Health Policy in 2026
Forecasting the year ahead in health policy is always treacherous, because events intervene and screw up even the best predictions. I am sure lobbyists already have a full agenda of actions Congress might take that will affect the interests they represent. In health care, even pinprick changes in legislation can move billions of dollars. But my working theory is that the sharp partisan divide in Congress, and possibly even sharper disagreement on health care policy, can produce only small-ball actions on health next year. Plus, it’s an election year, when we don’t usually see major legislation. So, what should you watch for that will really matter for people, policy, and politics?
First and foremost is the role that health care affordability will play in the midterms. Assuming there is no deal on the enhanced ACA tax credits, spiking premium payments in the Marketplaces will become the national symbol for voters of concerns about their health care bills. Bad as the problem will be on its own, the public will feel it is much worse as media coverage and Democrats (as a political strategy) give far more people than directly experience the problem the impression that their premium payments could be doubling too, capitalizing on the very real concerns people have about affordability throughout the health system. Many polls will start to show that out-of-pocket payments for health care run even with, or eclipse, the cost of food and utilities as an economic concern. Democrats will prosecute the issue to the fullest, and Republicans will generally try to shift the subject and fight on other issues. Health care affordability will be in the spotlight, but how important it is as a vote-and-turnout driver remains to be determined.
Second, again assuming there’s no deal on the tax credits, we’ll see how enrollees actually respond in the Marketplaces. What share of the 24 million enrollees switch to cheaper high-deductible plans? Who are they? What is the impact of doing that on their financial security and health-seeking behavior? What happens to older and sicker enrollees who need better, more comprehensive coverage? How many millions choose to be uninsured in 2026 and who are they? What happens to the uninsured rate in the U.S.?
Third, states that have expanded Medicaid will be gearing up for Medicaid work requirements, which kick in in 2027. Red states may be looking for flexibility to implement the toughest possible requirements and reduce their Medicaid rolls and spending. Blue states will be looking for nooks and crannies in the law and the rules to lessen the impact in the hopes that Democrats seize control again in 2028 and reverse the requirements. Having implemented state welfare work requirements myself, I know there is always some ability to shade implementation one way or the other depending on the goals of a state. In our case in New Jersey, we had little interest in kicking people off welfare (and into homelessness or deep poverty, which we’d also have to address), but we did have a big interest in providing job training, childcare, transportation, and a pathway to jobs.
Fourth, after years of moderate increases (not as people experience it, but as we experts quantify these things), health costs will increase more sharply again. Employer premium increases may not touch double digits but could come close. The average cost of a family policy for employers could approach $30,000. It’s likely that cost sharing and deductibles will rise again after plateauing for several years. Cost pressures may lead to action in Congress on such measures as site-neutral payment for hospitals or restrictions on PBMs. Employers and public payers are increasingly skittish about the costs of GLP-1s for weight loss. It’s possible GLP-1s could turn from today’s dilemma to a technology-diffusion success story of sorts. Costs are coming down, pills are on the horizon, and payers are developing more sensible guidelines for their initial and long-term use. In a country where the dam breaks on every effective new medical technology and it’s rapidly disseminated at high costs, GLP-1s could emerge as a more balanced and sensible example of technology diffusion, albeit, like most new medical technologies, still one that increases costs.
Fifth, the Trump administration has put pressure on drug prices through a variety of initiatives. Probably the most important is Medicare drug price negotiations, which began in the Biden years, but together they are putting pressure on drug prices. Sensing where the public is, President Trump has helped engineer a shift in the geopolitics of health care in which drug companies are no longer the NRA of health care and mostly untouchable (he obviously has not tried to engineer the same change for the NRA). Still, retail drug spending is only 9% of overall health spending (16% for employers) and there is growing awareness that hospitals gobble up the single largest share of the health care dollar.
Proposals to cap hospital prices or put hospitals on a budget seem to be coming back into fashion again but are non-starters with Republicans in charge, as of course is single payer. For 2026, we can therefore look generally for greater attention being paid to hospital prices and possibly greater action at the state level, where several states have established hospital cost targets with varying degrees of teeth.
Sixth, people (and providers) really do hate prior authorization review. Will the administration’s voluntary effort to work with industry to streamline and pare back prior authorization result in any concrete relief for patients when it kicks in this year? Voluntary health care industry efforts have generally disappointed, as did the now-forgotten but once infamous industry Voluntary Effort (“the VE”) to reduce costs that was mounted to fend off Jimmy Carter’s aggressive cost-containment plan. The jury is out.
Seventh, four in 10 Americans say they identify in some way with the MAHA agenda. We’ll learn more in the coming year about which tenets of this loose movement have staying power. Everyone is for exercise and for healthier food for kids (although I do still miss those Hostess Cupcakes and Twinkies that I had as a kid). But people who have serious illnesses may grow tired of the central MAHA notion that they are personally responsible for disease and may increasingly make the connection between their own need for medical care and cuts in Medicaid and ACA coverage. There is some overlap between MAHA and the anti-vax movement. Another thing to watch: will vaccination rates continue to decline as the administration chips away at universal vaccination and trust in vaccines?
Eighth, AI obviously already means a lot for physicians, researchers, hospitals, insurance companies and investors, with profound implications in some areas of medicine already, such as radiology. But when will AI start having real meaning for the things people care about most: their costs and their ability to navigate the health system? The implications and practical applications for consumers receive far less attention, as generally does the relatively low level of trust in AI consumers start with. Possibly, 2026 will be the year when attention shifts more seriously to the consumer side of AI in health.
All told, it will be a big year ahead in health policy. And this list only just scratches the surface. There’s also Mifepristone, and family planning, everything not happening now in HIV, CDC, NIH and FDA, and CMS waivers and CMMI, the Medicare Advantage wars that never end, and price transparency, and more. But there probably won’t be a lot of significant action in Congress. Still, every incremental change is a big fight in health care, and hard won, and in a hyper-partisan Congress, 2026 will be no different.
