As campaign 2026 nears its end in 15 days, polls show the potential for some surprising results and political pundits are already speculating about what to expect in the lame duck session and 120th Congress that convenes in January.
For healthcare, the realities are these:
- Healthcare will be on local, state and national ballots in the context of affordability and costs of living. It’s a top-of-mind concern to voters along with housing, gas prices and groceries. A fourth of the population has an unpaid medical bill, and the majority worry about a surprise medical bill that could wipe them out.
- Healthcare has lost much of the trust and confidence it enjoyed for decades. It has failed to navigate its positioning with voters because it lost control of its narrative. Among majorities of elected officials and voters across partisan aisles, the “system” is viewed as big businesses that put profits above all else. Reform is desirable to outside stakeholders but there’s no consensus about a ‘future state’ destination.
- Healthcare is structurally flawed. Its tribalism is reinforced by laws and regulations that protect its status quo. Primary and preventive health is subordinated. For-profit and non-profit distinctions are artificial. Value is not defined. Business practices are opaque.
As a result, the industry will operate in limbo in the immediate future. Structural change is unlikely. For the near term, states will be the labs for healthcare innovation, and large (non- healthcare) employers might force a needed national discussion. Thus, in the 119th Congress’ lame duck session and 120th Congress next year, public policies in healthcare will center on low-risk efforts in two domains that enjoy widespread, Bipartisan support among elected officials and voters:
Program integrity: Fraud, waste and abuse in the U.S. health system is a soft target. According to CMS’ 2025 Improper Payment data, improper payments in Medicare, Medicaid, CHIP and other programs amounted to amounted to $96.16 billion. The largest categories include:
- Medicare Fee‑for‑Service (FFS): 6.55% (≈ $28.83B)
- Medicare Part C (Medicare Advantage): 6.09% (≈ $23.67B)
- Medicare Part D: 4.00% (≈ $4.23B)
- Medicaid overall: 6.12% (≈ $37.39B)
- Children’s Health Insurance Program (CHIP): 7.05% ($1.37B)
- Advance payment of the Premium Tax Credit (APTC) program: 0.89% ($657.46M).
It includes enrollees or actions for which the DOJ, FTC, FBI or HHS-OIG may seek redress on behalf of the public:
- Billing for services not provided
- Upcoding or unbundling
- Billing for medically unnecessary services
- Kickbacks or inducements
- Duplicate billing
- DME schemes (back braces, wheelchairs) — a high‑risk category highlighted by FTC.
Elected officials and the majority of voters support intensification of policies that reduce FWA spending.
Price transparency: Polls show large majorities of voters want unfettered access to accurate prices for the services they receive from doctors, hospitals, insurers, prescription drugs and everything else. They reject insider reasoning they’re not available today due to complexity and believe most price estimator tools currently in use of limited help to consumers. They believe of willful avoidance of price transparency is a calculated business strategy to protect margins, executive compensation and revenue growth.
There’s no doubt healthcare will significantly impact the results of the November 3 vote. There’s no doubt it will be a major focus in the 120th Congress. The major unknowns are (1) how states and federal policymakers will address the realities noted above, (2) how large employers and community leaders will participate (or not) in the design of a reformed system of health and (3) how voters will decipher reforms that promise offer accessibility, affordability and effectiveness.
Game on.
Paul
P.S. I grew up watching ABC’s Wide World of Sports that opened with Jim McKay’s infamous call “The thrill of victory, the agony of defeat”. Last week, we felt both. Pope Leo’s successful lung surgery was the victory; the mass murder of 3 kids and a teacher at Silver Rail Elementary the defeat. Our nation’s psyche is on edge along with many of the 8 billion inhabitants of planet earth. We need hope. We need victories. We need a break from bad news. I’m just sayin’.
Quotables
Atlantic on affordability in healthcare: “There are three reasons for pessimism. The first is that affordability politics are a breeding ground for economically illiterate policy ideas. Popular anger over inflation is usually directed at cumulative price increases over the course of years…
The second problem of affordability politics is what these proposed solutions do to what little remains of voter trust in government…
The third problem is the cumulative cost of short-term affordability politics. Neither party in this election cycle is making much reference to the national debt, even though the United States has surpassed, for the first time ever, $1 trillion in interest costs this year. Deficit spending shows no sign of slowing down, even though the American economy is not in recession and the country is only mildly at war. But there is no political incentive to suggest that such spending cannot persist…”
Why Affordability Politics Breed Economic Illiteracy – The Atlantic
Mt. Sinai Med students on affordability: “Healthcare has not vanished from the midterms. Voters are increasingly concerned, candidates campaign on it, and parties disagree about how the government should address these issues. Yet, the foundation of the debate has changed. Increasingly the question is not how we should re-engineer the system, but rather, how we should make the system that we already have less expensive. In other words, instead of asking what kind of care Americans deserve, the 2026 debate is increasingly asking what Americans can afford.
