Perspectives on the forces shaping health

For decades, health policy debates in Washington were guided by a relatively stable set of inside-the-Beltway insiders: lobbyists, trade associations, think tanks, congressional staff, and government experts. Influence flowed primarily through these traditional channels, with institutional players acting as the gatekeepers of policy ideas and legislative outcomes.

That dynamic has not disappeared. Traditional institutions remain central to the health policy ecosystem. But they no longer hold a monopoly on how influence is built, amplified, and translated into action.

A Multidirectional Model of Influence

In today’s environment, new voices and leaders have emerged operating across three interconnected dimensions:

• Mobilizing influence: driving grassroots energy, activating constituencies, and shaping primary electorates through digital platforms and community organizing.
• Amplifying influence: reinforcing narratives across an expanded media environment of podcasts, digital outlets, and online personalities who serve as validators and message carriers.
• Channeling influence: directing this momentum into institutional arenas–candidate recruitment, campaign staffing, legislative offices, and even executive branch appointments.

This new model shows how influence now circulates dynamically, rather than moving only in one direction. The result is a more multidimensional and dispersed architecture of policy engagement.

A Changing Profile of Leadership

The individuals driving these flows often look very different from the traditional Washington insider. Many emerge from local leadership roles, issue-specific activism, or online networks, yet they exercise national impact.

Consider, for example, the profile of a new voice in today’s health policy landscape. Imagine a small business owner in a Midwestern county who first entered politics during the pandemic. Motivated by concerns about federal overreach, he built credibility by speaking directly to his neighbors and cultivating an online following that engaged with health care debates. Through mobilizing influence, he organized grassroots supporters and helped shape a competitive primary against the incumbent. Through amplifying influence, his voice gained traction in regional radio and national podcasts, reinforcing narratives among key audiences. And through channeling influence, he played a role in recruiting candidates, staffing offices, and even influencing federal agency appointments.

Though far from Washington, his reach now extends into Congress, the media ecosystem, and the executive branch. He is just one example of how new voices and leaders are reshaping the way health policy influence operates today.

Implications for Health Policy

For health care stakeholders, this shift requires a new approach. Advocacy campaigns must anticipate not only how ideas are received inside Washington but also how they mobilize communities, are amplified through digital channels, and are ultimately channeled into governing institutions. In this environment, understanding influence requires a multidimensional lens that integrates grassroots, narrative, and institutional dynamics.

Introducing Influence360

To meet this need, Reservoir has developed Influence360, a new framework for analyzing the multidirectional flows of today’s influence environment. Built on extensive research of nearly 5,000 congressional primary voters, Influence360 helps stakeholders map how influence mobilizes, amplifies, and channels across the political ecosystem. Launched alongside our PRISM audience intelligence platform that identifies sixteen new segments within the base of both political parties, Influence360 provides clients with a unique vantage point: not only identifying who the key audiences are but also understanding how influence moves through them.

In today’s fractured and fast-moving environment, the ability to recognize and adapt to this multidirectional flow of influence is no longer optional—it is essential for shaping the future of health care policy.

Health policy activity is not expected to slow down this fall. Several milestones on the horizon will present both challenges and opportunities for healthcare stakeholders seeking to advance their priorities by year-end.

Below is an overview of key issues to watch, their potential implications, and opportunities for engagement.

Government Funding Deadline Looms

• Status: Congress faces another government funding deadline at the end of September. While appropriators had been working to advance several bills through regular order, completion before the deadline is highly unlikely, teeing up another short-term funding patch through a continuing resolution. As of posting, Congress has not yet reached a funding deal with one week remaining until the deadline.
• Implications: There are also several healthcare extender policies, such as Community Health Centers and Medicare telehealth flexibilities, that are typically tied to appropriations or a continuing resolution, so there will be no lapse in funding for these programs. Whatever the path forward, Senate Republicans will need bipartisan support to bypass a filibuster, unlike the reconciliation process over the summer that only required a simple majority vote.

