Taking the pulse of 2026 health policy in the US

Healthcare costs and quality remain key in 2026 as policy changes reshape the industry. Explore our report for insights on what’s ahead.

In brief

• Providers face tighter margins and new compliance in 2026 amid pending Medicaid cuts and scrutiny of hospital pricing.
• Payers confront ongoing regulatory pressure and reimbursement shifts in Medicare Advantage and Medicaid as affordability remains a top priority.
• Drugmakers face MFN and IRA pricing commitments, shifts at FDA and NIH research priorities, and growing data privacy and security concerns.

The affordability of care and coverage remains a pressing concern as patients and employers face increasing health care costs. Ernst & Young LLP explores the policy solutions and more in our Health Policy Review and Outlook for 2026. This preview highlights key policy shifts shaping providers, payers, manufacturers and patients.

Read on to see what’s driving the change and what it means for the future of healthcare policy in America.

2025’s impact on 2026’s healthcare policy

Affordability takes center stage

Healthcare affordability will dominate 2026 policy debates as lawmakers clash over solutions. Democrats have pushed to revive ACA premium tax credits, while the Trump administration prefers tax-advantaged accounts and cost-sharing reductions. Narrow congressional margins and the Senate filibuster make new legislation uncertain. Rising premiums and Medicaid changes tied to the OBBBA will heighten political pressure ahead of the midterms. With Congress focused on the elections, the Trump administration will drive health policy through regulatory actions and private-sector negotiations, pressing insurers to lower rates and advancing drug pricing talks with pharmaceutical companies and foreign governments.

Health policies to watch in 2026

Industry Outlooks

Provider leaders must prepare for a challenging 2026 as Congress intensifies its scrutiny of hospital pricing and the tax-exempt status amid affordability concerns. New compliance demands from the Center for Medicare & Medicaid Innovation (CMMI) models, drug reimbursement tied to maximum fair prices and ongoing CMS reviews of physician pay will reshape operations. Medicaid reimbursement cuts and enrollment shifts linked to the OBBBA add pressure, while the 340B Drug Pricing Program faces a continued regulatory focus and potential reimbursement changes. Download the full report to understand these urgent developments and learn how to navigate the evolving policy landscape to protect your organization’s future.

Payers face mounting pressure from the administration and Congress as affordability brings increased scrutiny of coverage costs and lawmakers target prior authorization and care delays. Medicare Advantage will see lower reimbursements in 2027, alongside shifting risk adjustments and star rating rules. Medicaid payers must manage new OBBBA compliance and operational changes amid funding cuts, while ACA exchange payers struggle with enrollment drops tied to rising premiums.

Drug manufacturer actions on most favored nation deals will be closely monitored, while those with drugs selected for negotiation will engage with the administration throughout the year and will see the effectuation of maximum fair prices for the first 10 negotiated drugs. The industry may also continue to see potential shifts in the Health Resources and Services Administration’s approach to the 340B Drug Pricing Program rebate model pilot and contract pharmacies will need to navigate continued changes and uncertainty related to FDA drug approval processes and research priorities. Data privacy and international data exchange are expected to continue as topics of interest in both Congress and the administration because Republicans are focused on addressing national security concerns related to adversarial countries.