PwC: Healthcare Leaders Should Prepare for Continued Policy Shifts Ahead of 2026 Midterms

As Washington turns its attention toward the 2026 midterm elections, healthcare organizations should expect policy uncertainty to remain a defining feature of the operating environment, according to a new report from PwC's Health Policy and Intelligence Institute.

The report concludes that healthcare is undergoing a structural transformation driven by changing federal priorities, increased state-level influence, and a greater emphasis on affordability and transparency. Rather than viewing these developments as temporary political shifts, PwC suggests healthcare leaders should prepare for long-term changes that will reshape how organizations plan, invest and deliver care.

PwC identifies four major policy trends that are already influencing the healthcare landscape:

• Greater emphasis on state and individual choice over federal standards.
• Reduced federal healthcare spending.
• Stronger alignment of incentives with national policy priorities.
• Continued deregulation paired with heightened enforcement activities.

Together, these forces are expected to increase financial pressure on providers, create greater variation across states, and require healthcare organizations to become more agile in responding to policy changes.

Affordability Expected to Remain Front and Center

Among the issues likely to dominate healthcare policy discussions over the next year, affordability stands out as the most significant.

PwC notes that the expiration of enhanced Affordable Care Act premium tax credits, combined with Medicaid eligibility changes and funding reductions enacted through the One Big Beautiful Bill Act (OBBBA), could increase the number of uninsured Americans and place additional financial strain on providers through higher levels of uncompensated care. The report also anticipates continued pressure on commercial insurance premiums and growing consumer demand for lower-cost coverage options.

The firm expects affordability and access to become central campaign issues leading into the midterms, influencing both federal and state policy agendas.

Transparency and Consumer Choice Continue to Expand

PwC also predicts continued movement toward a more consumer-driven healthcare marketplace.

Federal and state policymakers are expected to expand transparency initiatives affecting hospital pricing, pharmaceutical costs and pharmacy benefit managers (PBMs). At the same time, direct-to-consumer healthcare models and telehealth platforms are giving patients more options for accessing care outside traditional delivery channels.

According to the report, organizations that treat transparency as a strategic capability rather than simply a compliance requirement will be better positioned to navigate increasing pricing pressure and build trust with consumers.

Impacts Will Vary Across the Healthcare Sector

While many policy changes affect the entire healthcare ecosystem, PwC highlights distinct implications for different sectors.

For providers, priorities include preparing for increased uncompensated care, workforce challenges and opportunities to modernize operations through technology, partnerships and AI-enabled automation. Rural health systems may also benefit from significant federal investments through the Rural Health Transformation Program.

Health plans are expected to face continued PBM reform, increased oversight of fraud, waste and abuse, and greater administrative complexity tied to Medicaid and Marketplace eligibility changes.

Pharmaceutical manufacturers will likely need to adapt to changing pricing dynamics, evolving evidence requirements from the Food and Drug Administration, and increased pressure to strengthen patient engagement and care coordination. Meanwhile, medical technology companies should prepare for a regulatory environment that reduces some premarket oversight while placing greater emphasis on post-market monitoring and real-world evidence.

Looking Ahead

As the 2026 election cycle accelerates, PwC advises healthcare leaders to closely monitor several policy themes, including affordability, price transparency, state-level policy divergence, healthcare consolidation, and the continued use of targeted federal negotiations with industry.

The report concludes that organizations should avoid waiting for policy certainty. Instead, leaders should continue investing in operational flexibility, strategic partnerships, digital capabilities and governance structures that position their organizations to adapt as healthcare policy continues to evolve.

For more, including recommended action steps for providers, payers and other sectors, view the full report.