Maybe that change is overdue. However, as medical students entering a system that these debates will shape, we hope that by confronting what healthcare costs, we do not stop asking what — and for whom — healthcare is for.”
Healthcare Is Still on the Ballot. But the Debate Has Changed. | MedPage Today
NYT on economy: “The economic news was grim last week. Government data revealed something millions of Americans have known for months: Rising energy costs, largely driven by the war with Iran, have pushed prices up all over. Wages are flat. And nearly half of Americans are having trouble paying for basic needs right now.
The climate news hasn’t been much better. It was the hottest summer on record in the United States, hotter than the Dust Bowl summer of 1936. Over the past few months, Americans ran a lot of air-conditioning to keep themselves cool — and, in some places, to keep themselves alive. Now about one in six U.S. households is behind on utility bills, according to federal data.
Some hot-weather states have laws to prevent utility companies from shutting off someone’s electricity during the most dangerous heat. But then comes fall, and the disconnections begin to mount. It’s when, Eli Saslow reports, “a climate crisis turns into a collection notice.”
A Bad Combination – The New York Times
MedPage on state spending caps: “There is no single answer to the question of whether spending caps work. The more useful questions are what policymakers want to constrain — total spending, price growth, or price levels — and what changes elsewhere in the healthcare system when they do. California, Rhode Island, Oregon, Delaware, and other states are testing different answers. Their experience can help show not only whether spending falls, but how those savings are produced and what tradeoffs come with them. We’re looking forward to finding out the answers.”
Can States Put the Brakes on Healthcare Spending? | MedPage Today
NYT Review of Holmes documentary: “The nominal subject of the trippy “You Can See Everything” is Elizabeth Holmes, the celebrated entrepreneur turned celebrity jailbird. As a portrait, the movie is intimate and analytic, informative and incomplete. It’s also off-the-charts bonkers, which isn’t surprising given the participants. Directed by the comic Nathan Fielder and the filmmaker Lance Oppenheim, the movie is, among other things, a wily, disturbing, self-aware exploration of the relationship between documentarians and their subjects. It’s often funny, even if the questions that it raises about truth, reality and knowledge can make it feel like a tragedy — few movies speak as uncannily to the pathos and destabilizing confusions of the present moment.
At this point, it’s a tossup whether Holmes is better known for her pop-cultural profile or her real-world exploits or if Fielder, the creator of absurdist comedy TV shows like “Nathan for You,” is now the bigger draw. Her fame was relatively brief but sensational. In 2014, Forbes deemed Holmes, the founder of a blood-testing start-up named Theranos, the youngest self-made female billionaire. She claimed, among other things, that her technology would revolutionize health care, which proved untrue. By 2022, Holmes had been found guilty of four charges of fraud for deceiving investors, a turn of events that seemed to baffle even the presiding judge. “What was it that caused Ms. Holmes, regrettably, to make those decisions that she did,” Judge Edward J. Davila asked, before sentencing her to 11 years in prison.”
‘You Can See Everything’ Review: The Slippery Mind of Elizabeth Holmes – The New York Times
Economist’ review of Holmes documentary: “You Can See Everything”, released on Friday, is a documentary about Elizabeth Holmes, who was sentenced to more than 11 years for fraud and conspiracy relating to Theranos, her blood-testing startup. She let the cameras into her home in San Diego for 34 days before she reported to prison in May 2023
The co-director, Nathan Fielder, a Canadian film-maker and comedian, spends the first half of the film quizzing Ms Holmes and her partner on the charges. She squirms and obfuscates, insisting that she has never told a lie in her adult life. Baffled, Mr Fielder enlists the help of others who were sucked into Ms Holmes’s orbit.
John Carreyrou, the reporter who partly uncovered Ms Holmes’s fraud, has described her as having “a reality distortion field” that “forced people to momentarily suspend disbelief”. Indeed, a subject who willingly throws open her door would seem to have nothing to hide. But is her openness a disguise in itself? The audience is kept guessing—and glued to the screen.”
Elizabeth Holmes continues to confuse The Economist October 16, 2026
NACD on Board Oversight of Strategic Planning: Key Takeaways from Blue Ribbon Commission:
- “Strategy execution oversight needs greater board attention: 60% of public and private directors ranked it as a top board improvement priority.
