Update: On February 3, 2026, the President signed the “Consolidated Appropriations Act, 2026” which includes funding provided in the FY 2026 Labor, Health and Human Services, Education, and Related Agencies (Labor HHS) conference bill and accompanying report detailed below. This resource was originally published on January 22, 2026.

The Committee on Appropriations released its FY 2026 Labor, Health and Human Services, Education, and Related Agencies (Labor HHS) conference bill and accompanying report on January 20, 2026.

While most U.S. global health funding is provided to the State Department through a separate appropriations bill (see the KFF budget summary on this funding here), the Labor HHS appropriations bill includes funding for global health programs at the Centers for Disease Control and Prevention (CDC) as well as funding for global health research activities at the National Institutes of Health (NIH). Total global health funding at CDC and NIH through the Labor HHS bill is not yet known, as funding for some programs (i.e. global HIV/AIDS and malaria research) at NIH is determined at the agency level rather than specified by Congress in annual appropriations bills. Funding for global health in the Labor HHS bill remained flat compared to the FY 2025¹ level as follows:

• CDC: Funding for global health programs at CDC totals $693 million, the same level as the FY 2025 enacted amount.² Within CDC, funding for each specific global health program area was also maintained at the FY 2025 level.
• NIH: Funding for global health research activities at the Fogarty International Center (FIC) at NIH totals $95 million, the same level as the FY 2025 enacted amount.

In addition, Section 236 under the Labor HHS section of the bill specifically states that funding “shall be for the budget activities, and in the amounts specified in the table under each such heading in the explanatory statement” instructing the administration to provide the amounts for the areas specified.

See the table below for additional details on global health funding. See other budget summaries and the KFF budget tracker for details on historical annual appropriations for global health programs.

1. Funding for FY25 was provided in a full-year Continuing Resolution (CR), which maintained FY24 levels. All FY25 amounts and associated notes are based on those specified in relevant FY24 appropriations bills. ↩︎
2. The FY26 Request eliminates CDC’s Global Health Center and most of its bilateral programs, except funding for “Global Disease Detection & Emergency Response”, which is transferred to “Crosscutting Activities and Program Support”, and “Parasitic Diseases and Malaria”, which is transferred to “Emerging and Zoonotic Infectious Diseases”. ↩︎

Ahead of the Trump administration’s planned expansion of Medicare coverage for GLP-1s to treat obesity through temporary models and the availability of Medicare’s negotiated price for certain GLP-1 products beginning in 2027, new data from the Centers for Medicare & Medicaid Services (CMS) shows that use and spending for these drugs under Medicare has grown substantially in recent years, reflecting their demonstrated effectiveness at treating type 2 diabetes and other conditions. Medicare currently covers GLP-1s for type 2 diabetes, cardiovascular disease, and sleep apnea, but coverage for weight loss drugs is prohibited by law, even as GLP-1s have proved to be highly effective for this purpose (and even cost-effective, according to a recent analysis).

To address this gap in coverage for GLP-1s to treat obesity, CMS is launching a model called BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) under which CMS will negotiate pricing and coverage rules for GLP-1s, with the aim of expanding access to these medications and lifestyle interventions to support weight loss. The model, beginning in 2026 for Medicaid and 2027 for Medicare, is voluntary for drug manufacturers, state Medicaid programs, and Medicare Part D plans.

This analysis examines CMS’s Medicare Part D claims data from 2019 to 2024 to document the increase in the number of beneficiaries being treated with GLP-1 drugs and the growth in Medicare spending and claims for GLP-1s. Expansion of coverage under Medicare of GLP-1s to treat obesity under the BALANCE model is likely to increase utilization above current levels, as Medicare begins to meet the demand for obesity drugs among beneficiaries who have been unable to access or afford these medications to date. At the same time, the availability of Medicare’s lower negotiated price for certain GLP-1 products under the Medicare Drug Price Negotiation Program (semaglutide beginning in 2027 and dulaglutide beginning in 2028) could mitigate the increase in Medicare spending that could come about from ongoing and expanded use of these medications.

