Election day is finally here though final results may not be known this week due to election protocols and likely challenges in states. Per polls and commentary across the ideological spectrum, Campaign ‘26 is unprecedented for the money spent ($11.9 billion per Open Secrets), the acrimony between candidates and the blatant disinformation featured in campaigns on both sides.
Like most, I am happy it’s behind us. I value civil debate. I don’t think complex issues are explained in soundbites. I value data that’s not cherry-picked and polls that are honest. I hate campaigns that justify any means necessary to win. I respect candidates willing to debate. And I worry that statesmanship in local, state and federal policy-setting has been sacrificed to political brinksmanship.
But while uncertainty may dog the outcome this week and potentially in the weeks ahead, there’s certainty for healthcare in the lame duck session of Congress starting next week and in states:
- State ballot measures and fed mandates will get immediate attention by Governors and state legislatures: implementation of Medicaid work requirements in every state, abortion rights (ID, NV, VA) and referenda that address healthcare funding, school health, vaccines and more in others. CA, CO, MA, MO, NM, NC, RI, SD, WA, and WI). And governors in every Blue State and a few Red States will revisit recission of Medicaid cuts in the Big Beautiful Bill (HR1) slated to start January 1, 2027.
- Trade associations will update their 2027 advocacy agendas and health committee profiles to prepare for the 120th Congress starting in 60 days.
- Lobbyists and consultants will be active with their clients–trade groups, special interests, single issue advocacy 501C3s, municipalities, corporate interests et al—around (1) potential low-hanging legislative wins before the 119th Congress adjourns, (2) potential regulatory shifts in 2027 and (3) extension/expansion of their contracts with clients.
- And the Executive Branch will sequester its key leaders across its agencies (HHS, CMS, FDA, FTC, USDA, DOJ, Commerce, et al) to protect its priorities via prepare Executive Orders, Administrative Actions, Court filings, budget appropriations and key appointments. Price transparency, competition, lower drug costs, less consolidation and stepped-up fraud, waste and abuse efforts will be its emphasis.
Looking to 2027, healthcare will be lightening rod in legislative circles and posturing by White House hopefuls in Campaign 2028. Importantly, two overarching realities will frame politics and policy discussions:
Healthcare is a major contributor to household affordability concerns. Healthcare is one of four major sources of affordability pressure on households along with housing, fuel and groceries. But unlike the other three, healthcare costs are considered unmanageable to voters because they’re often unpredictable, inexplicable and rarely transparent. It’s an issue that garners bipartisan repudiation in politics and unflattering attention to the industry’s opaque business practices.
Healthcare is seen as big business, not public service. The persona of rural hospitals, primary, behavioral and public health, nursing and home care and others is typified by many that struggle and the few that prosper. Stoked by disgruntled employees, physicians and large self-insured employers, bipartisan criticism of consolidation, vertical integration, private equity ownership, board independence, executive compensation, non-profit tax exemptions and more. Corporatization in every sector and regardless of ownership (non-profit, for-profit, or public) will be blamed and capital deployment in healthcare will reflect caution.
Healthcare will be prominent in the election post-mortem this week. Industry leaders face headwinds in the public square with voters and legislators in local, state and federal chambers. Some operate on the assumption that voters will defend the U.S. system against major changes believing it the world’s best. It’s been a safe bet historically, but the future may not be a repeat of the past.
Paul
Sections in today’s report
- Quotables
- Economy
- Hospitals
- Insurance
- Polling
Quotables
New York Times on election issues November 1: “Financial concerns have been the most pressing issue for voters in four of the six previous midterm elections of this century. But with the war in Iran and tariffs driving up gas prices, inflation and mortgage rates, the worries feel deeper, more desperate and decidedly center stage in the final days of the hard-fought campaign that will decide control of Congress…
The worries of voters, which cross lines of generation and gender, race and political ideology, reflect the anxieties of a country convinced that the American dream is slipping away. In polls, focus groups and interviews, voters described some of the traditional promises of a middle-class life — health care, a college education, homeownership and retirement — as becoming rapidly unaffordable. They fear their children will live a worse life than they do.”