- More board engagement is not always better oversight. Engagement should be focused, timely, and proportionate to the situation.
- Boards need earlier visibility into changing conditions. Strategic assumptions and forward-looking signals can reveal execution drift and emerging inflection points.”
Board Oversight of Strategy Execution: https://www.nacdonline.org/all-governance/governance-resources/governance-research/blue-ribbon-commission-reports/strategy-execution-oversight/
Economy
Axios on health stocks: “The S&P 500’s health care sector is up more than 9% over the last three months, the second-best performer of the blue-chip index’s 11 sectors. (Energy was the best.)
- Pharmaceutical shares like Eli Lilly, Merck and AbbVie were some of the strong contributors over that period.
- Hospital chains such as HCA and Universal Health Services (+21%) as well as insurers like Elevance Health (formerly Anthem, +15%) have also posted gains.”
Atlantic on CPI Report, Consumer Sentiment: “America just had its last major checkup on inflation ahead of the midterm elections, and the results aren’t looking good. Yesterday, the Bureau of Labor Statistics released September’s update to the Consumer Price Index, one of the most important metrics for understanding how much Americans actually pay for goods and services. (Among them: cupcakes, dental care, sports equipment.) Overall, costs for consumers have been rising faster than economists expected. They’re up 3.7% over the past year, and September marked the largest monthly increase since April—much of which had to do with massive Iran-war-driven spikes in energy prices.
That’s just the first half of the problem. At the same time, the BLS revealed yesterday that Americans now have less spending power than they did earlier this year. Real wages—the average amount, adjusted for inflation, that workers earn an hour—have tumbled back down to about where they were when Donald Trump retook the presidency last January. Prices are now rising so fast, across so many different industries, that they’ve overwritten nearly two years of wage gains…
Taken together, the BLS numbers offer a compelling explanation for Americans’ frustrations with the cost of living. Another recent report helps put those frustrations in context: People’s confidence in the economy is approaching a record low, per the preliminary October results of the University of Michigan’s consumer-sentiment survey. And according to today’s BLS data on wholesale prices, businesses are reckoning with higher costs too. The Producer Price Index is now at its highest level in four years.”
America’s Latest Inflation Check-In Doesn’t Look Good for Trump – The Atlantic
Digital health investments in 3Q26: “Digital health companies raised $7.7B across just 546 deals in Q3. Funding held steady as deal activity fell, with large rounds like Neko Health’s $700M Series C and Ortet’s $500M launch helping sustain the total. Average deal sizes are climbing. Meanwhile, slowing exits are keeping companies private longer, and the unicorn ranks continue to grow.
- Mega-rounds took 56% of Q3 funding, the third straight quarter above half
- M&A fell 8% QoQ, while IPOs dropped by two-thirds to just 2
- $32.2B in projected 2026 funding would top 2025’s $28.2B
State of Digital Health Q3’26 – CB Insights Research
Hospitals
Modern Healthcare on in-home caregivers: “Health systems are funneling millions of dollars to train, educate and support family caregivers as they expand medical services into the home.
Untrained family caregivers are vital to hospital at home, dementia care and other home-based medical programs. They provide medication management, wound care, meal preparation and other services to patients. However, the responsibility can stress family members and put them at risk for burnout, illness or injury.
Forty-two states, Washington, D.C., Puerto Rico and the U.S. Virgin Islands have Caregiver Advise, Record and Enable, or CARE, Act laws that require hospitals to identify a family caregiver at discharge, and provide them training and information to safely care for patients at home. However, the requirements vary from state to state, according to AARP.”
Health systems spend big on family caregiver support programs – Modern Healthcare
IT Professionals survey: Per the symplr Compass Survey, symplr of IT professionals fielded June 1 and July 17, 2026:
- Executives and IT leaders agree on the top threat. Clinicians don’t. Financial pressure ranks as the top threat to their organization’s operations among 65% of C-suite/VP respondents and 45% of IT respondents, while nearly half of clinicians (46%) rank burnout first, the same position it has held since 2023.
- AI governance is uneven across the organization. Only 26% of all respondents report a comprehensive AI policy that is actively enforced. More than half of clinicians (51%) say they’re unsure whether an AI policy exists, while executives are far more certain, with just 3% saying they don’t know if their organization has a policy.
- Deployment of emerging technology moves faster than measurement and training. Twenty-one percent say their organization has deployed AI without establishing metrics to evaluate it. Meanwhile, just 3% name staff development and change management as their organization’s primary strategy for addressing operational challenges, compared with 27% who name AI deployment.