Ozempic Was Used by Two Million Medicare Part D Enrollees in 2024, Up from Fewer Than 150,000 in 2019

Semaglutide, the GLP-1 drug branded as Ozempic, Rybelsus, and Wegovy, was the most used GLP-1 in 2024. Two million Part D enrollees took Ozempic, which was approved by the FDA in 2017 to treat type 2 diabetes, up from fewer than 150,000 in 2019 (Figure 1). Nearly 1 million Part D enrollees took Mounjaro, approved in 2022 for type 2 diabetes, up from 54,000 in 2022. This increase reflects a pattern of growing use of newer GLP-1s, such as Ozempic and Mounjaro, while use of older products, such as Byetta (approved in 2005), Victoza (approved in 2010), and Trulicity (approved in 2014), has declined. While most GLP-1 drugs are currently available as injections, the introduction of new oral formulations, which could be easier for patients to take, could result in additional shifts in utilization among GLP-1s.

Medicare Part D Gross Spending on GLP-1s Increased Five-Fold Between 2019 and 2024, But Estimated Rebates of Around 50% Mean That Net Spending is Much Lower

Gross Medicare Part D spending on GLP-1s in 2024 (not accounting for rebates) totaled $27.5 billion, a five-fold increase from 2019, reflecting an expansion in use of GLP-1s with more recent FDA approvals for type 2 diabetes. (FDA approvals of Wegovy for cardiovascular disease and Zepbound for sleep apnea occurred in 2024 and therefore these uses are likely not reflected in Part D data through 2024.) More than half of gross spending in 2024 was on semaglutide products (Ozempic, 47%; Rybelsus, 7%; Wegovy, 1%) and nearly one fourth (23%) was for Mounjaro. Gross spending overstates the true cost of these products to the Medicare program, however. According to estimates from MedPAC, negotiated rebates for diabetic therapy were equal to or greater than 50% in 2023. Assuming rebates of 50% across all GLP-1 products in 2024 would mean net spending of around $14 billion in 2024.

Claims for GLP-1s Increased Four-Fold Between 2019 and 2024

In accordance with an increase in both the number of Medicare Part D enrollees using GLP-1s and spending on these products, the number of claims for GLP-1s increased four-fold between 2019 and 2024, from 4.8 million to 21.8 million, with claims doubling between 2022 and 2024 alone. More than 10 million claims for Ozempic were submitted in 2024, up from 524,000 in 2019 (an 82% average annual growth rate) and another 5.1 million for Mounjaro, up from 122,000 in 2022 (average annual growth of 549%).

In December, Nebraska was the first state to announce that it would be enforcing Medicaid work requirements early, starting May 1, 2026. The 2025 reconciliation law requires states to condition Medicaid eligibility for adults in the ACA Medicaid expansion group and enrollees in partial expansion waiver programs (Georgia and Wisconsin) on meeting work requirements starting January 1, 2027; however, states have the option to implement requirements sooner through a state plan amendment (as is the case for Nebraska) or through an approved 1115 waiver. Implementing work requirements will require complex changes to eligibility and enrollment systems, as well as enrollee outreach and education, staff training, and coordination with managed care plans, providers, and other stakeholders. Early reports from the state during its recent January Medicaid Advisory Committee (MAC) meeting and data from KFF’s Medicaid work requirements tracker provide initial insight into how Nebraska is preparing to implement Medicaid work requirements. Similar information from MAC meetings in other states and data on the KFF tracker can be helpful to assess how other states may implement new requirements as well. 

Most Medicaid adults in Nebraska under age 65 who will be subject to the new work requirements are working already or attending school. As of March 2025, there were about 72,000 expansion enrollees in Nebraska who could be affected by the new requirements. KFF analysis indicates that roughly 65% of Medicaid adults without dependent children in Nebraska who could be subject to work requirements work 80 or more hours per month or are attending school. In addition, many enrollees who are not working the required hours will likely qualify for exemptions from the new work requirements.

In a recent Medicaid Advisory Committee (MAC) meeting, Nebraska provided a first look into how the state is planning to implement work requirements. All states are required to have a Medicaid Advisory Committee to advise the State Medicaid agency about health and medical care services. These groups include Medicaid enrollees, advocates, and providers. In its January 15, 2026 meeting, Nebraska state officials provided early insight into key decisions related to work requirements and look-back periods, data matching, medically frail exemptions, enrollee verification, short-term hardship exceptions, and outreach (Table 1). State officials also confirmed that the state does not intend to hire or increase staffing levels to facilitate implementation of work requirements or other eligibility changes.

