A perfect storm
Prices are on the rise. Corporate layoffs are stacking up. And Americans are doing the household arithmetic of late-year budgeting: what to pay now, what to defer, and what to silently hope resolves itself. An economic landscape already running warm could be heading to a pressure chamber.
A perfect storm of budget cuts, legislative reforms, and the sunsetting of federal aid is converging to deal a staggering blow to the American healthcare machinery in 2026. This could undo a decade of progress in widening coverage and push the costs of healthcare beyond the reach of far too many consumers.
That was the consensus of health policy experts at an American Community Media’s briefing held on November 21, 2025.
A panel—featuring Tomas Bednar of Healthsperien, Amber Christ of Justice in Aging and Sophia Tripoli of Families USA—outlined a grim forecast driven by three motifs: soaring costs, shrinking access, and perpetual political gridlock.
Expiration of tax credits
The most immediate threat is the expiration of enhanced premium tax credits (APTCs). These credits, which help keep insurance affordable on the Affordable Care Act (ACA) marketplace, are accessed by some 22 million Americans—about 92 percent of individual market beneficiaries.
Without their reinstatement, American consumers could see their monthly premiums jump by as much as 70 percent. Some households could experience an even steeper hike, depending on their income, their plan, and where they live. Insurers themselves project premiums in 2026 will be 25 percent higher, even before factoring in the loss of the APTCs.
Public health budget cuts
Compounding this crisis are sweeping cuts to public health programs. The nonpartisan Congressional Budget Office (CBO) estimates a $45 billion cut to the Medicare budget next year, which amounts to $536 billion over the next decade. Furthermore, HR1, dubbed the “One Big Beautiful Bill,” strips $900 billion from the Medicaid budget over 10 years and adds new work requirements that many current beneficiaries may not be able to meet.
Amber Christ of Justice in Aging noted that HR1 is particularly devastating for older adults as it ends Medicare eligibility for scores of lawfully present immigrants, including refugees and asylum seekers, many of whom have paid Medicare taxes for years. At a higher level, the legislation places a massive fiscal burden on states, forcing them to confront big deficits in the Medicaid budget and leaving them with limited choices for filling those deficits—ultimately resulting in decreased access for consumers.
Public charge rule
The threat to access extends to immigrant communities through the re-imposition of the “public charge” rule by the current administration. Tomas Bednar explained that the rule, which has been subject to a “ping-pong” of policy changes over the past eight years, allows immigration officials to consider an applicant’s eligibility for public benefits, such as Medicaid, when assessing their eligibility for permanent residency status (green cards). Bednar said, “It’s due to the fact that there’s a perceived chilling effect to the access of Medicaid.”
While intended to narrow the scope of Medicaid beneficiaries, the rule is expected to have a “chilling effect,” where eligible immigrants are dissuaded from applying for essential benefits out of fear that it could jeopardize their immigration status. Bednar contextualized this move as part of a far bigger “attack on Medicaid” that includes restricting eligibility for emergency healthcare for certain immigrant populations under HR1.
An affordability crisis
As so many face sticker shock on their premiums and loss of coverage, Sophia Tripoli of Families USA stressed that extending tax credits, while essential, is not enough to fix an infrastructure that was “already buckling” under pressure. “The number one driver of unavoidable healthcare in America is … not overuse, not bad decisions. It’s prices.”
She argued that the country is grappling with an affordability crisis rooted not in “overuse or bad decisions,” but overwhelmingly in high prices.
These soaring prices are driven by two structural forces: corporate consolidation and payment incentives that reward volume over value. According to Tripoli, fewer companies now control more of the market across hospitals, physician practices, and drug companies, granting them “more power to raise prices.” Furthermore, the system’s fee-for-service model rewards “doing more, not doing better,” ignoring prevention and financial security.
The collective consequence of these political and systemic failures is a domino effect on the entire population. Consumers are increasingly forced to delay or avoid necessary care due to high deductibles and out-of-pocket costs, leading to higher rates of mortality and increased reliance on costly emergency room services.
An election year agenda
With 2026 being an election year, the experts agree that coverage and affordability are inextricably connected, providing an opportunity for lawmakers to come to the table with a bold, bipartisan agenda. This agenda must include systemic changes like curbing provider consolidation, restricting predatory billing, and modernizing payment models to reward keeping people healthy. Christ warns, “You cannot cut nearly $1 trillion out of the healthcare system and not have severe ramifications across the entire society.”
This article was written with support from the American Community Media Fellowship Program.