A Midterm Campaign Dominated by Concerns Over High Prices Nears Its End – The New York Times
Gallup on election issues: ”Half of registered voters rate the economy and healthcare as extremely important to their vote for Congress this year, and 47% rate the situation in Iran this highly. Closer to four in 10 rate income and wealth distribution (44%) and gas prices (42%) as extremely important.
The 50% of voters rating the economy as extremely important this year is essentially unchanged from 49% in the 2022 midterms amid high inflation, but well above the 34% recorded in 2018, when 55% of Americans rated economic conditions as excellent or good. Still, it falls short of the 63% “extremely important” reading in 2010, when the country was recovering from the Great Recession and about one in 10 Americans rated the economy positively.”
Record Lows Say Incumbents Deserve Reelection
New York Times on health costs: “Public opinion polls have shown that the cost of health care has been among voters’ top economic concerns going into the midterm elections on Tuesday. In a recent poll from KFF, about 60% of registered voters said they were worried about being able to afford health care for themselves and their families.
Across the private and public health sectors, the increases have been driven by rising hospital prices, high payments under a consumer protection law that changed how some doctors are compensated, and the growing use of artificial intelligence in doctors’ offices… Several large employers also pointed to a rising bill for expensive specialty prescriptions, like cancer drugs and GLP-1 medicines.”
Obamacare Policies Hit Again With Steep Premium Increases for 2027 – The New York Times
Bain on GenAI: “Generative AI has become a fully embedded habit for billions worldwide. In the US, 73% of the consumers we surveyed in April said they were using generative AI applications and tools in their personal lives, up from 53% in September 2025. Adoption in Germany, France, and the UK has advanced with similar rapidity, with the average personal usage rate rising from 47% to 69% over the same period.
Crucially, generative AI use is a habit that builds over time. In the US, about 50% of early adopters—those who started using generative AI more than two years previously—told us they were using it once a day or more. Of those who started using it in the preceding year, slightly less than 30% were daily users.
However, there’s also a paradox at the heart of generative AI’s dash into the consumer mainstream: Trust in the technology’s accuracy has been falling in the US, even among the early adopters who are likely to be its most sophisticated and pragmatic users. Our research illustrates this contrary trend.”
Workers Are Less Worried About AI If It’s Done by Them, Not to Them | Bain & Company
Levitt on Medicare for All: “A drawn-out legislative debate over Medicare for All would mean furious lobbying by the health care industry and likely compromises along the way. Premiums and cost sharing or more limited benefits might be considered, shifting costs to patients while also lowering the cost to the government and reducing the tax increase required to finance the system. Physicians and hospitals would argue for guarantees of higher payment rates, pushing costs up. Insurance companies would advocate for a continued role as with Medicare Advantage plans, which would preserve some continuity with the current system but also add complexity and administrative overhead.
Given these and other competing interests, a Medicare for All system could end up looking more like today’s Medicare program than the proposals introduced in Congress. Medicare is a popular and proven program, which is why Medicare for All proposals use Medicare’s trusted name and infrastructure. But when compared with Medicare for All plans, Medicare’s coverage today is, in fact, not as comprehensive and affordable for those already eligible as many might believe. Medicare for All is unlikely to be enacted in the near future, but the political push for it could prompt a debate about the services Medicare itself does not cover and the high costs current Medicare beneficiaries can incur.”
Economy
U.S. Bureau of Labor Statistics employment report October 30:
- Compensation costs for civilian workers increased 3.4%, not seasonally adjusted, for the 12-month period ending in September 2026. Wages and salaries increased 3.1%, and benefit costs increased 3.9% over the year.
- Compensation costs for private industry workers increased 0.8%, seasonally adjusted, for the 3-month period ending in September 2026. Wages and salaries increased 0.8%, and benefit costs increased 0.9% from June 2026.
- Compensation costs for private industry workers increased 3.4%, not seasonally adjusted, for the 12-month period ending in September 2026. Wages and salaries increased 3.1%, and benefit costs increased 3.9% over the year. Inflation-adjusted (constant dollar) wages and salaries decreased 0.6 percent over the year.