There remain multiple operational and implementation issues the state will need to resolve in the next four months. State officials emphasized that conversations with the federal government are ongoing, and that Centers for Medicare and Medicaid Services (CMS) staff had recently travelled to Nebraska to plan implementation with state officials. As part of the MAC meeting discussion, state officials noted areas where there is ongoing work to identify data sources to verify compliance or exemption status:

• Volunteer activities. Officials acknowledged they had not yet determined how volunteer activities will be defined or how volunteer activities could be identified through data matching. Current guidance from CMS does not clearly outline what types of volunteer activities count towards compliance with Medicaid work requirements.
• Education activities. Officials said the state is working on specifics for defining hours of educational activity using course credit hours. The state is also exploring data matching for educational activities, including higher education enrollment data.
• Work verification. Data matching for work hours was not discussed during the meeting, though officials confirmed that, as required by the reconciliation law, individuals can meet the work requirement if they are working and earn the equivalent of the federal minimum wage multiplied by 80 hours in a qualifying month.
• Number of enrollees affected. State officials could not yet provide internal estimates of how many enrollees could already be identified as in compliance with the new requirements using currently available data sources, but explained they are currently running models to see who they can identify as being in compliance or exempt from Medicaid work requirements.

KFF is tracking metrics related to Medicaid enrollment, renewal outcomes, and application processing times that can provide insight into a state’s potential readiness to implement data matching and other necessary system changes. As of September 2025, Nebraska was performing in line or better across several renewal metrics compared to the United States national average (Figure 1). Nearly nine in ten applications were processed within 30 days and eight in ten individuals going through a Medicaid eligibility redetermination had their coverage renewed. Of people who retained coverage, 88% were renewed via ex parte processes (meaning the state verifies ongoing eligibility through available data sources before sending a renewal form or requesting documentation from an enrollee), although this percentage in September 2025 was higher than the average of 69% across the prior 6 months. Among those who were disenrolled, 53% were terminated for procedural reasons (meaning an individual was disenrolled because they did not complete the renewal process). While these metrics provide insight into Nebraska’s Medicaid eligibility systems, they are not the only indicators or predictors of successful implementation of work requirements, which will also require enrollee outreach and education, staff training, and coordination with managed care plans, providers, and other stakeholders.

As states implement work requirements, ongoing monitoring can help assess how processes are working and identify areas of concern. Central to that oversight is timely data on renewal outcomes, including data on disenrollments related to work requirements. While available data (highlighted above) from CMS can be helpful, these data are not timely enough for real-time monitoring and they do not isolate outcomes for the expansion population. States can fill that gap by reporting more timely data on application and renewal outcomes that include breakouts for individuals subject to work requirements. During the MAC meeting, state officials in Nebraska communicated their intention to be transparent in reporting how many enrollees are disenrolled.

As part of broader efforts to reduce immigration, the U.S. Department of State (DOS) recently announced that it will pause issuance of all immigrant visas for individuals from 75 countries. This analysis shows that workers from 69 of the 75 countries affected by the pause for which data are available make up nearly one in ten (8%) of the U.S. health care workforce. The pause will likely reduce the supply of workers and particularly health care workers in the U.S., which could exacerbate existing health care worker shortages. Shortages are likely to be compounded by other policies limiting immigration into the U.S. as well as ongoing deportation efforts. Estimates suggest the Trump administration’s policies could reduce legal immigration to the U.S. by 33% to 50% over four years.

On January 14, 2026, the DOS announced that it will pause processing of immigrant visas for individuals from 75 countries who it identified as at, “high risk for use of public benefits” and becoming a public charge. (See Methods for full list of impacted countries). This policy is part of broader efforts to expand public charge policies.The DOS indicates that the pause is being implemented to ensure “immigrants must be financially self-sufficient and not be a financial burden to Americans”. However, the DOS has not provided details about the process used to identify countries subject to the pause. Moreover, few immigrants are eligible for federal benefits due to longstanding restrictions. For example, most lawfully present immigrants have to wait five years after obtaining a “qualified” immigration status to be eligible for federal programs including Medicaid and the Supplemental Nutrition Assistance Program (SNAP).  

