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As Congress returns for its post-midterm 2026 session, policy experts expect health care measures to be negotiated mainly through must-pass bills. A Medicare physician-payment fix and routine program extensions appear more feasible than changes to surprise-billing arbitration or the 340B drug discount program, but no package is settled.
With Congress due back after next week’s midterm elections to finish the 2026 legislative year, health policy experts say a Medicare physician-payment fix and routine program extensions may have a better chance than major changes to surprise-billing rules or the 340B drug discount program. No legislative package has been agreed, and the final agenda may depend on election results, leadership prospects and negotiations over must-pass bills.
Health care measures are likely to move, if at all, as provisions attached to legislation Congress needs to pass, including appropriations bills, the defense authorization bill and the Farm Bill. Michael Baker, health policy director at the American Action Forum, told MedPage Today that projected control of the House and Senate—and which current members may return or seek committee leadership—could affect whether lawmakers act before year-end or defer decisions until the new Congress.
One possible measure is a Medicare “doc fix” to adjust physician payments. Joe Antos, a senior fellow emeritus at the American Enterprise Institute, said lawmakers could face pressure to counter a proposed reduction of more than 1% in Medicare physician payments and a Centers for Medicare & Medicaid Services plan to limit payment for same-day physician services. Antos said a change could be included in a final budget bill, but the source report describes this as a possibility, not a settled agreement.
Routine health program extensions may also feature in year-end legislation. Wendell Primus, a visiting fellow with the Brookings Schaeffer Initiative on Health Policy, predicted an extensions package could include community health centers, which he put at a cost of $4.4 billion. Baker said several prominent authorities, including Medicare telehealth and acute hospital care at home, had already been authorized beyond 2026; he expected remaining, more standard extensions to be less controversial.
Likely Health Care Provisions
The year-end decisions could affect physician reimbursement and funding or authority for health services, including community health centers. If Congress does not act, some proposed payment changes or expiring provisions may remain unresolved as lawmakers leave for the year. The report does not specify the full list of remaining extenders or their individual deadlines.
For patients and health care organizations, the distinction between narrow extensions and broader reforms matters. Experts interviewed by MedPage Today see more potential for limited adjustments to existing policy than for a major rewrite of contested programs. That is an assessment of the current legislative landscape, not a prediction guaranteed by congressional leaders.
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Why Major Reforms May Wait
The No Surprises Act bars patients from receiving surprise bills for out-of-network care at an in-network facility. Its arbitration process, used to resolve payment disputes between insurers and providers, has drawn complaints from both sides, according to the experts cited in the report. They said lawmakers may agree that the system is creating friction without sharing a clear view of how to change it.
The 340B program gives qualifying hospitals access to outpatient drugs at discounted prices. The Trump administration has proposed replacing the current upfront discount arrangement with a rebate model. Primus anticipated a delay in changes, saying hospitals favor postponement. Separately, Baker pointed to bipartisan price-transparency bills that have cleared committee and said they could potentially be reconciled and attached to a larger package.
“A prospective chairmanship or ranking membership slot may influence what policies a member or committee consider for passage in the remaining 2026 legislative days or hold for action in the new year.”
— Michael Baker, American Action Forum
The Package Is Not Settled
The election outcome, committee leadership changes and lawmakers’ willingness to negotiate remain unknown. The experts cited differ in their forecasts, and none described a finalized list of health provisions or a confirmed deal. It is also unclear whether any price-transparency proposals can be reconciled in time to attach to a year-end bill.
For the No Surprises Act and 340B, the report identifies disagreement over solutions and expectations of delay, rather than a formal decision to postpone action. The scope and timing of any Medicare payment adjustment are also unsettled.
Election Results and Year-End Bills
After the midterms, Congress is expected to return for the remaining legislative days of 2026. Lawmakers will need to address must-move legislation, creating possible vehicles for health provisions. The next indicators will be which members are projected to lead committees, what measures appear in bill negotiations and whether leaders assemble an extensions package.
Until those negotiations produce legislative text or an announced agreement, the physician-payment fix, community health center funding, transparency proposals and other potential provisions remain possibilities. The experts interviewed expect any action to focus more on targeted adjustments than fundamental changes.
Key Questions
What health care issue appears most likely to get attention?
Experts cited a Medicare physician-payment adjustment and routine program extensions as more feasible than broader reforms. Neither is confirmed as part of a final bill.
Will Congress change the No Surprises Act this year?
That remains uncertain. The experts interviewed said the arbitration system is causing friction, but they described limited agreement on a solution and expected major action could wait until next year.
What could happen to the 340B program?
The Trump administration has proposed shifting 340B from upfront discounts to rebates. Primus forecast a delay, but Congress has not announced a decision in the source report.
Could community health centers be included in an extensions bill?
Primus predicted that a package of extensions could include community health centers and cited a cost of $4.4 billion. The report does not establish that funding as approved.
When will the congressional agenda become clearer?
The outlook should sharpen after the midterms, as election results and potential committee leadership changes become known and Congress negotiates must-pass legislation for the rest of 2026.
Source: medpagetoday.com
