⭐ABIG Updates by Santiago O’Neil⭐

TL;DR - New Year, Same Stakes
2025 closed with subsidies lapsing, measles surging, and industry warning of turbulence ahead; 2026 opened with vaccine policy being rewritten overnight and fresh deal-making on the Hill. The system is under strain, but so is the status quo. AI adoption is accelerating, coverage and cost battles are intensifying, and the organizations building real infrastructure are separating from those still running pilots. From everyone on the ABIG Team: Happy New Year!

Goodbye, 2025: What You May Have Missed

Twists and Turns

The final weeks of 2025 delivered a cascade of policy shifts, funding announcements, and public health warnings that set the stage for a turbulent year ahead.

🏥 The access squeeze is real, and AI is filling gaps. As enhanced ACA subsidies lapsed on January 1st, blue and purple states scrambled to deploy state-funded premium assistance, reinsurance programs, and targeted tax credits to blunt steep Marketplace premium hikes: stopgap measures that still leave many low- and middle-income enrollees facing higher net premiums and deductibles. But the scramble underscores a deeper trend: Americans are increasingly navigating a complex, often inaccessible healthcare system on their own. OpenAI's new report, "AI as a Healthcare Ally," reveals that over 40 million people now ask ChatGPT healthcare questions daily: more than 5% of all global messages. Of the platform's 800M regular users, one in four submits a health-related prompt each week.
↪ The usage patterns tell the story. Between 1.6 and 1.9 million weekly messages focus on health insurance alone: plan comparisons, claims disputes, billing questions, coverage queries. Seventy percent of health conversations happen outside clinic hours, when providers' offices are closed. And in rural "hospital deserts", areas more than 30 minutes from a general medical or children's hospital,users send nearly 600,000 healthcare messages per week. OpenAI is leaning into the opportunity, previewing a healthcare AI policy blueprint and calling for FDA regulatory clarity on AI medical devices.

💊 Meanwhile, the policy picture got messier. The DEA granted a fourth temporary extension of COVID-era telehealth flexibilities, pushing expiration into late 2026 while permanent rules remain in limbo: a pattern that has now repeated for three years running. Provider groups and telehealth companies welcome the reprieve, but warn that prolonged regulatory uncertainty is hampering long-term investment and care planning for patients who rely on virtual prescribing for behavioral health and chronic pain management. On the drug pricing front, the Trump administration moved to accelerate Medicare price negotiations and expand penalties on manufacturers that fail to offer required discounts; this comes even as high-profile biotech deals from AstraZeneca, Neurocrine, and CRISPR-based programs illustrated the persistent tension between aggressive price controls and sustaining investment in innovative therapies.

🚨 And the public health red flags kept coming. CDC data confirmed more than 2,000 measles cases in 2025, the highest in over three decades, with 87% tied to 50 distinct outbreaks and roughly 93% of patients unvaccinated or of unknown vaccination status. Texas alone accounted for over 800 cases. Public health experts warn the surge, compounded by declining vaccination rates and misinformation, could cost the U.S. its hard-won "measles elimination" status as early as this month. ↪ On a more hopeful note, the administration announced a $50 billion Rural Health Transformation Program, with all 50 states set to receive first-year awards averaging $200 million to stabilize financially distressed rural hospitals and clinics. The funding (tied to closures, uncompensated care burdens, and workforce shortages) represents an unprecedented federal investment in rural healthcare infrastructure. Supporters see a critical lifeline for communities hit hard by Medicaid churn and low commercial reimbursement rates; critics question guardrails and worry flexible grants could substitute for broader payment and coverage reforms.

🧠 Recapping ABIG Year: the executives who steered health systems through 2025's turbulence are sounding a note of caution on the way out. A Fierce Healthcare round-up of dozens of retiring health system CEOs reveals a striking consensus: workforce burnout, relentless payment pressures, and the imperative to reshape care delivery around outpatient and digital models defined their final years at the helm. Their parting advice centers on sustained investment in staff well-being, strategic partnerships, and technology modernization—but comes with a warning. Ongoing margin compression and political volatility, they caution, could make the next decade even more turbulent for provider leadership than the one they just navigated. ABIG Health exists to provide expert guidance and support to those aiming to thrive in the current market and regulatory landscape. [Click here for more insights.]