The pause went into effect on January 21, 2026, for nationals from the 75 countries applying for immigrant visas. Immigrant visas allow an individual to live and work in the U.S. on a permanent basis and can provide a pathway to citizenship. Examples of immigrant visas include family-based visas (when a U.S. citizen or lawful permanent resident (LPR or “green card” holder) sponsors a family member for permanent residency), certain types of employment-based  visas, as well as refugee visas (although entry of refugees to the U.S. has already largely been eliminated through executive action). Individuals applying for non-immigrant visas such as a student visa, tourist visa, or temporary work visa like H-1B are not impacted by the pause. The DOS states that, during this pause, applicants from impacted countries may submit visa applications and attend visa interviews, but that it will not issue any immigrant visas. The pause does not impact immigrants from the 75 countries who are already present in the U.S.

Foreign-born workers from 69 of the 75 countries impacted by the DOS visa pause for which data are available make up nearly one in ten (8%) of health care workers in the U.S. Based on KFF analysis of 2025 Current Population Survey data, there were 7.8 million foreign-born workers (ages 19 to 64) from 69 of the 75 countries impacted by the visa pause as of 2025, including 1.2 million health care workers. A little over half (55%) of health care workers from these countries are employed in health care support occupations such as home health aides and nursing aides, and the remaining 45% are in health care practitioner and technical occupations such as physicians, surgeons, and nurses. These workers include individuals who may have arrived on immigrant or non-immigrant visas since the data do not include information on visa type. Separate data for the remaining six countries affected by the pause (The Gambia, Kosovo, Kyrgyz Republic, Rwanda, South Sudan, and Tunisia) were not available. Among foreign-born workers from the 69 countries, those from Haiti (13%), Jamaica (10%), and Nigeria (9%) made up about one in three (32%), or the highest shares, of health care workers. Workers from 69 of the 75 countries affected by the DOS visa pause accounted for 6% of the total U.S. adult workforce and 8% of health care workers under age 65 (Figure 1). Immigrants from other countries not impacted by the pause accounted for 14% of the U.S. adult workforce and 11% of health care workers, and U.S.-born citizens accounted for the remaining eight in ten workers.

For many years, KFF polling has found that the high cost of health care is a burden on U.S. families, and that health care costs factor into decisions about insurance coverage and care seeking. These costs also rank as the top financial worry for adults and their families. This data note summarizes recent KFF polling on the public’s experiences with health care costs. Main takeaways include:

• Just under half of U.S. adults say it is difficult to afford health care costs, and about three in ten say they or a family member in their household had problems paying for health care in the past 12 months. Hispanic adults, young adults, and the uninsured are particularly likely to report problems affording health care in the past year.
• The cost of health care can lead some to put off needed care. About one-third (36%) of adults say that in the past 12 months they have skipped or postponed getting health care they needed because of the cost. Notably three in four (75%) uninsured adults under age 65 say they went without needed care because of the cost.
• The cost of prescription drugs prevents some people from filling prescriptions. About one in five adults (21%) say they have not filled a prescription because of the cost while a similar share (23%) say they have instead opted for over-the-counter alternatives. About one in seven adults say they have cut pills in half or skipped doses of medicine in the last year because of the cost. A third of all adults say they have taken at least one of these cost saving measures in the past year, including larger shares of women and those with lower incomes.
• Health care debt is a burden for a large share of Americans. In 2022, about four in ten adults (41%) reported having debt due to medical or dental bills including debts owed to credit cards, collections agencies, family and friends, banks, and other lenders to pay for their health care costs, with disproportionate shares of Black and Hispanic adults, women, parents, those with low incomes, and uninsured adults saying they have health care debt.
• Those who are covered by health insurance are not immune to the burden of health care costs. Almost four in ten insured adults under the age of 65 (38%) worry about affording their monthly health insurance premium and large shares of adults with employer-sponsored insurance (ESI) and those with Marketplace coverage rate their insurance as “fair” or “poor” when it comes to their monthly premium and to out-of-pocket costs to see a doctor.
• Notable shares of adults say they are worried about affording medical costs such as the cost of health care services (including the cost of health insurance and out-of-pocket costs for things like office visits and prescription drugs). About two-thirds of adults say they are either “very worried” (32%) or “somewhat worried” (34%) about being able to afford the cost of health care for themselves and their families. The cost of health care ranks at the top of the list when it comes to things that people worry about affording, followed by food, utilities, and other household expenses.

