Election day is finally here though final results may not be known this week due to election protocols and likely challenges in states. Per polls and commentary across the ideological spectrum, Campaign ‘26 is unprecedented for the money spent ($11.9 billion per Open Secrets), the acrimony between candidates and the blatant disinformation featured in campaigns on both sides.
Like most, I am happy it’s behind us. I value civil debate. I don’t think complex issues are explained in soundbites. I value data that’s not cherry-picked and polls that are honest. I hate campaigns that justify any means necessary to win. I respect candidates willing to debate. And I worry that statesmanship in local, state and federal policy-setting has been sacrificed to political brinksmanship.
But while uncertainty may dog the outcome this week and potentially in the weeks ahead, there’s certainty for healthcare in the lame duck session of Congress starting next week and in states:
- State ballot measures and fed mandates will get immediate attention by Governors and state legislatures: implementation of Medicaid work requirements in every state, abortion rights (ID, NV, VA) and referenda that address healthcare funding, school health, vaccines and more in others. CA, CO, MA, MO, NM, NC, RI, SD, WA, and WI). And governors in every Blue State and a few Red States will revisit recission of Medicaid cuts in the Big Beautiful Bill (HR1) slated to start January 1, 2027.
- Trade associations will update their 2027 advocacy agendas and health committee profiles to prepare for the 120th Congress starting in 60 days.
- Lobbyists and consultants will be active with their clients–trade groups, special interests, single issue advocacy 501C3s, municipalities, corporate interests et al—around (1) potential low-hanging legislative wins before the 119th Congress adjourns, (2) potential regulatory shifts in 2027 and (3) extension/expansion of their contracts with clients.
- And the Executive Branch will sequester its key leaders across its agencies (HHS, CMS, FDA, FTC, USDA, DOJ, Commerce, et al) to protect its priorities via prepare Executive Orders, Administrative Actions, Court filings, budget appropriations and key appointments. Price transparency, competition, lower drug costs, less consolidation and stepped-up fraud, waste and abuse efforts will be its emphasis.
Looking to 2027, healthcare will be lightening rod in legislative circles and posturing by White House hopefuls in Campaign 2028. Importantly, two overarching realities will frame politics and policy discussions:
Healthcare is a major contributor to household affordability concerns. Healthcare is one of four major sources of affordability pressure on households along with housing, fuel and groceries. But unlike the other three, healthcare costs are considered unmanageable to voters because they’re often unpredictable, inexplicable and rarely transparent. It’s an issue that garners bipartisan repudiation in politics and unflattering attention to the industry’s opaque business practices.
Healthcare is seen as big business, not public service. The persona of rural hospitals, primary, behavioral and public health, nursing and home care and others is typified by many that struggle and the few that prosper. Stoked by disgruntled employees, physicians and large self-insured employers, bipartisan criticism of consolidation, vertical integration, private equity ownership, board independence, executive compensation, non-profit tax exemptions and more. Corporatization in every sector and regardless of ownership (non-profit, for-profit, or public) will be blamed and capital deployment in healthcare will reflect caution.
Healthcare will be prominent in the election post-mortem this week. Industry leaders face headwinds in the public square with voters and legislators in local, state and federal chambers. Some operate on the assumption that voters will defend the U.S. system against major changes believing it the world’s best. It’s been a safe bet historically, but the future may not be a repeat of the past.