Welcome, 2026: What's Already Happened

🏃‍➡️ Steps and Leaps

The first week of 2026 has already delivered substantial shifts in federal health policy: from ACA negotiations to a historic overhaul of childhood vaccine recommendations.

🏛️ The ACA subsidy fight enters a new phase. Senate Majority Leader John Thune (R-SD) signaled he's "not averse" to a bipartisan deal extending enhanced premium tax credits, as Sens. Bernie Moreno (R-OH), Susan Collins (R-ME), and Jeanne Shaheen (D-NH) continue negotiations. The Moreno-Collins proposal would extend subsidies while phasing them out for households earning over $200K. Thune prefers bipartisan legislation over reconciliation but acknowledged it's a "heavy lift" given Hyde Amendment disagreements. President Trump urged House Republicans to "own" healthcare and show "flexibility on Hyde" ahead of 2026 midterms.
↪ Whether any deal can thread the needle remains uncertain: health policy experts remain skeptical that proposed reforms will meaningfully address affordability for the ~22M enrollees now facing higher premiums.

💉 Vaccine policy is being rewritten in real time. Acting CDC Director Jim O'Neill signed a decision memo reducing universally recommended childhood vaccines from 18 diseases to 11, following President Trump's directive to align U.S. recommendations with "peer, developed nations." The new three-tier framework maintains routine recommendations for core vaccines (DTaP, Hib, pneumococcal, polio, MMR, HPV, varicella) while shifting RSV, hepatitis A/B, meningococcal, COVID-19, influenza, and rotavirus to high-risk or "shared clinical decision-making" categories. All vaccines remain covered without cost-sharing, but the AAP, AMA, and Sen. Bill Cassidy (R-LA) criticized the move as "dangerous" and made "without scientific input."
↪ Days earlier, CMS quietly dropped mandatory childhood vaccine reporting from the 2026 Core Sets, notable timing given that vaccination rates have already fallen below herd-immunity thresholds in counties home to 5.2 million kindergartners.

🩺 On a brighter note: HRSA endorsed at-home HPV screening for cervical cancer detection, a move that could expand access for women facing barriers to in-clinic Pap smears.

New Year, New Outlook

🔁 The More Things Change…

What should stakeholders be watching as 2026 unfolds? The consensus: affordability pressures, coverage disruptions, and the maturation of healthcare AI will define the year.

📉 Affordability is the through-line. Drew Altman's eight major health-policy storylines for 2026 are led by one theme: cost pressures are about to hit households harder than at any point since the ACA's passage. If enhanced tax credits remain lapsed, sharper premium and cost-sharing increases could trigger voter backlash as health costs rival food and utilities as top concerns. Add looming Medicaid work requirements, intensified scrutiny of hospital prices, GLP-1 coverage dilemmas, and frustration with prior authorization—and the policy landscape looks volatile. Altman also predicts a shift in the AI debate from clinician tools to consumer-facing cost and navigation applications, all against a backdrop of limited congressional "small-ball" policymaking in an election year.

🏥 The Medicaid domino effect is coming. Fierce Healthcare's payer outlook warns that scheduled Medicaid cuts and work requirements could cascade into coverage losses, higher uncompensated care burdens for providers, and premium pressure in commercial markets as cost-shifting accelerates. The piece flags employers' growing alarm over GLP-1 spending, escalating cost-sharing that obscures true price growth, and increasing momentum for site-neutral payment and state-level cost-growth caps as policymakers hunt for savings.

🤖 AI moves from pilots to production. Health systems and payers are expected to shift from pilot AI tools to standardized enterprise programs in 2026, with governance frameworks, bias monitoring, and integration into clinical workflows becoming central differentiators. Regulators and professional groups are coalescing around minimum expectations for validation, performance monitoring, and transparency, but organizations still struggle to prove ROI and maintain clinician trust amid rapid model iteration.

🏪 Primary care is fragmenting fast. A new study documents rapid growth in alternative primary care models - value-based, concierge, and virtual-first practices - alongside rising ownership by private equity, insurers, and retail chains. Researchers note potential benefits like extended hours and care coordination but raise concerns about churn, upselling, and uneven access, especially in rural and low-income communities where safety-net clinics remain under-resourced.

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