Difficulty Affording Medical Costs

Many U.S. adults have trouble affording health care costs. While lower income and uninsured adults are the most likely to report this, those with health insurance and those with higher incomes are not immune to the high cost of medical care. Just under half of U.S. adults say that it is very or somewhat difficult for them to afford their health care costs (44%). Uninsured adults under age 65 are much more likely to say affording health care costs is difficult (82%) compared to those with health insurance coverage (42%). Additionally, a slight majority of Hispanic adults (55%) and half of Black adults (49%) report difficulty affording health care costs compared to about four in ten White adults (39%). Adults in households with annual incomes under $40,000 are more likely than adults in households with higher incomes to say it is difficult to afford their health care costs. (Source: KFF Health Tracking Poll: May 2025)

When asked specifically about problems paying for health care in the past year, about three in ten (28%) adults say they or a family member in their household had problems paying for care, rising to four in ten among Hispanic adults (41%) and young adults ages 18 to 29 (40%). Among those under age 65, six in ten (59%) uninsured adults report problems paying for health care in the past year, about twice the share of insured adults who say the same (30%). (Source: KFF Health Tracking Poll: November 2025)

The cost of care can also lead some adults to skip or delay seeking services, with one-third (36%) of adults saying that they have skipped or postponed getting needed health care in the past 12 months because of the cost. Women are more likely than men to say they have skipped or postponed getting health care they needed because of the cost (38% vs. 32%). Adults ages 65 and older, most of whom are eligible for health care coverage through Medicare, are much less likely than younger age groups to say they have not gotten health care they needed because of cost.

Three-quarters of uninsured adults say they have skipped or postponed getting the health care they needed due to cost. Having health insurance, however, does not offer ironclad protection as about four in ten adults with insurance (37%) still report not getting health care they needed due to cost. (Source: KFF Health Tracking Poll: May 2025)

Skipping care due to costs can have notable health impacts. Nearly two in ten adults (18%) report that their health got worse because they skipped or delayed getting care. Among adults under age 65, those who are uninsured are twice as likely as those with health coverage to say that their health worsened due to skipped or postponed care (42% vs. 20%). About four times as many adults under age 65 (23%) say their health got worse after skipping or postponing care as adults ages 65 and older (6%), most of whom have Medicare coverage. (Source: KFF Health Tracking Poll: May 2025)

A 2022 KFF report found that people who already have debt due to medical or dental care are disproportionately likely to put off or skip medical care. Half (51%) of adults currently experiencing debt due to medical or dental bills say in the past year, cost has been a probititor to getting the medical test or treatment that was recommended by a doctor. (Source: KFF Health Care Debt Survey: Feb.-Mar. 2022)

Prescription Drug Costs

The high cost of prescription drugs also leads some people to cut back on their medications in various ways. About one in four adults (23%) say in the past 12 months they have taken an over-the-counter drug instead of getting a prescription filled because of cost concerns and about one in five (21%) say they have not filled a prescription due to the cost. Additionally, about one in seven adults (15%) say that in the past 12 months they have cut pills in half or skipped doses of medicine due to cost.

One-third of the public (33%) say they have taken any of these cost saving measures in the past 12 months. Four in ten women (39%) say they have taken any of these prescription medication measures compared to one-quarter (26%) of men. Additionally, just under half of Hispanic adults (46%) say they’ve either taken an over-the-counter drug, skipped doses, or not filled prescriptions because of the cost, compared to three in ten (29%) White adults who say the same. Similarly, larger shares those with lower incomes report having taken a cost-saving measure in the last year compared to those with higher incomes (41% of those with a household income of less than $40,000 a year vs. 29% of those with an income of $40,000 or more). (Source: KFF Health Tracking Poll: May 2025)

Notably, adults with chronic conditions, who tend to have higher health care and medication needs, can often face challenges affording prescriptions. In KFF’s 2023 Survey of Consumer Experiences with Health Insurance, insured adult with a chronic condition were twice as likely as those without a chronic condition to say they had delayed or gone without prescription drugs due to the cost (18% vs. 9%).