- Within the private industry, compensation costs increased 4. % for union workers and 3.3 % for nonunion workers for the 12-month period ending in September 2026. Wages and salaries increased 4.3% for union workers and 3.0% for nonunion workers over the year. Benefit costs increased 4.3% for union workers and 3.9% for nonunion workers over the year.
Employment Cost Index Summary – 2026 Q03 Results
Federal Reserve Report: 2025 Household finances:
- Real median family income rose 7% between the 2022 to 2025 surveys to $82,200, while real mean family income fell 6% to $145,200. Families in the lower ends of the income and net worth distributions saw modest increases in median and mean income, while families in the upper ends saw declines.
- Between 2022 and 2025, real median net worth rose by 2% to $215,900, while real mean net worth rose by 7% to $1.24 million. Most families across the net worth and income distributions experienced increases in median and mean wealth.
- The homeownership rate was 66% in 2025, about unchanged from 2022. For families that owned a home, the median net housing value (the value of a home minus home-secured debt, such as a mortgage) rose to $230,000 in 2025 from $218,900 in 2022.
- Retirement plan participation, which includes account-type plans, individual retirement accounts, or defined benefit plans, was up slightly between 2022 and 2025 at around 65%. For families with account-type plans, mean and median balances rose.
- Participation in the stock market, which includes direct stock and indirect holdings, declined slightly from 58% in 2022 to 56% in 2025. Conditional on holding stock, median stock holdings grew 36% from $56,900 in 2022 to $77,400 in 2025.
- The fraction of families with any type of debt remained about stable at 77% Median and mean debt outstanding remained unchanged from 2022.
- The fraction of families with debt payment-to-income ratios greater than 40%, which are families with particularly high debt payment obligations relative to their incomes, increased from 6.5 to 8.6%, a level last seen in the 2013 survey.
Hospitals
Study: 340B participation impact: “In this cohort study including more than 23 million claims from 901 hospitals, using a difference-in-differences analysis of Medicare fee-for-service outpatient claims from 2016 through 2019, 340B participation led to significant increases in off-campus service volume and drug administration volume at newly established or acquired off-campus sites subject to site-neutral payment, with no significant changes observed in other settings. These findings suggest that 340B participation has various implications for vertical integration which vary across payment settings, highlighting that incentives provided by 340B persist even under site-neutral payment.”
HCA financial results: “Despite better-than-expected Q3 2026 results, HCA Healthcare (HCA) traded lower on Tuesday as the company, the hospital sector’s bellwether for the earnings season, reaffirmed its full-year outlook, sending its peers also lower.
Notable decliners include Community Health Systems (CYH), Tenet Healthcare (THC), Universal Health Services (UHS), Ardent Health (ARDT), and Acadia Healthcare (ACHC), which are yet to report their latest quarterly results.
Earlier in the day, Nashville, Tennessee-based HCA recorded $19.9B in revenue for the quarter with ~4% YoY growth, exceeding the consensus by $520M, while its adjusted EBITDA for the period reached $3.9B with a ~1% YoY rise.
The company noted a roughly $400M impact on its profit before tax in Q3, citing a payer mix shift driven by those who lost coverage on health insurance exchanges following the expiry of their COVID-era enhanced tax credits at the end of 2025.
HCA Healthcare stock down after Q3 results (HCA: NYSE) | Seeking Alpha
Insurance
Study: Medicare Advantage delays of care: “Medicare Advantage organizations (MAOs) enroll 54% of Medicare beneficiaries and receive $500 billion in annual federal payments to administer benefits…This study systematically characterized violations cited in CMS enforcement actions, focusing on inappropriate denials or delays of care or medications because these may have the most severe consequences for enrollees’ health and financial well-being…
We analyzed textual data from CMS enforcement actions issued between September 17, 2021, and February 27, 2026, which included detailed information on associated violations by MAOs.6 In accordance with 45 CFR §46.104…
From September 2021 to March 2026, CMS reported 66 violations leading to enforcement actions…During the study period, CMS imposed sanctions on 22 violations by MAOs involving inappropriate denials or delays of care or medications. These violations collectively amounted to $616 366 in fines, and their median fines were lower than for other violations.
