ACADEMYHEALTH'S SITUATION REPORT: CRITICAL POLICY DEVELOPMENTS WE'RE WATCHING IN 2026

The following information was released by AcademyHealth:

In this edition of AcademyHealth's Situation Report, we highlight key policy developments that shape access to care, health services research, and the role of evidence, especially in light of continued concerns related to the health workforce, Medicaid cuts, NIH and AHRQ grantmaking, and more. As AcademyHealth continues to champion the role of evidence to understand the impact of these changes, we remain committed to keeping the field informed and prepared to take action. Read on for the latest news related to vaccine schedules, NIH grantmaking, rural health funding, and more.

In this issue:

What We'll Be Watching in 2026

NIH Director Predicts Lack of Funding Renewals for Restored DEI Research

HHS Reduces Childhood Vaccine Schedule, Alters Reporting Requirements

Party Divisions Emerge as Democrats Consider Shutdown Over ACA Subsidies

Physicians Express Concern Over Disparities in Rural Health Funding Allocation

Paragon Health Institute Launches New State Health Reform Initiative

What We'll Be Watching in 2026

As 2026 unfolds, health policy is entering a period of heightened uncertainty and heightened demand for credible, timely evidence.AcademyHealth will be closely monitoring developments that shape access to care, the strength of the health services research enterprise, and the role of evidence in policy and practice. Key pressure points to watch include:

The stability of the federal health services research enterprise

Significant workforce losses and operational disruptions at AHRQ have sharply constrained the agency's ability to award and manage research grants, with ripple effects across the health services research community.After layoffs, early retirements, and hiring freezes, an estimated 80 percent of AHRQ staffers have left the Agency. This has led to a collapse in the ability of the Agency to lawfully execute on the appropriations that they have, specifically in their extramural grantmaking and scientific review portfolios. Since April 1, 2025, AHRQ has not awarded a single new grant. And since September 30, they have not awarded a single dollar for any continuing grants. This constitutes an illegal impoundment,when the Executive Branch withholds or refuses to spend funds that Congress has already legally appropriated for specific programs, bypassing the proper legal process. has had a devastating impact on the health service research community and our ability to undertake the evidence generations that saves lives and improves health outcomes. We are laser-focused on forcing AHRQ to restart and restore these grants.

Government spending for the 2026 budget year

Federal funding decisions for FY26 will be critical for determining whether the research and public health infrastructure can recover from recent disruptions. The deal to end the longest government shutdown in our history extended federal funding for 9 of the 12 appropriations bills until January 30. However, the challenges that have plagued this fiscal year, such as illegal impoundments, mass federal layoffs, and sharp shifts in federal policy all remain. We are expecting to see a proposed Labor-HHS bill being released the week of January 19. This isa key piece of legislation that determines funding for numerous federal programs, including the National Institutes of Health (NIH) and other research agencies.We are waiting to see if it will provide necessary support and guardrails for the federal research enterprise or if it will double down on the steep cuts the Administration made last year. If Congress is unable to pass these bills by January 30, they will either have to pass another continuing resolution or trigger a partial government shutdown.

Expert-driven policymaking

Recent changes affecting federal advisory bodies have raised concerns about the consistency and credibility of expert input in health policy decisions. An example of this was the firing of experts on the Advisory Committee on Immunization Practices (ACIP) and how the Committee began relying on poor science to reduce the trust and access of lifesaving vaccines. Because of the loss of credibility of the Committee, outside expert groups, state governments, and intergovernmental collaborations have all risen up to try and fill this vacuum. Additionally, similar threats have faced the US Preventive Services Task Force (USPSTF), although our field's advocacy efforts have so far shown the value of keeping the Task Force credible. We are continuing this educational campaign.AcademyHealth continues to support efforts that reinforce the value of independent, evidence-based guidance in policymaking across the federal government.

Coverage affordability and the ACA marketplaces

The expiration of enhanced ACA marketplace subsidies has renewed the risk of premium increases and coverage losses for millions of people.Congress had until December 31st to avert spiking premiums for millions of consumers who purchase insurance through the ACA marketplaces, and failed to do so. These subsidies were a critical component of the shutdown. At the end of last year, four House Republicans joined House Democrats in signing a discharge petition to force a vote on a three year extension of the subsidies, which will take place in the coming days. If it passes, it faces an uncertain future in the Senate.These dynamics underscore the importance of evidence on affordability, access, and market stability, and will be a key pressure point in the coming months.