Health Insurance Cost Ratings

Health insurance provides some financial protection, but premiums and out-of-pocket costs can still present a financial burden for many individuals. Overall, most insured adults rate their health insurance as “excellent” or “good” when it comes to the amount they have to pay out-of-pocket for their prescriptions (61%), the amount they have to pay out-of-pocket to see a doctor (53%), and the amount they pay monthly for insurance (54%). However, at least three in ten rate their insurance as “fair” or “poor” on each of these metrics, and affordability ratings vary depending on the type of coverage people have.

Adults who have private insurance through employer-sponsored insurance or Marketplace coverage are more likely than those with Medicare or Medicaid to rate their insurance negatively when it comes to their monthly premium, the amount they have to pay out of pocket to see a doctor, and their prescription co-pays. About one in four adults with Medicare give negative ratings to the amount they have to pay each month for insurance and to their out-of-pocket prescription costs, while about one in five give their insurance a negative rating when it comes to their out-of-pocket costs to see a doctor.

Medicaid enrollees are less likely than those with other coverage types to give their insurance negative ratings on these affordability measures (Medicaid does not charge monthly premiums in most states, and copays for covered services, where applied, are required to be nominal). (Source: KFF Survey of Consumer Experiences with Health Insurance)

Health Care Debt

In June 2022, KFF released an analysis of the KFF Health Care Debt Survey, a companion report to the investigative journalism project on health care debt conducted by KFF Health News and NPR, Diagnosis Debt. This project found that health care debt is a wide-reaching problem in the United States and that 41% of U.S. adults currently have some type of debt due to medical or dental bills from their own or someone else’s care, including about a quarter of adults (24%) who say they have medical or dental bills that are past due or that they are unable to pay, and one in five (21%) who have bills they are paying off over time directly to a provider. One in six (17%) report debt owed to a bank, collection agency, or other lender from loans taken out to pay for medical or dental bills, while similar shares say they have health care debt from bills they put on a credit card and are paying off over time (17%). One in ten report debt owed to a family member or friend from money they borrowed to pay off medical or dental bills.

While four in ten U.S. adults have some type of health care debt, disproportionate shares of lower income adults, the uninsured, Black and Hispanic adults, women, and parents report current debt due to medical or dental bills.

Vulnerabilities and Worries About Health Care and Long-Term Care Costs

At the start of 2026, health care costs are at the top of the list of people’s financial worries, with two-thirds (66%) saying they are at least somewhat worried about affording the cost of health care, including the cost of health insurance and out-of-pocket costs for things like office visits and prescription drugs for themselves and their families. This is larger than the shares who say they worry about affording food and groceries (57%), utilities (57%), housing costs (52%), and gas or other transportation expenses (52%) for their families.

Notably, about nine in ten uninsured adults under age 65 say they are worried about affording the cost of health care (88%), but a large share of insured adults are also worried (68%). Health care costs are at the top of household cost worries across insurance types and partisans. (Source: KFF Health Tracking Poll: January 2026)

Many U.S. adults may be one unexpected medical bill from falling into debt. About half of U.S. adults say they would not be able to pay an unexpected medical bill that came to $500 out of pocket. This includes one in five (19%) who would not be able to pay it at all, 5% who would borrow the money from a bank, payday lender, friends or family to cover the cost, and one in five (21%) who would incur credit card debt in order to pay the bill. Women, those with lower household incomes, Black and Hispanic adults are more likely than their counterparts to say they would be unable to afford this type of bill. (Source: KFF Health Care Debt Survey: Feb.-Mar. 2022)

Among older adults, the costs of long-term care and support services are also a concern. Almost six in ten (57%) adults 65 and older say they are at least “somewhat anxious” about affording the cost of a nursing home or assisted living facility if they needed it, and half say they feel anxious about being able to afford support services such as paid nurses or aides. These concerns also loom large among those between the ages of 50 and 64, with more than seven in ten saying they feel anxious about affording residential care (73%) and care from paid nurses or aides (72%) if they were to need these services. See The Affordability of Long-Term Care and Support Services: Findings from a KFF Survey for a deeper dive into concerns about the affordability of nursing homes and support services.