Healthcare affordability and access could shape Congress’ post-midterm priorities

The Trump administration maintains considerable authority to implement health policy through regulatory and agency action. But the outcome of the Nov. 3 midterm elections will shape the prospects for legislative action, congressional oversight and funding priorities leading up to the 2028 presidential election.

A panel of Manatt analysts examined what the midterm results could mean for healthcare.

Several healthcare-related issues still have bipartisan support in Congress, Kendall Hussey, Manatt senior advisor, said. They include healthcare affordability, program integrity, Medicare physician payment reform, reforming the No Surprises Act and lowering prescription drug costs.

Hussey said that although the Make America Healthy Again movement has become fractured in recent months, she expects Health and Human Services Secretary Robert F. Kennedy Jr. to pursue initiatives to address chronic disease and implement H.R. 1 in the coming year.

Next year is when many provisions of H.R. 1 – the One Big Beautiful Bill Act – take effect. One major provision is establishing work requirements and more frequent eligibility redeterminations for people on Medicaid.

“This is not just about affordability but also about basic access to care for people who will lose eligibility in the new year,” said Allison Orris, partner at Manatt. “We are thinking about how the increases in the number of people who are uninsured and the increased amount of uncompensated care for providers will potentially impact healthcare.”

Orris predicted there will be calls in the new Congress to delay or reverse the Medicaid cuts, “but it’s likely to be an uphill battle.”

Congress is not the only government entity facing the fallout from H.R. 1. Medicaid is jointly funded by the federal government and state governments through an open-ended matching program, which means states impacted by these Medicaid cuts “will have to make decisions based on their expectations of what H.R. 1 will do to their budgets,” Orris said.

She predicted some states could make work requirements for Medicaid recipients more restrictive.

“I think this will be a dynamic year for state legislative sessions,” she said.

Opportunities exist for bipartisan solutions for Medicaid program integrity, Orris said, “but the devil is in the details.”

“The states and the federal government have shared interest in integrity in the Medicaid program – both have money on the table here,” she said.

Orris predicted continued targeted audits from the administration and more regulatory activity to crack down on fraud.

“Nobody wants bad actors to have a pass or defraud the government, but to go after bad actors without cutting services is a challenge for Democrats and Republicans to agree on,” she said.

Affordability and anti-fraud in ACA marketplace

H.R. 1 also impacts the Affordable Care Act marketplace. The bill restricts and phases out certain ACA advanced premium tax credits, eliminating subsidies for individuals with incomes below 100% of the federal poverty level who fall into coverage gaps and adding pre-enrollment verification rules. Those preparing to enroll in ACA coverage for 2027 face a median 15% rate increase, higher out-of-pocket maximums, and the permanent end of enhanced temporary tax credits through the HealthCare.gov marketplace or state-based exchanges.

ACA enrollees also face the end of automatic plan renewal, an inability to receive tax credits until they are fully verified and the requirement to be fully verified each year.

“Risk pools will get riskier as enrollees get tripped up in these provisions and fewer people enroll in coverage,” said Ellen Montz, Manatt managing director.

She predicted Congress could address anti-fraud issues by attaching anti-fraud measures to any proposed bill related to ACA marketplace affordability, as well as in a standalone piece of legislation.

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Susan Rupe is editor in chief, magazine, for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at susan.rupe@innfeedback.com.