republicans introduced legislation to extend the subsidies for one year. But intense opposition from more conservative members could throw a wrench into the process. → There are eight legislative days until the federal government funding deadline on Sept. 30, with lawmakers scheduled to be in their districts during the week of Sept. 22. Where the debate is going: There seems to be a recognition from GOP leadership that not extending the subsidies could present a huge problem for them politically — and for their constituents, according to lobbyists working on the issue. “We’ve seen the [political] will build. We’ve seen support grow on both sides of the aisle, less so on the Republican side,” said one hospital lobbyist, speaking on the condition of anonymity to protect relationships on the Hill. “But it’s now more about the way than the will at this point, and how it comes together. Industry players: Hospitals, providers and insurers are among the sectors that have been intensely involved in pushing lawmakers to extend the premium subsidies. → More than 4 million people could lose their insurance coverage if Congress doesn’t act by the end of the year, according to the Congressional Budget Office — and that would compound coverage losses expected as a result of the One Big Beautiful Bill. → Analysts predict health insurance premium increases of about 75 percent for about 20 million Americans if Congress doesn’t act. Although the subsidies end on Dec. 31, not having a deal before open enrollment begins on Nov. 1 could impact ACA plan rates. Plans worry that people could see higher rates and decide not to enroll in coverage altogether. → More than half of people enrolled in Obamacare plans live in GOP-controlled congressional districts, according to KFF. Seventy-six percent of enrollees live in states Trump won in 2024. What’s been said: House Speaker Mike Johnson (R-Louisiana) acknowledged to Punchbowl that, while he’s not a fan of the policies, he is concerned about people losing coverage. Senate Majority Leader John Thune (R-South Dakota) last week told reporters that Democrats set up the subsidy cliff and are therefore responsible for coming up with the solution, Politico reported. What hasn’t been said: President Donald Trump has not yet weighed in on the issue, something policymakers and industry lobbyists say could prove essential to getting a deal done. Conservative pollster John McLaughlin, who has advised Trump, recently wrote an op-ed saying that neglecting to act on the tax credits could be the top midterm threat to the GOP. K Street Files At the doctor’s office, the robot will hear you now: Health artificial intelligence company Abridge AI is entering the Washington fray and hiring its first K Street firm. The company, which offers a platform that automates doctors’ notes and summarizes patient visits, brought on top lobbying shop Holland & Knight. The company, founded and run by cardiologist Shiv Rao, is also interested in Medicare coverage reimbursement policy and privacy standards for AI technology, according to federal forms disclosing the hire. → Tech companies have historically been slow to get involved in Washington politics and advocacy, but a new crop of companies has learned to make sure policymakers know about them and their products before policy becomes solidified. Miranda Franco, a senior policy adviser at Holland & Knight, said the firm is focused on taking the company around Capitol Hill for meet-and-greets with lawmakers and their offices. Why it matters: There’s a hope that AI technologies can help improve how providers do their jobs and improve overall care. As use has increased in clinical settings, so have talks about bolstering privacy rules. Abridge bills itself as a way to reduce burdens on providers and reduce errors in medical records, recording patient visits — with the patient’s consent — and summarizing the conversation. (The tech has security measures, the company says, and is HIPAA-compliant.) The platform recognizes and groups medical language with specific billing codes and can make orders for prescriptions ready to review at the end of the visit. Abridge is also trying to use the technology to speed prior authorization approvals — an insurer practice critics say can delay patient care. → It’s generated interest from players in the health industry and big-dollar funders. In June, the company said it had raised $300 million in a round of funding led by venture capital firm Andreessen Horowitz, which the Wall Street Journal reported values Abridge at $5.3 billion. Abridge announced a partnership last month with Highmark Health — an organization that has an insurance arm, known as Highmark, and the Allegheny Health Network, a health system with 14 hospitals in Pennsylvania. Money Moves Health lobbying shop Tarplin, Downs & Young has been acquired by lobbying and strategic communications firm FGS Global. The combination brings the firm’s health policy headcount to about 50 people, according to a release. Tarplin, Downs & Young has long been one of the most well-regarded health care firms on K Street, attracting clients including several pharma major companies, such as Boehringer Ingelheim, Novo Nordisk, Genentech and Merck, and provider groups such as the National Association of Accountable Care Organizations and the American College of Physicians. | 
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