The 2026 midterm elections have reset the political landscape in Washington and across several states, introducing new dynamics for healthcare policy, regulatory oversight and the financial environment in which healthcare organizations operate.
For healthcare executives, the implications extend well beyond the balance of power in Congress. The next two years will bring important decisions around Medicaid, Medicare reimbursement, affordability, coverage, innovation and the role of the public and private sectors in delivering care. At the same time, implementation timelines, state budget pressures and regulatory uncertainty will require organizations to remain nimble in their strategic and operational planning.
During the Nashville Health Care Council’s November Virtual Policy Update, moderator Vice President of Community and Government Relations at Ballad Health John Goetz, joined Operating Director of Health Policy at The Vistria Group, Liz Jurinka, and Founding Partner at Marshall & Popp, Monica Popp, for a timely examination of the post-election environment and the policy developments healthcare leaders should be watching.
Several themes emerged as particularly consequential for the industry in 2027.
The midterms establish a new balance of power in Congress, but the practical implications for healthcare policy will take time to emerge. New members, leadership transitions and changing state political dynamics will influence which priorities advance and how policymakers approach the next legislative session.
Affordability remains a defining issue for voters and a central lens through which both parties are likely to evaluate healthcare policy. However, translating that concern into legislative action is considerably more complex. Proposals addressing premiums, out-of-pocket costs, prescription drugs and access will require difficult decisions about funding, reimbursement and who ultimately absorbs the cost.
For healthcare organizations, the distinction between political messaging and actionable policy will be important. Leaders should monitor not only the proposals gaining attention, but also the legislative mechanisms, budget considerations and political coalitions required to move them forward.
With a change in congressional control comes increased opportunity for oversight of federal agencies, programs and administration policies. Healthcare organizations should anticipate greater scrutiny of regulatory decisions and federal initiatives, particularly in areas such as prescription drug pricing agreements, health insurance exchange participation, FDA oversight, NIH funding and emerging technology.
Oversight can have operational consequences even when it does not result in immediate legislative changes. Congressional inquiries, information requests and investigations can redirect agency resources, slow regulatory activity and create additional demands for organizations involved in federally supported programs.
For organizations participating in federal initiatives, the takeaway is to maintain strong compliance practices, clear documentation and the ability to respond to increased information requests. Regulatory uncertainty is not simply a policy concern; it can affect timelines, resources and execution.
Medicaid is one of the most consequential areas to watch as federal policy changes move into implementation. While the new Congress may pursue efforts to repeal or revise provisions enacted in recent legislation, broad legislative reversal is far from assured. More incremental adjustments—including changes to implementation timelines, temporary pauses or modifications to specific requirements—may become part of the discussion.
The state-level impact is particularly important. Medicaid is a federal-state partnership, and states will be responsible for translating federal requirements into operational and budgetary decisions. Changes in gubernatorial leadership, legislative control and Medicaid expansion status could create very different implementation environments across the country.
For multi-state healthcare organizations, this creates an increasingly complex planning landscape. State fiscal conditions, enrollment requirements, work requirements, eligibility revalidations, provider taxes and supplemental payment arrangements may all influence financial projections and access to care.
Importantly, state budget pressures were already emerging as pandemic-era funding expired. Those pressures will not disappear with election results, making Medicaid policy and state fiscal planning closely connected priorities for 2027.
Healthcare affordability was a prominent theme in the election, and it will remain central to the policy conversation. Yet reducing costs while maintaining access, quality and financial sustainability presents a difficult challenge: savings in one part of the system often create financial pressure somewhere else.
Transparency measures, protections from out-of-pocket costs, prescription drug reforms and payment policy changes are all potential areas of continued attention. But the underlying economics matter. Every affordability proposal raises questions about who pays, who benefits and how costs shift across the healthcare ecosystem.
For healthcare organizations, this reinforces the importance of demonstrating measurable value. Efficiency, appropriate utilization and care delivered in the most effective and lowest-cost setting will remain important considerations. As utilization patterns and site-of-care decisions receive greater attention, organizations will need to understand how their operating models affect both cost and patient experience.
The broader challenge is to connect the value delivered to the financial and consumer realities people experience. Cost savings that are not visible to patients, employers or beneficiaries may do little to build confidence in the system.
Artificial intelligence and healthcare technology continue to raise important questions around innovation, oversight, national security and infrastructure. While there is bipartisan interest in discussing AI policy, comprehensive federal legislation may take time to develop. The pace of technological advancement, questions around data infrastructure and growing public concerns about data centers add complexity to the debate.
In 2027, healthcare leaders should watch for congressional hearings, regulatory activity and policy development that could influence how AI is deployed and governed. The conversation will likely extend beyond the technology itself to the infrastructure, data and oversight frameworks required to support it.
For healthcare organizations investing in innovation, the policy environment is another reason to evaluate long-term technology strategies with an understanding of potential regulatory and infrastructure considerations.
The transition between Congresses creates a narrow window for action on outstanding legislation and funding measures. The end-of-year continuing resolution, potential healthcare payment extensions and other must-pass legislation could create opportunities for bipartisan negotiations before the new Congress begins.
Looking into 2027, FDA user fee reauthorization and related innovation policy are among the areas where bipartisan engagement may develop. Other issues, including physician reimbursement, drug pricing, site-neutral payment and Medicare solvency, will continue to warrant attention, though the path to meaningful agreement remains uncertain.
For executives, understanding when decisions may occur is just as important as understanding what is being considered. Legislative deadlines, regulatory implementation dates and state budget cycles can all affect the timing of financial and operational decisions.
The post-midterm environment is not defined by a single policy shift. It is a convergence of political transitions, fiscal constraints, regulatory scrutiny and growing pressure to demonstrate healthcare value.
For senior leaders, several priorities stand out:
The healthcare policy landscape will continue to evolve throughout 2027, and the distinction between what is proposed, what is enacted and what is ultimately implemented will be critical. For the healthcare ecosystem, staying informed and connected across sectors is essential to understanding these developments and navigating their implications for the business of healthcare.
The Nashville Health Care Council serves as common ground for the vibrant healthcare community, bringing together leaders from across the healthcare ecosystem to exchange ideas, share perspectives and explore the complex issues facing the industry. Through curated convenings, educational programs and meaningful connections, the Council creates space for candid dialogue, diverse perspectives and productive conversations that might not otherwise happen. As a neutral convener, the Council does not advocate for a particular position or seek consensus. Instead, we bring the right people to the table, foster thoughtful discussion and extend important insights to the broader healthcare community, helping move conversations and opportunities forward while strengthening and elevating Nashville as The Healthcare City.
The Nashville Health Care Council shares recaps and key insights from our convenings to extend the value of these conversations to our broader community. The perspectives and information reflected are those shared by participating experts and speakers and do not necessarily represent the views, positions, or opinions of the Nashville Health Care Council.