TL;DR
As Congress returns after the November 2026 midterms for the final legislative stretch of the year, observers expect health measures to ride on must-pass bills. Medicare physician payment changes and routine extenders appear more plausible than a broad No Surprises Act or 340B overhaul, but lawmakers’ plans remain uncertain.
With Congress expected to return after next week’s midterm elections to finish the 2026 legislative year, health policy observers see a possible Medicare physician payment fix and routine program extensions as likelier targets than major changes to surprise billing or the 340B drug discount program. Any health provisions would probably be attached to legislation lawmakers need to pass, but the election outcome and lack of agreement on several policies leave the year-end agenda uncertain.
Michael Baker, health policy director at the American Action Forum, told MedPage Today that lawmakers’ choices may be shaped by the projected control of the House and Senate and by which current members are expected to return or seek leadership positions in the next Congress. Those calculations could affect whether members advance a measure during the remaining days of 2026 or hold it for the new Congress.
Baker identified appropriations bills, the annual defense authorization bill and the Farm Bill as potential vehicles for health provisions because they are legislation Congress must move. The telehealth and acute hospital care-at-home authorities have already been extended beyond this year, he said, leaving more routine program extensions to address. Wendell Primus, a visiting fellow at the Brookings Schaeffer Initiative on Health Policy, also expects extensions to feature prominently and said a package could include community health centers, which he put at a cost of $4.4 billion.
Joe Antos, an emeritus senior fellow at the American Enterprise Institute, said lawmakers could face pressure to counter a proposed 1% or greater Medicare physician payment reduction and a Centers for Medicare & Medicaid Services plan to limit payment for same-day physician services. He said a change might be included in a final budget bill. Antos and Baker also pointed to bipartisan price-transparency bills that have passed committee as possible candidates for attachment to a broader package.
The Year-End Health Policy Stakes
The choices matter to physicians and patients because Medicare payment rules affect what clinicians receive for covered services, while program extensions can sustain funding or authority for health providers and services. The potential community health center extension is one example of a provision that could be included in a larger year-end deal.
For people with insurance, the No Surprises Act’s protections against certain out-of-network bills remain in place, but disputes over its arbitration process have created friction between insurers and providers, according to Antos. A failure to revise that process this year would leave those disagreements unresolved in the near term. The proposals discussed are possibilities, not enacted decisions, and the experts interviewed differ on which measures are likely to move.
Why the Legislative Calendar Matters
The report was published on October 29, 2026, ahead of midterm elections scheduled for the following week. Although newly elected members would not yet have taken office, Baker said anticipated changes in party control and committee leadership could influence current members’ decisions about what to pass before year-end and what to leave for 2027.
The No Surprises Act bars certain surprise bills when patients receive out-of-network care at an in-network facility. The law’s central protection is broadly accepted by the experts quoted, but its arbitration system is disputed. Separately, the Trump administration has proposed changing the 340B outpatient drug discount program from an upfront discount model to a rebate approach. That proposal, and possible legislative changes, are not settled.
“A prospective chairmanship or ranking membership slot may influence what policies a member or committee consider for passage in the remaining 2026 legislative days or hold for action in the new year.”
— Michael Baker, director of health care policy at the American Action Forum
Which Proposals Can Win Support
No legislation or final year-end health package has been confirmed. The election result, the composition of the returning Congress, and the remaining legislative schedule could all affect what lawmakers take up. It is also unclear whether enough agreement exists to resolve the No Surprises Act arbitration dispute or change the 340B program. Baker said those issues could be debated but questioned whether lawmakers agree on a preferred solution.
Price transparency measures are another possibility, not a guarantee: Baker said bipartisan bills that cleared committee could be reconciled and attached to a larger bill. Antos said lawmakers and the White House were not showing strong incentives to negotiate on health policy. The source report does not identify a finalized legislative text, vote schedule or confirmed cost for the other proposals discussed.
The Post-Election Legislative Window
After the midterms, Congress is expected to return for the remaining legislative days of 2026. The next practical test will be whether negotiators assemble appropriations, defense authorization, Farm Bill or other must-move legislation with health provisions attached. A Medicare physician payment adjustment and routine extensions are among the measures observers identify as possible additions.
Lawmakers’ decisions may also reflect who is expected to lead committees in the next Congress. If negotiations do not produce agreement before the year ends, some contested matters could be left for 2027; Primus specifically expects the surprise-billing issue to wait. No timetable for action on that issue, 340B or price-transparency legislation has been confirmed.
Key Questions
What health measures are most likely to be considered after the midterms?
Experts cited in the report see a Medicare physician payment adjustment and routine program extensions as plausible year-end measures. They may be attached to legislation Congress needs to pass, but no package is confirmed.
Will Congress change the No Surprises Act this year?
That remains uncertain. The law’s arbitration system is causing disputes, but both Antos and Primus described significant obstacles to a fix, and Primus expects the issue to be addressed next year instead.
What could happen to the 340B drug discount program?
The Trump administration has proposed replacing the current upfront discount arrangement with a rebate model. Primus expects action on a 340B fix to be delayed, but Congress has not announced a final decision.
Could community health centers be included in a year-end bill?
Primus said he expects an extenders package to include community health centers and cited a cost of $4.4 billion. That is his forecast, not a confirmed legislative provision.
Source: medpagetoday.com
