Top trends of 2026: Healthcare policy shifts will reshape the business of care in 2026

Policy change is rewriting the rules of healthcare. In this blog, we dive into the major reforms of 2025 and how they might impact how providers, payors, manufacturers, and innovators navigate uncertainty in 2026 and beyond.

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The U.S. healthcare system is no stranger to disruption and change, but 2025 may prove to be one of its most impactful years in recent memory. Sweeping federal and state legislation, a flurry of executive orders, and major agency restructuring are reshaping the way care is financed, delivered, and regulated. No corner of the industry is untouched-from hospitals and insurers to pharmaceutical manufacturers, digital health companies, and the patients they serve.

While it's clear these policy changes will present significant challenges, there will also be new opportunities for organizations to serve their communities, innovate, and generate revenue. In 2026, organizations that adapt quickly, armed with the right data and strategies, will be best positioned to not only weather the political and economic turbulence but also unlock new avenues for growth.

A year of sweeping healthcare policy changes

2025 was a year defined by disruption. Nearly every month brought a new policy announcement, regulatory shift, or executive action that rippled across the healthcare ecosystem.

Here's a chronological look at some of the most significant developments:

Early 2025 healthcare policy changes

At the outset of 2025, executive orders fundamentally reshaped the U.S. health policy landscape-especially in areas of reproductive rights, gender identity, and civil rights protections:

• On January 20, President Trump signed Executive Order 14168, which rescinded federal recognition of transgender identities and cease funding for programs involving what it termed "gender ideology."
• On January 24, Executive Order 14182 went into effect, reaffirming and strengthening restrictions on the use of federal funding for elective abortions.
• On January 28, Executive Order 14187 was signed to limit gender‐affirming care for minors under age 19. As a result, hospitals and clinicians in many states paused or altered service offerings.

By March, a reorganization plan consolidated agencies into a new "Administration for a Healthy America" and eliminated nearly 20,000 federal positions. Cuts were especially steep at the CDC, FDA, NIH, and CMS-all agencies that play a central role in drug approvals, outbreak response, and care reimbursement. For healthcare companies, the move signaled longer review timelines, fewer federal resources for public health programs, and heightened uncertainty about regulatory processes.

Mid 2025 healthcare policy changes

As 2025 reaches its halfway mark, the federal government rolled out several high-stakes reforms that influenced drug pricing and how insurance markets and health coverage enforcement operates:

• In May, the administration issued Executive Order 14297, which directed HHS, CMS, and other agencies to develop mechanisms to align U.S. drug prices with the lowest prices paid in comparable developed countries.
• Soon after, in June, CMS finalized the Marketplace Integrity and Affordability Final Rule, which changed longstanding protections concerning unpaid or past-due premiums in the ACA exchanges. Under the new rules, insurers are permitted to require consumers to pay any past-due premiums before providing coverage. This reverses earlier rules barring coverage denials for past-due premiums and opens the door for more rigorous financial verification and enforcement in the marketplace.

In July, Congress passed the 2025 Budget Reconciliation Act, nicknamed the "One Big Beautiful Bill." The new law will have significant impacts across Medicaid, the Affordable Care Act, food nutrition programs, and more, and cuts more than $1 trillion in healthcare spending over the next decade. Industry analysts and the Congressional Budget Office estimated that millions of people could lose health coverage by 2034. Hospitals, especially rural facilities, are bracing for higher levels of uncompensated care and, in some cases, possible closure.

Late 2025 healthcare policy changes

As the year begins to wind down, vaccine policy has become a flashpoint. This fall, the Trump administration removed CDC Director Susan Monarez, PhD, from her post, after only a month on the job. Multiple resignations followed, including several top CDC staff, which raised concerns from the AMA about the nation's ability to coordinate against potential public health threats.

The move quickly triggered state-level action: California, Oregon, Washington, and Hawaii announced the formation of the West Coast Health Alliance, a coalition dedicated to maintaining science-based vaccine guidelines. This divergence between federal and state approaches highlights the growing fragmentation of public health policy, forcing providers, payors, and manufacturers to navigate multiple, and sometimes conflicting, frameworks.

Meanwhile, policymakers and insurers braced for the expiration of enhanced ACA premium tax credits at year-end 2025, with analysts warning of sharp premium increases and coverage losses absent congressional action.

2026 will also bring numerous and significant state-driven reforms to the pharmacy benefit management industry. Read our trends blog on the laws and regulations impacting drugmakers and insurers to learn more.

