This year brings several major healthcare policy changes for patients. While some of these changes improve healthcare access and affordability, two key decisions could have a detrimental impact on millions of Americans starting this year.

Policies impacting care in 2026

• Some policy changes in 2026 could be positive for patients, improving access and affordability for the care they need. The Centers for Medicare and Medicaid Services (CMS) will begin modernizing prior authorization procedures, including in Medicare Advantage plans. As a result, decisions could be made within 72 hours for expedited requests and seven calendar days for standard requests—reducing delays in care.
• 2026 is the second year that Medicare Part D beneficiaries will have an annual out-of-pocket (OOP) cap on their prescription drug costs. This year, the annual cap is $2,100, which will continue to be beneficial for many who had previously seen very high OOP costs for prescription medications. However, it’s important to note that $2,100 may be unaffordable for some, especially those on fixed incomes.
• The Medicare Prescription Payment Plan, which allows those on Medicare to spread out their medication costs throughout the calendar year, begins its second year. Unfortunately, many Medicare beneficiaries remain unaware of this payment option, with few opting into this program in 2025.

Despite these potentially positive changes, two policy decisions could, at the same time, negatively impact healthcare access and affordability for many.

The One Big Beautiful Bill Act, passed in 2025, changes Medicaid eligibility, requiring Medicaid recipients to now carry out some kind of work for at least 80 hours a month. Noncompliance with work hours, combined with the administrative burdens this causes, could result in millions being left without insurance.

As of Dec. 31, 2025, expiration of enhanced premium tax credits has left millions of marketplace enrollees facing higher premiums. As a result, and unless subsidies are re-instated by Congress, many have or may make the decision to give up health insurance that is now unaffordable.

Calling on Congress to improve access to care

There are actions Congress can take to improve access to affordable, equitable healthcare for Americans. At the PAN Foundation, we are asking Congress to consider the following:

• Enhanced premium tax credits: By reinstating the enhanced premium tax credits for people enrolled in the ACA marketplace, millions of Americans could afford their premiums and maintain health insurance.
• HELP Copays Act: Requiring all payments made by or on behalf of a patient to count toward deductibles and OOP limits, this bill would improve access for those with commercial insurance.
• Safe Step Act: Requiring group health plans to offer a clear, timely exceptions process when step therapy is not in a patient’s best interest, this bill would connect patients with the care they need faster.
• Improving Seniors’ Timely Access to Care Act: Establishing an electronic prior authorization process for Medicare Advantage plans, this bill would improve the timeliness of care for patients.
• Treat and Reduce Obesity Act (TROA): Enhancing Medicare coverage for obesity treatment, this bill would address the growing obesity epidemic.
• Clinical Trial Modernization Act: Addressing economic and geographic barriers, this bill would help increase clinical trial participation.
• CONNECT for Health Act: Recognizing the benefits of virtual care, this bill would permanently remove restrictions on Medicare coverage of telehealth services.

At PAN, we remain committed to advocating for patient-centered, common-sense policies that expand access to care for people with serious and chronic conditions.

About the Author

Amy Niles is chief mission officer at PAN Foundation.