Predicting the future of health policy is never simple. Even the best forecasts can shift when unexpected political or economic events hit. But as we move closer to 2026, several major issues are already rising to the surface—issues that will likely influence the cost of care, access to coverage, and the everyday experience of patients across the country.
At the heart of everything is affordability. For many Americans, health care costs are no longer an abstract policy concern—they are a direct and growing financial strain. If federal premium subsidies under the Affordable Care Act are not renewed, Marketplace enrollees could face sharp increases in what they pay each month. Rising premiums would amplify the already mounting stress families feel from increases in housing, groceries, utilities, and overall cost of living. In a year when the economy and household budgets are front of mind, the affordability of health care could quickly become one of the defining political issues of 2026.
These potential cost increases could also change how people behave within the insurance market. Some may shift into leaner, high-deductible plans that reduce premiums but offer less protection. Others may decide that coverage has become unaffordable altogether and drop out, creating a risk of growing numbers of uninsured individuals. The true impact will depend on who leaves—whether it’s younger, healthier individuals or older adults and people with chronic conditions who need coverage most. Their decisions will shape the stability of the Marketplaces and ripple through the broader health-care system.
Medicaid will also be entering a period of transition. New work requirements are scheduled for 2027, but states will begin preparing throughout 2026. How these requirements are implemented will depend heavily on state politics. Some states may pursue strict policies intended to shrink enrollment, while others may try to preserve flexibility and keep people covered. Either approach could dramatically affect who remains insured and how easily vulnerable populations can maintain access to care.
Meanwhile, employer-sponsored coverage—the largest source of insurance in the U.S.—may see renewed cost pressures. After a few calmer years, premiums and deductibles could climb again, pushing the average cost of a family plan close to the $30,000 mark. This will strain both businesses and workers. Families who rely on employer coverage may feel squeezed, while employers could face hard decisions about benefit design and cost-sharing. These pressures may revive conversations about the drivers of health-care costs, particularly hospital prices and prescription drug spending.
Policy discussions around hospitals are likely to intensify. Hospital costs remain one of the strongest forces pushing overall spending upward. Ideas such as site-neutral payment, global budgets, or caps on certain hospital charges may re-emerge as states look for ways to manage spending. Drug prices will continue receiving attention as well, though they represent a smaller share of total costs compared to hospital care.
Another major theme for 2026 is frustration over prior authorization. Patients and providers continue to experience delays, denials, and administrative hurdles. While there may be voluntary efforts from insurers or industry groups to streamline the process, it remains unclear whether those changes will significantly improve the patient experience or simply shift the burden in different ways.
At the same time, new medical technologies—particularly high-demand drugs like GLP-1s for weight loss and emerging AI-driven diagnostic tools—are raising new questions about access and affordability. Advances in medicine bring incredible promise, but they often increase costs. Without thoughtful policies and coverage strategies, many patients may find that the newest, most effective treatments are out of reach.
Underlying all of this is the political reality. In a divided government and an election year, sweeping health-care reform is unlikely. Instead, Congress may focus on smaller, targeted changes that move spending and coverage in incremental ways. Even modest adjustments—such as tweaks to subsidies, payment structures, or regulatory standards—could have major real-world consequences for millions of people.
Taken together, the forces shaping 2026 point toward a year in which affordability, access, and the everyday usability of the health-care system come into sharper focus than ever. Health care may shift from a background concern to a central household issue, affecting families’ budgets as directly as housing or groceries. It may also push policymakers, insurers, and providers to confront long-standing structural challenges—some of which have been avoided for years.
Whether any of this leads to meaningful reform remains to be seen. But one thing is clear: 2026 will not be a quiet year in health policy. The choices made—by families, by states, by Congress—will shape the future of coverage and care for years to come.