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After the November 2026 midterms, Congress is expected to have a short period to finish its work for the year, with health measures potentially attached to must-pass legislation. Analysts see a Medicare physician payment adjustment and program extensions as more plausible than changes to surprise-billing rules or the 340B drug discount program; no outcome is settled.
Congress could consider a Medicare physician payment adjustment and extensions of health programs after the November 2026 midterms, while larger changes to surprise-billing rules and the 340B drug discount program may be postponed. The outlook is uncertain: analysts cited by MedPage Today say lawmakers’ priorities will depend partly on election results and whether health provisions can be attached to must-pass bills.
Medicare physician payments are among the more plausible items for action, according to Joe Antos, a senior fellow emeritus at the American Enterprise Institute. He said Congress will 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 an adjustment could be included in a final budget measure, but no agreement or legislative text is reported.
Health program extensions could also feature in a year-end package. Michael Baker, healthcare policy director at the American Action Forum, said Medicare telehealth authority and acute hospital care at home have already been extended beyond 2026, leaving more standard extensions for lawmakers to address. Wendell Primus, a visiting fellow at Brookings, predicted an extensions package would include community health centers, which he said would cost $4.4 billion.
By contrast, analysts described a fix to the No Surprises Act arbitration system as difficult to resolve quickly. The law bars many surprise bills when patients receive out-of-network care at an in-network facility, but its dispute-resolution process has caused friction for insurers and providers. Proposed changes to the 340B drug discount program may also be delayed. The Trump administration has proposed replacing the current upfront discounts for participating hospitals with a rebate model.
The Likely Reach of Year-End Health Legislation
The post-election legislative window could determine whether health policy changes are limited to funding and targeted adjustments or include broader reforms. For patients and providers, a Medicare payment change could affect physician reimbursement, while extensions may keep certain health programs operating under current authority. The source report does not establish which provisions will pass or specify the final terms of any payment adjustment.
For the surprise-billing system and 340B program, delay would leave existing arrangements in place while lawmakers continue debating possible remedies. Those issues affect patients, hospitals, clinicians and insurers, but analysts cited in the report said there is not yet clear agreement on what a fix should contain. The distinction matters: discussion of a possible provision is not evidence that Congress has agreed to act.
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Why Post-Election Timing Matters
The midterms will take place before the end of the 2026 congressional session, so newly elected members will not yet have taken office when lawmakers return to finish the year. Baker said the results could still shape decisions because members may weigh projected party control and future committee leadership positions when deciding whether to advance legislation now or wait for the next Congress.
Health measures could be attached to larger bills that Congress needs to move, including appropriations legislation, the National Defense Authorization Act and the Farm Bill, Baker said. He also noted that bipartisan transparency bills have passed out of committee and might be reconciled and included in a package. These are possible legislative vehicles and candidates, not confirmed additions.
Analysts interviewed for the report generally expect limited action. Antos said lawmakers have little incentive to negotiate and that the White House is not pushing a health package. He said any action is more likely to involve small fixes to existing policies than fundamental changes.
“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, director of healthcare policy at the American Action Forum
Which Proposals Can Attract Agreement
No final legislative package has been identified, and the report does not say which bills will reach a vote or when. Election results, committee leadership prospects and negotiations over larger funding measures could all affect what is considered during the final legislative days.
It is also unclear whether Congress can agree on the details of a No Surprises Act change or the proposed 340B shift. Baker said there may not be enough consensus for either measure to move quickly, even as part of a must-pass bill. The possibility of price-transparency provisions, drug-pricing offsets, a physician payment adjustment and community health center funding remains under discussion rather than confirmed.
Watch the December Legislative Package
Congress is expected to return after the November midterms to finish the year. The next indicators will be election results, decisions about which must-pass bills lawmakers move, and whether health provisions appear in legislative text. Analysts expect standard program extensions and a possible physician payment fix to be more realistic near-term candidates than broad changes to surprise billing or 340B.
Any specific outcome will depend on negotiations and the final package. The report points to December as a potential window for action but does not identify a confirmed vote, deadline for a health measure or agreed policy details.
Key Questions
What health issue is most likely to get congressional attention after the midterms?
Analysts cited in the report see a Medicare physician payment adjustment and health program extensions as among the more plausible items. Neither has been confirmed as part of a final bill.
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 said lawmakers may lack agreement on a solution and could defer action until 2027.
What change has been proposed for the 340B program?
The Trump administration has proposed replacing the current arrangement, in which hospitals receive discounts upfront, with a rebate model. The report says a congressional change may be delayed; it does not describe an enacted change.
Could community health centers receive funding through an extensions package?
Primus predicted that an extensions package would include community health centers and put the cost at $4.4 billion. That is an analyst’s forecast, not a confirmed funding commitment.
Source: medpagetoday.com