Most inappropriate denials or delays involved Part D medications, with relatively few involving Part C services. All violations were attributed to procedural deficiencies and human or system processing errors. These procedural errors might highlight the importance of streamlining administrative processes and reducing system complexity to improve timely access to care for Medicare beneficiaries.”
KFF on Part D Coverage: “For Medicare Part D prescription drug coverage, the average beneficiary has 28 Medicare Advantage prescription drug plans (MA-PDs) and 9 stand-alone prescription drug plans (PDPs) to choose from, with varying costs associated with these different options. This analysis examines premiums and cost-sharing requirements for Part D coverage in 2027. Highlights:
- The estimated average enrollment-weighted monthly premium for Medicare Part D stand-alone PDPs is projected to be $51 in 2027, a 50% increase from $34 in 2026 (based on June 2026 enrollment), assuming current enrollees keep their same plan for 2027.
- Monthly premiums for drug coverage are estimated to be more than 5 times higher for PDPs compared to MA-PDs in 2027 – $51 versus $9.
- Three-fourths of PDP enrollees without low-income subsidies (76% or 10.4 million) will pay a higher monthly premium in 2027 if they make no changes during open enrollment, compared to 56% of enrollees who faced a higher premium for their plan in 2026.
- Average monthly premiums for the 8 national PDPs are projected to range from around $6 to $204 in 2027.
- Most Part D enrollees will face a deductible for drug coverage in 2027, including 85% of MA-PD enrollees (up from 80% in 2026) and virtually all PDP enrollees (99.8%, up from 96% in 2026), based on current enrollment.
- Most Part D enrollees will face coinsurance rather than copayments for both preferred brands and non-preferred drugs, which can mean less predictable out-of-pocket costs.”
Medicare Part D Premiums and Cost Sharing in 2027 | KFF
KFF 2026 Employer Benefits Survey: The 2026 survey included 1,937 interviews with non-federal public and private firms. Key Finding:
“Annual premiums for employer-sponsored family health coverage reached $28,303 this year, 5% higher than in 2025. On average, covered workers contributed $7,471 toward the cost of family coverage. The average deductible among covered workers in a plan with a general annual deductible was $1,955 for single coverage.”
2026 Employer Health Benefits Survey | KFF
Study: Post-partum coverage: “We examined if extending Medicaid through 12 months postpartum increased postpartum health care utilization for women with pregnancies complicated by diabetes or hypertension. We analyzed 2019–2023 deliveries in Medicaid claims data from New York (NY) and Texas (TX) using an interrupted time series design and segmented regression analysis. Results:
We found that postpartum diabetes screening and outpatient utilization increased during the continuous enrollment provision (CEP) of the COVID-19 public health emergency, decreased during unwinding of the CEP in TX, and increased after implementation of postpartum extension legislation in NY. Postpartum hypertensive medication prescriptions increased slightly in TX and saw no change in NY.
Given that NY and TX are states with large Medicaid-insured populations and diverse policy climates, the consistency of our findings suggests that postpartum extension of Medicaid is an effective strategy to increase follow-up care among Medicaid beneficiaries with pregnancy complications.”
Polling
Gallup American Job Quality Study (AJQS): Highlights from survey of 17,000 U.S. workers across industries: 5 elements of a healthy work environment:
- Financial Well-Being (39%): Fair pay, stable employment and benefits that meet basic needs and reduce financial stress.
- Workplace Culture and Safety (39%): A safe, respectful environment free from discrimination or harassment.
- Growth and Development Opportunities (52%): A clear path to build skills, gain experience and advance in one’s career.
- Agency and Voice (49%): Influence over decisions that shape one’s job, such as pay, working conditions and implementation of technology.
- Work Structure and Autonomy (15%): A stable, predictable schedule, a manageable workload and meaningful control over when and how work gets done.