Medicaid financing, implementation, and workforce impacts

H.R. 1, a major federal budget and reconciliation bill passed in July 2025, cut nearly a trillion dollars in Medicaid funding, in part due to new requirements around eligibility and restrictions for how states are able to use provider taxes to pay for care. There are deep concerns about the ability of states to build up the infrastructure necessary to implement these cuts, risking even worse losses of coverage. Additionally, this law will limit medical student access to subsidized student loans, which will further restrict the workforce pipeline.Evidence will be essential to understanding how these changes affect patients, providers, and state systems.

Across these issues, AcademyHealth will continue to elevate the role of rigorous health services research in informing policy decisions, supporting effective implementation, and protecting access to care. AcademyHealth's ability to respond to these challenges depends on sustained, independent support. Contributions help us protect the health services research ecosystem, provide timely evidence-informed assistance to policymakers and practitioners, and strengthen the capacity of leaders across sectors to use evidence effectively. If you value credible research and evidence-based decision-making, consider supporting AcademyHealth's work through a donation here.

NIH Director Predicts Lack of Funding Renewals for Restored DEI Research

Despite legal decisions pushing back on directives from NIH to halt or deprioritize grants related to diversity, equity, and inclusion, Director Bhattacharyaintimated that those grants may not be renewed. In June, more than 2,000 terminated grants had their fundingrestored following two lawsuits filed in federal court and a recent agreement with plaintiffs in another lawsuit led to funding of more than a hundredgrants whose reviews had been paused. However, Director Bhattacharya commented on apodcast that while NIH can't cut the funding for grants that they were legally required to restore, the agency may not renew such funding, noting that "these grants no longer meet NIH priorities."

There has been much movement, legally and bureaucratically within NIH, regarding restoring grants, reevaluating proposals, and realigning projects with new priorities. For example, some projects not directly impacted by litigation have been renegotiated, with NIH program officers instructed to make sure their portfolios aligned with the most recent set ofagency priorities. These priorities include broadly-accepted points, such as training future biomedical scientists and artificial intelligence, but also some that have caused concern, such as the emphasis on understanding the etiology of autism, in light of Secretary Kennedy's refutation of evidence-backed consensus on autism and the formation of an autism database. In addition, researchers and NIH staffers have reportedly removed words from projects they believe areflagged by political appointees. It is unclear how NIH leadership will ultimately proceed with DEI research projects, but if Director Bhattacharya is to be believed, the agency will likely not renew funding for projects that "the courts forced [NIH] to restore." The emphasis on NIH's updated research priorities and decision to cease funding to some reestablished grants will continue to impact health researchers' efforts to continue projects and their decisions about applying for NIH funding in the future.

HHS Reduces Childhood Vaccine Schedule, Alters Reporting Requirements

Recent federal policy changes have significantly altered the landscape of childhood immunization in the U.S. On Monday, the CDC introduced an updated childhood vaccine schedule that takes effect immediately, reducing the recommended immunizations from 18 diseases to 11. The removedvaccines are now recommended for "high-risk groups" or by shared decision-making. Notably, the new recommendations mimic Denmark's schedulea comparisoncritics argue is flawed since Denmark has a significantly smaller population and universal health care access. Public healthexperts warn that reducing the number of vaccines recommended vaccines decreases uptake and makes deadly diseases appear benign and condemn the agency's lack of transparency and evidence to inform these decisions.

Additionally, CMS announced that states are no longer required to report childhood and adolescent immunization statuses, though voluntary reporting is still permitted. Approximately40 percent of children are covered by Medicaid, and expertswarn that losing comprehensive childhood immunization data impedes researchers and policymakers from identifying trends in vaccine access.

These changes underscore the critical need for robust, empirical research to generate evidence as well as strengthening the linkage between evidence and policymaking. Policy-level vaccine recommendations can influence key factors related to vaccine uptake, such as school mandates, insurance coverage, and public trust in immunization. Without evidence-informed decision-making, policy changes risk undermining decades of progress and may lead to preventable consequences.

