Even a master seer would have problems predicting what may occur in healthcare in 2026.
In my last blog, I gave you my 2025 Healthcare Year In Review. After that, as I always do each year, I play Nostradamus to prognosticate about what will happen in the next 12 months in the world of healthcare. Despite my Irish last name, I do have French blood (well, 50% French Canadien, so I count it). But I don’t claim to be an oracle or seer like our 16th century physician, apothecary, and astrologer friend.
I do take a page from Nostradamus, though, in that my healthcare predictions for 2026 (not really prophecies) will be sometimes deliberately vague (they include a lot of less thans, abouts, probabilities, mays, coulds, shoulds, perhaps, likelys and possibles) so as to amass a reasonable record for those tracking and putting together my forecasting report card for the history books. It also tends to make my head bigger (as if it needs it) and boost my sometimes fragile ego.
Here is hoping my crystal ball is clear and not cloudy, but don’t hold me to any of this; I am simply your intrepid Healthcare Labyrinth blogger having a little fun.
Happy New Year and to a great 2026 to all of you personally and professionally. Remember that a lasting legacy is not in the money you leave behind, but in the lives you impact – family, friends, and the greater community.
My 2025 Prediction Report Card
Where I was right:
- The influence of conservative think tanks on Trump.
- Healthcare nominees approved.
- Major Department of Government Efficiency (DOGE) cuts and employee downsizing as well as regulatory repeals.
- Passage of the Big Beautiful Bill with tax cuts.
- Trump and the GOP would shy away from a master overhaul of healthcare programs but still dramatically impact coverage with reductions in Medicaid and the Exchanges.
- Promotion of individual coverage.
- Enhanced Exchange subsidies would expire at the end of 2025.
- “Making America Healthy Again” will be a reality.
- Health plan financial troubles and major costs, with a huge shakeup in plan leadership to help plot a recovery.
- MA enrollment growth, yet contraction in offerings; poor Star performance as well as overpayment activity.
- Drug price reform by Trump, including pushing MFN pricing.
- PBM transparency would take hold.
- Prior authorization (PA) reforms.
- Greater interoperability proposals.
- Partial Medicare doc rate fix.
- Beginnings of site neutral payment reform.
- Some rise in the uninsured rate.
Where I was wrong:
- PBM reform (almost, but didn’t happen).
- Antitrust efforts (not much focus).
- Supplemental benefits and marketing reform in MA.
- MA as default option and other reforms in the One Big Beautiful Bill.
- Retreating on some Part D Inflation Reduction Act cost-sharing changes.
- Possible Medicaid reimbursement cuts and restructure (although the provider taxes were phased down).
- Employer tax deductibility possibly changed.
2026 predictions
- New government shutdown: There is a less than 50-50 chance that there will be a second government shutdown.
- Exchange subsidy extension: There is about a 50-50 chance that a last-minute compromise on some sort of enhanced Exchange premium subsidy extension could occur.
- Healthcare reform: There is a higher probability that the GOP will seek further healthcare reforms to attempt to insulate the party from fallout on affordability in the 2026 midterms. Changes could include expansion of Health Savings Accounts (HSAs), leaner coverage products, and personalized approaches.
- Midterm elections: Despite GOP efforts to cast aside affordability in general and with healthcare specifically, the GOP may see major losses in the 2026 midterms. The GOP may have between 51 and 53 seats in the Senate (holding the current count or losing two seats) and the House likely will flip to Democratic control. Democrats may gain between 20 and 30 seats, giving them 235 to 245 seats to the GOP’s 190 to 200.
- Tariffs: The president’s tariffs likely will largely be struck down by the Supreme Court, including for drugs and medical devices.
- Health plan finances: Health plans will see recovery in 2026 but be impacted by high costs and trends. Still, investors should see plans hitting targets and this will cause stocks to recover.
- Drug prices: Drug price reform should continue under the president’s guidance, including GLP-1 coverage in 2027 for obesity in Medicare and lower cost-sharing.
- MA: MA likely does not contract in 2026 as many project but will see a leveling off or just small growth. MA rates should be big for 2027 given huge trends. Star changes will be finalized. The Centers for Medicare and Medicaid Services (CMS) may try to move forward on Risk Adjustment Data Validation (RADV) audits but be hobbled by the federal ruling against it. It will lose appeals, but Congress may pass overpayment reform or CMS could (perhaps less likely) adjust rates for some overpayments. Congress may also pass further PA reforms and PBM reforms. Plans are likely to rein in mainstream offerings slightly again in 2027 while continuing investments in SNPs.
- AI: AI regulation will be hotly debated, with states challenging the president’s bar on state-level regulation.
- M&A: M&A will recover but Congress and the administration may seek to intervene to stop and better regulate mergers and consolidations. Modest vertical integration reforms may finally pass.
With that, again I wish everyone a Happy New Year in 2026!
#healthcare #healthcarereform #healthinsurance
— Marc S. Ryan
