A bipartisan bill designed to move the United States toward eliminating hepatitis C has not advanced in the Senate since its introduction more than a year ago, and its lead sponsor says a Congressional Budget Office cost estimate is the obstacle.
Sen. Bill Cassidy of Louisiana, who chairs the Senate Health, Education, Labor and Pensions Committee and spent much of his career as a liver doctor treating the disease, said the measure received a disappointing score and that conversations are underway with CBO about a rescore. His office declined to provide the figure but said it was higher than a related CBO estimate from the previous Congress. The office of Sen. Chris Van Hollen, the bill's Democratic cosponsor, also said discussions with CBO were ongoing.
For Americans living with chronic hepatitis C, the stall has a concrete meaning. Hepatitis C is curable with a course of direct-acting antiviral medication, but the disease is largely silent until it is advanced, and the people least likely to be diagnosed and treated are the people the bill was written to reach. MedicalDaily has covered how settlement money is reaching similar populations through other channels.
The Slow Path from Infection to Liver Failure
Hepatitis C damages the liver slowly and usually without symptoms. Over years, chronic inflammation drives scarring, and scarring can progress to cirrhosis, in which the liver's architecture is permanently altered, and its function declines.
From there, the pathway branches toward liver failure and hepatocellular carcinoma, the most common form of primary liver cancer. Both are far more expensive to treat than the infection that caused them, and a liver transplant sits at the end of that sequence for some patients.
This is why the fiscal argument and the clinical argument point the same direction. A 2024 CBO analysis estimated that a five-year program raising hepatitis C treatment rates among Medicaid beneficiaries to a peak of 100% would save roughly $7 billion over a decade through avoided costs of treating complications, while increasing spending on testing and treatment by about $4 billion.
The same tension shapes the current bill. CBO has estimated it could save $6.6 billion over a decade by preventing the costs of liver failure, cancer, and transplants, but the proposal would require an initial federal investment of about $10 billion to buy medication and expand access to testing and treatment.
Inside the Proposed Elimination Program
The Cure Hepatitis C Act would create a national test-to-treat elimination program, expanding testing and treatment with particular focus on populations least likely to reach care: people who are incarcerated, uninsured, low-income, or receiving care through the Indian Health Service.
Its financial centerpiece is a subscription model. The federal government would negotiate five-year agreements with drug manufacturers to purchase unlimited hepatitis C treatments at a fixed price. Because a course of treatment can otherwise cost tens of thousands of dollars, the structure is intended to remove the per-patient cost that makes large-scale treatment expansion unaffordable for state programs.
The model is not theoretical. Louisiana pioneered the approach, and Washington and Texas have adopted similar arrangements, allowing substantial treatment expansion for Medicaid and incarcerated populations at roughly capped expenditure levels.
Announcing the bill, Cassidy said the country could virtually eliminate hepatitis C in a fiscally responsible way, arguing that curing the infection removes the need for chronic care later. Current treatment cures more than 95% of cases with almost no side effects.
The Gap Between a Budget Score and a Health Outcome
A CBO score is a specific instrument with specific limits, and understanding those limits is essential to reading this dispute fairly.
CBO estimates effects on the federal budget over a defined window, typically 10 years. It does not measure health outcomes, quality of life, or savings that fall outside federal accounts. If a treated patient avoids a liver transplant 15 years later, that benefit may fall outside the scoring window. If costs are avoided by a private insurer or a state, they may not register as federal savings.
None of that makes a score incorrect. CBO is answering the question it is designed to answer. But a bill that reduces disease burden can still show a federal cost inside a 10-year window, and a bill that shows savings can still require money up front. Both facts can be true simultaneously.
The sponsors are not disputing CBO's methods publicly. They are seeking a rescore, which suggests a disagreement about inputs or assumptions rather than about the institution's role.
The Political Clock Running on This Bill
Timing gives the stall additional weight. The Senate bill has received no hearings and no committee vote since its introduction in June 2025. Cassidy leaves Congress in January and has said passing the measure is a priority before then.
The House and Senate versions also differ. Reps. Mariannette Miller-Meeks and Diana DeGette introduced a similar bill in the House last month that does not include language in the Senate version preventing unauthorized immigrants from accessing medication under the program. Reconciling that difference would be necessary for any bill to reach the president.
Nothing about the current situation changes what individual patients should do. Hepatitis C testing is recommended at least once for all adults 18 and older and during each pregnancy, and it requires only a blood draw. Anyone who has ever injected drugs, received a blood transfusion before 1992, or has abnormal liver enzymes should ask about testing specifically. Treatment is short, generally well tolerated, and cures the great majority of patients, and existing coverage pathways remain available regardless of whether this legislation advances. MedicalDaily has covered how federal price negotiation is reshaping drug costs for other conditions.
Key Questions Answered
What is holding up the bill? Its lead sponsor says a Congressional Budget Office cost estimate came back higher than expected, and sponsors are in discussions with CBO about a rescore. The Senate bill has had no hearings or committee vote since June 2025.
What would the legislation do? Create a national test-to-treat hepatitis C elimination program focused on people who are incarcerated, uninsured, low-income, or served by the Indian Health Service, funded partly through five-year fixed-price subscription agreements with manufacturers.
Has this approach worked anywhere? Louisiana pioneered subscription contracts, and Washington and Texas have adopted similar approaches, allowing substantial treatment expansion for Medicaid and incarcerated populations at roughly capped spending levels.
Why does untreated hepatitis C matter? It damages the liver silently over years, progressing to cirrhosis, liver failure, and liver cancer in some patients. Those complications are far more expensive and harder to treat than the infection itself.
Does a high CBO score mean the bill is a bad investment? Not necessarily. CBO measures federal budget effects over a defined window, usually 10 years. It does not measure health outcomes, and benefits falling outside that window or outside federal accounts may not appear in the estimate.
Is hepatitis C curable? Yes. Direct-acting antiviral medications cure more than 95% of cases with a short course of treatment and few side effects. The difficulty is diagnosis and access, not efficacy.
Who should be tested? Testing is recommended at least once for all adults 18 and older and during each pregnancy. Anyone who has injected drugs, received a transfusion before 1992, or has abnormal liver enzymes should ask specifically.