Party Divisions Emerge as Democrats Consider Shutdown Over ACA Subsidies

Anothergovernment shutdown looms as Democratic leaders look to the January 30 government funding deadline as an opportunity to push back on the Administration's health care policies. However, the party is not fully united. Senate Democratic Leader Chuck Schumer of New York does not seem to be in favor of another shutdown, while many Democratic voters and activists were frustrated by the previous shutdown's end when a group of senators voted to reopen the government without their goals met on health insurance premiums. Although enhanced subsidies under Affordable Care Actexpired at the end of 2025, many Democrats still consider the last shutdown a success given health insurance premiums became a top issue ahead of the 2026 election and Trump's approval rating dropped. Democrats could focus on the expired health care premium subsidies again if they force a shutdown this month, this time, with the assurance that the Supplemental Nutrition Assistance Program (SNAP) would not be at stake, given its funding through September 2026. Schumer's goal is to pass five-bill appropriations package this month, which if successful, would fund 85 to 90 percent of the federal government through the fall and virtually remove the possibility of a government shutdown.

Health services researchers should continue to monitor updates on a potential shutdown and how the appropriations package could impact health care affordability for Americans.

Physicians Express Concern Over Disparities in Rural Health Funding Allocation

Physicians and rural health care leaders have sparked concern over the initial disbursement of the $50 billion dedicated to "transforming" rural health care as part of the budget reconciliation bill.State disbursements are determined by the size of the state's rural population and vary in range between $145 million and $281 million for 2026, according to Dr. Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services (CMS).

States with smaller rural populations willreceive a much larger proportion per capita with states such as Texas and California receiving the least. California and Montana, for example, are set to receive essentially the same amounts in 2026 despite their huge variance in size. Advocates have stated this allocation will hardly offset the billions of dollars lost due to Medicaid cuts, withArizona alone expecting the impact of said cuts to be $34 billion over the next decade. Rob Davidson, an emergency physician in rural Michigan,further notes that the $50 billion cannot offset the $1 trillion in Medicaid cuts to rural hospitals in the next ten years.

Rural health advocates and lawmakers have further expressed concern that states who have passed legislation aligned with the Trump administration are set toreceive billions more in funding. States who feel that their respective allocations are unfair will not be able to appeal for more money as the budget reconciliation billspecifically bars states from suing the administration or appealing for more money. Dr. Oz further commented that the Trump administration could"claw back" disbursed funds if states do not implement policies they committed to in their applications.

Notably, states whose senators were involved in rural health care negotiations in the summer of 2025 seemed to be amongst those who received the most money. Senators Lisa Murkowski (R-AK) and Senator Susan Collins (R-ME), for example, were very vocal on the impact of Medicaid cuts on their constituents.Both states were amongst the top 10 states receiving the highest dollar amount per capita. Health services researchers can work with policymakers to ensure that they are vocal about the impact of Medicaid cuts on their respective states to advocate for higher future allocations. Moreover, implementation researchers can work with policymakers to ensure that the promised policies are implemented to prevent CMS taking money back from states in future years.

Paragon Health Institute Launches New State Health Reform Initiative

Paragon Health Instituteannounced a new State Health Reform Initiative focused on implementation of state-level health policy. As states grapple with how to effectively administer mandated Medicaid work requirements, Paragon is spearheading an initiative to further reduce fraud, lower health care costs, and protect the vulnerable

Notably, this health care research think tank formulated the basis of the near$1 trillion Medicaid cuts in the budget reconciliation passed in July 2025 and campaigned against renewing enhancedACA tax credits. The institute says the new State Health Reform Initiative will help advance evidence-based, free-market policies to transform vulnerable state health care. Initial strategic priorities include ending self-attestation, rooting out fraud, refocusing Medicaid on vulnerable populations, increasing managed care insurer accountability, and removing barriers to care through patience choice of alternative coverage options and diversified physician training pathways.

Given the recent influence of this think tank on federal health policy reform, its strategic priorities could provide a preview of what Republican lawmakers might eye next. Site-neutral payment and cost-sharing reduction subsidy reform are two that have emerged, both of which aim to reduce premiums by injecting greater competition into healthcare. Paragon's founder Brian Blase also noted actions that could be taken by the White House rather than Congress, including the promotion of short-term and association health plans and individual coverage health reimbursement arrangements.