Navigating the new healthcare landscape in 2026

The policy changes of 2025 rewrote the rules of engagement for the healthcare industry. Looking toward 2026 and beyond, healthcare providers and organizations must confront a new reality: One where funding and reimbursements are tighter, regulations are more fragmented, and patient coverage is less certain.

But within this disruption lies an opportunity for healthcare leaders to reimagine how they deliver care, engage patients, and position their businesses for growth.

The challenges ahead

Here are some of the broad challenges organizations will need to navigate:

Growing coverage gaps and financial strain

With Medicaid work requirements and income verification measures set to take effect, and ACA subsidies at risk of expiring, millions of Americans could lose coverage in the following years. Providers, especially rural and safety-net hospitals, are bracing for a rise in uncompensated care, shrinking margins, and difficult decisions about service-line reductions or closures.

Intensified pressure on drugs and devices

The most-favored-nation drug pricing model and a downsized FDA could likely mean slower product approvals, tighter price controls, and higher stakes for market access. Pharma and medtech firms might face a future where every launch must be backed by stronger evidence, sharper pricing strategies, and more careful global coordination.

Rising administrative and compliance burden

Administrative demands are climbing due to stricter healthcare coverage eligibility and verification checks. Providers and payors will need to scale up data infrastructure and automation or risk potentially higher denial rates, increased patient dissatisfaction, and regulatory exposure.

Equity and access challenges

Coverage losses and service cutbacks will hit vulnerable populations the hardest. Organizations will face growing pressure from policymakers, advocacy groups, and the public to find ways to close these gaps and ensure care reaches the patients who need it most.

Workforce stress and shifting talent

Policy changes, particularly those around reproductive and gender care, are influencing where clinicians choose to practice. In some regions, talent flight could worsen staffing shortages, forcing health systems to compete more aggressively for clinicians while trying to prevent burnout among those who stay.

Playbook for finding success in 2026

2026 will favor organizations that act quickly and strategically. Here's how you can weather the turbulence of the upcoming healthcare policies and find opportunities to differentiate, innovate, and better serve patients and the community.

Build financial and operational resilience

Shrinking margins and rising uncompensated care mean healthcare leaders must shore up their foundations:

• Pharma and medtech companies should consider reevaluating their portfolios, prioritizing high-impact products, and adopt new pricing models to align with value-based care trends.
• Providers may want to leverage market and population intelligence to identify high-value service lines or expand ambulatory and outpatient services to better meet shifting care demand.
• To retain members and combat coverage churn, payors should consider designing more affordable and accessible plan options.

Strengthen trust and relationships

Some of the new policies are eroding patient trust in the healthcare industry, making relationship-building and spreading awareness more important than ever:

• Software and technology firms can support clients where they are needed most, such as by developing tools that streamline eligibility verification and claims management, alleviate administrative burden and regulatory compliance, and keep organizations' network infrastructure secure and protected.
• Providers, of course, should continue to invest in outreach and engagement programs that cultivate a talented workforce and ensure consistent, high-quality care.
• Payors can build trust and relationships by deploying programs that engage members specifically at risk of losing coverage. Leveraging digital tools and AI ethically and appropriately can also streamline certain processes, which in turn can lower costs and ease provider friction.

Turn data into a competitive advantage

If 2025 proved anything, it's that healthcare organizations can't afford to fly blind. In the years ahead, data will be the difference between leading in the market and lagging behind. It will guide resource allocation, de-risk decision-making, and help organizations find opportunities for growth their competitors miss.

Market intelligence will also be key. These insights help pinpoint the highest-value providers, health systems, or patient populations to focus on, whether you're a medtech company launching a new device, a payor expanding Medicare Advantage, or a software firm selling revenue cycle solutions.

Artificial intelligence and predictive analytics, already taking the healthcare industry by storm, will continue to be valuable tools. When supported by a high-quality database, this technology allows providers and payors to spot trouble before it hits their balance sheets. And knowing which service lines, facilities, or regions are most vulnerable means leaders can take proactive action instead of scrambling to respond.

In 2026, turn policy disruption into opportunity

If 2025 was a year of upheaval, 2026 can be a year of reinvention. The organizations that succeed won't be the ones that wait for stability - they'll be the ones that embrace change, lean into data-driven decision-making, and use intelligence to find the whitespace others miss.

With Definitive Healthcare's commercial intelligence, you can discover the right markets to enter, identify who needs your solutions the most, and confidently make the decisions that will position your organization for growth in a rapidly changing healthcare landscape. Book a demo today to see firsthand how we can help your business grow.