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After the November 2026 midterms, Congress is expected to return for a short legislative period, when health measures could be attached to must-pass bills. Analysts see a Medicare physician payment adjustment and routine program extensions as more plausible than major changes to surprise billing or the 340B drug discount program. No final agenda or agreement has been announced.
With the November 2026 midterms approaching, health policy analysts expect Congress to face a short list of potential health measures when lawmakers return to finish the year, including a possible Medicare physician payment adjustment and extensions of existing programs. Major changes to the No Surprises Act and the 340B drug discount program appear less certain, and no post-election legislative agreement has been announced.
Congress-watchers say the election could influence what lawmakers pursue even before newly elected members take office. Michael Baker, healthcare policy director at the American Action Forum, told MedPage Today that projected control of the chambers and the identities of lawmakers expected to lead committees next year may shape which policies current members try to move before the end of 2026.
Potential vehicles include appropriations bills, the National Defense Authorization Act and the Farm Bill, which Baker described as measures Congress must move. Health provisions could be attached to those bills. Baker also said some prominent extensions, including Medicare telehealth authority and acute hospital care at home, have already been authorized beyond this year, leaving what he called more routine extensions for consideration.
Joe Antos, a senior fellow emeritus at the American Enterprise Institute, said Congress may face pressure to respond to 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 payment change could be included in a year-end budget measure, but it remains a forecast, not a confirmed congressional decision.
Payment Rates and Program Funding
The choices matter to Medicare patients and clinicians because changes to physician payment can affect the funding available for covered services. The source report describes the reduction as a CMS proposal; Congress has not yet enacted an alternative or settled the issue.
Extensions also determine whether health programs continue under existing authority and funding arrangements. Wendell Primus, a Brookings Schaeffer Initiative on Health Policy visiting fellow and former adviser to House Speaker Nancy Pelosi, predicted that an extension package could include community health centers, with a reported cost of $4.4 billion. That figure and the package are part of his forecast, not an enacted commitment.
For patients, providers and hospitals, the gap between a narrow year-end fix and a broader policy overhaul matters. Analysts expect any near-term action to focus more on specific problems or program continuity than on fundamental changes, although the outcome depends on negotiations and the election.
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The Disputes Behind the Forecast
The No Surprises Act bars certain surprise bills when patients receive out-of-network care at an in-network facility. The source report says analysts agree the law achieved its main goal, but its payment arbitration system has caused friction for insurers and providers. Antos said the system is creating problems but that the solution is unclear; Primus argued that a fix is too large to complete in the post-election session and may be left to next year.
The 340B program provides outpatient drug discounts to eligible hospitals. The Trump administration has proposed changing how discounts are delivered, shifting from discounts received upfront to a rebate model. Primus predicted a delay, saying hospitals want one, while Baker said there was not enough agreement on a preferred reform for it to move quickly.
Baker also pointed to bipartisan price-transparency bills that have passed out of committee as a possible subject for negotiations. He said those proposals could be reconciled and attached to a larger package, potentially alongside a physician payment adjustment. Their inclusion is uncertain.
“Post-election health policy productivity will depend not only on projected party control of the chambers, but also which sitting members are returning next year, and who may be expected to assume gavels in the new Congress.”
— Michael Baker, American Action Forum healthcare policy director
The Year-End Package Is Unsettled
The post-election agenda will depend on the midterm results, committee leadership and negotiations, and the source report describes possibilities rather than decisions. It is not clear which must-move bills will carry health provisions, whether lawmakers will reach agreement on physician payments, or which extensions will be included.
There is also no confirmed timetable or final proposal for changes to the No Surprises Act, 340B or price transparency. Baker said bipartisan transparency bills could be combined, but he questioned whether enough agreement exists for other proposed reforms to move quickly. Antos also said the White House was not pushing a health policy package, according to his assessment.
Lawmakers Return After the Election
After the November midterms, Congress is scheduled to return to complete the year’s legislative work. Attention will turn to whether leaders attach health provisions to year-end appropriations or other must-move legislation, and whether lawmakers address Medicare physician payments or program extensions.
The next meaningful indicators will be the bills lawmakers advance and any negotiated package language. Until those emerge, projections about community health centers, price transparency, surprise billing and 340B should be treated as analyst expectations, not settled policy.
Key Questions
What health issue is most likely to receive attention after the midterms?
Analysts cited a possible Medicare physician payment adjustment and routine program extensions as more plausible items. Congress has not announced a final agenda.
Will Congress change the No Surprises Act this year?
That is uncertain. The law’s arbitration system has drawn criticism from payers and providers, but analysts quoted in the report said a fix may be too difficult to complete in the short post-election session.
What change is being discussed for the 340B program?
The Trump administration has proposed replacing the current upfront discounts with a rebate model. The report says a delay is possible, but no congressional action is confirmed.
Could community health centers be included in an extension package?
Wendell Primus predicted that an extensions package could include community health centers and cited a cost of $4.4 billion. That remains a forecast, not an enacted funding decision.
Source: medpagetoday.com