- Nearly half of respondents say foundational workflows remain fully manual. This includes provider credentialing, onboarding and contract management (46% each), supply chain and vendor management (44%), provider evaluation (43%), workforce scheduling (41%), and safety performance (40%). Yet nearly 60% of respondents say their organizations are pursuing operational efficiency and automation initiatives.
symplr’s Compass Survey Finds Nearly Half of Healthcare Operations Remain Manual – symplr
Insurers
KFF analysis on Medicare Advantage enrollment:
- 74% of Medicare Advantage enrollees or 20.9 million people in 2023 had a pre-existing medical condition identified from KFF’s review of Medigap applications that could result in a denial for a Medigap policy.
- At least one in five Medicare Advantage enrollees have a diagnosis for peripheral vascular disease (25%), chronic kidney disease (24%), coronary artery disease (21%), or diabetes with related complications (21%) documented in the Medicare Advantage encounter data, all of which could trigger a Medigap denial.
- The share of Medicare Advantage enrollees who have a deniable pre-existing condition rises with age among people 65 and older, with close to 9 in 10 enrollees 85 and older (88%) having a medical condition that could trigger a Medigap denial.
- The share of Medicare Advantage enrollees who have a pre-existing condition that could trigger a denial for Medigap varies by state, from a high of 82% in Florida to a low of 59% in Alaska.
Study: Tele-mental health visits: “In this cross-sectional study with a secret shopper design of 5822 calls to psychiatrists and psychologists listed in the directories of the largest commercial carriers across 5 states, 61.3% of calls yielded no definitive outcome. Among evaluable calls, only 23.6% resulted in a scheduled appointment while 55.6% were subject to directory errors, and 21.6% were subject to capacity constraints; a single call attempt yielded an appointment in 12.4% of cases.”
Report: Alliance for Fair Health Pricing: “Price transparency in health care is foundational and is widely supported by the public and policymakers. The federal executive and legislative branches, in collaboration with consumer groups, purchasers, states, researchers, and clinicians, should continue to bolster price transparency by strengthening reporting requirements, refining the tools available to make transparency data available to consumers, purchasers, and researchers, and fostering greater awareness of and sensitivity to irrational and rising health care prices. In the near term, there is an urgent need and opportunity for policymakers to codify current price transparency rules and expand transparency to ownership and site-of-service billing. These are critical building blocks to reduce high prices, unwarranted price variation and high costs in the US health care system.”
The-Price-Isnt-Right-Policy-Options-to-Strengthen-Health-Care-Price-Transparency.pdf
WSJ Matthews on Medicare benefits: “It is going to be a tough year for seniors shopping for Medicare coverage. If you don’t choose wisely, you might get hit with surprise bills for your medications, or learn too late that your doctors are out of network. For the third year in a row, major Medicare insurers are pruning some benefits while adding bigger out-of-pocket charges such as deductibles.”
Note: Medicare enrollees have from today until Dec. 7 to select coverage for 2027.
Buyer Beware: New Medicare Plans Have Fewer Benefits, Higher Costs – WSJ
Broker lawsuit against HHS, CMS: Last Thursday, the broker trade group the National Association of Benefits and Insurance Professionals sued the Health and Human Services Department and the Centers for Medicare and Medicaid Services in the U.S. District Court for the District of Maryland alleging the agencies violated the Administrative Procedure Act of 1946 by failing to ask for public comments before banning new marketers from selling policies on HealthCare.gov for 2027. The lawsuit also alleges the agencies lack the statutory authority to implement the freeze.
Healthcare Is Still on the Ballot. But the Debate Has Changed https://www.fiercehealthcare.com/payers/nabip-sues-cms-over-moratorium-new-aca-broker-registrations
Workforce
Nurse Practitioner census: Per the CMS’ National Plan and Provider Enumeration System (NPPES):
- Nurse practitioners registered 5,097 new practices between Jan 1 and Sep 26, 2026. That is 5.9× the same period of 2019 (859) and 40% more than the same period of 2025 (3,647).
- Fewer new NPs are registering: 20,312 in the 2026 window, down 19% from 25,115 in 2023. There are now 25.1 new NP practices for every 100 new NPs, up from 3.7 in 2019.
- Psychiatric and mental health NPs account for 2,734 of this year’s new practices, 54% of the total.
- It is not only a full-practice-authority story. Since 2022, NP practice registrations grew 2.58× in full-practice states, 3.25× in reduced-practice states and 2.86× in restricted-practice states.
