Healthcare Services: Key Considerations for Healthcare Services Ahead of the 2026 Midterm Elections

Research evidence excerpt

Healthcare Services: Key Considerations for Healthcare Services Ahead of the 2026 Midterm Elections

olicy-setting

framework. As a result, we see the most important decisions (e.g., 2028 MA rates, policy

changes around stars) as less impacted by changes in Congress, with minimal changes to

the bureaucratic apparatus. For this key reason, while we acknowledge that there could

be noise around the headlines from Congress, we still see the most influential policy

makers as unchanged and expect to see a continued focus from CMS on prior

authorization, risk coding (particularly in MA), fraud, and AI, consistent with what we

heard from them at AHIP earlier this year.

• For healthcare facilities, policy priorities tend to focus on hospital pricing and

consolidation, protecting financially distressed facilities, and tightening oversight

of ownership and business practices. While we believe that the hospitals maintain

mainstream bipartisan support and sizable lobbying influence (particularly at the local

level), the size and growth of hospital spending in recent years (and subsequent pay-for

potential from reforms) has led to renewed interest in reining in spending growth,

typically under arguments revolving around potential budgetary or profiteering

concerns. This has included dialogue regarding the downstream impact to coverage and

rural/safety net facilities following changes to Medicaid under the OBBBA and coverage

and collections volatility tied to ACA Exchange enrollment shifts, as well as prospective

discussions regarding changes to Medicare payment and delivery-site reform (e.g., site-

neutral, 340B), heightened oversight of market conduct, and use of AI within utilization

management (e.g., WISeR Model). Should nothing change, we think the most concrete,