Drug Pricing and Coverage in the Spotlight

• Most Favored Nation (MFN) Executive Order
  • Status: The end of September also marks 60 days since President Trump sent letters to 17 drug manufacturers urging compliance with his May 2025 MFN Executive Order. HHS reports negotiations with 14 companies and, working with the Commerce Department, is using potential pharmaceutical tariffs as leverage to encourage action.
  • Implications: It is unclear what additional administrative actions might follow this upcoming deadline, but with the recent Presidential Memoranda on revisiting requirements related to direct-to-consumer (DTC) drug advertisements, the focus on pharma is not slowing down.

• Medicare Open Enrollment
  • Status: Additional detail on Medicare Advantage and Part D plan offerings for 2026 is expected in the coming weeks leading up to the start of open enrollment, October 15 through December 7.
  • Implications: Based on the national bid and premium amounts announced in late July and news of several notable plan departures from the market, it could be a challenging road ahead for the 2026 plan year with significant disruption and increased costs for patients.

• Medicare Drug Price Negotiation
  • Status: By the end of November, the Trump administration will announce the maximum fair prices (MFPs) for the 2027 cohort of drugs under the Inflation Reduction Act’s (IRA) Medicare drug price negotiation program.
  • Implications: While year two of the program, it is the first year that the Trump administration has driven the process. All eyes will be on whether they secured more significant price reductions relative to the Biden administration for the 2026 cohort of drugs. This will provide an additional data point on what to expect in future years of the program and how progress here might intersect with the administration’s efforts on MFN. With MFPs starting to get picked up by state Prescription Drug Affordability Boards (PDABs), there is the potential for these prices to spread beyond Medicare.

Expiration of Enhanced Affordable Care Act (ACA) Premium Tax Credits

• Status: The enhanced premium tax credits under the ACA are set to expire at the end of this year, and Congress is considering near-term action to extend the credits on a short-term basis. The enhanced premium tax credits were first enacted in 2021 and later extended through the end of 2025 through the IRA.
• Implications: Exchange markets are bracing for an average18% premium increase heading into 2026 if credits lapse. CBO previously estimated that an additional 4.2 million people would become uninsured over the next decade if the tax credits expire, on top of Medicaid changes in the recently passed reconciliation bill that are also expected to increase the number of uninsured individuals. Politically, Republicans face pressure: opposing an extension is unpopular with voters heading into next year’s midterm elections. This dynamic could drive bipartisan support for a short-term extension, potentially as part of the continuing resolution mentioned above.

Where To Head Next?

This fall’s packed health policy agenda presents both risks and opportunities for stakeholders looking to shape outcomes and advance their priorities. Now presents an optimal time to consider any need to refine your engagement strategies, sharpen and target your messaging, and uncover compelling evidence to support policy and advocacy strategies.

The worst crisis an organization can confront is one it faces without preparation. 

It’s easy for a successful organization to be caught flat-footed by events—some truly unforeseen, others not yet fully anticipated. Such an unexpected event or issue can pull a company into crisis within hours. In these moments, how an organization reacts can substantially impact brand and reputation.

While there is no one-size-fits-all approach to crisis management, advance efforts toward building readiness and resiliency while also establishing roles and responsibilities will serve to minimize reputational harm and protect market value.  

Having guided organizations of all sizes through highly complex challenges, we have several guiding principles for effectively navigating a crisis. 

Pre-appoint the right team.

Identify the most important members of your crisis management team now before a crisis unfolds—not during one. While you can and should develop a crisis playbook, more critical is establishing a high-functioning team that can collaborate under pressure and exercise sound judgment. The make-up of this team may vary, but often includes those in charge of legal, operations, finance, investor relations and communications. A small, nimble team that can make decisions quickly with a direct reporting line to the top of the organization will be most effective in managing a crisis.

Designate a crisis leader.  

This should be an insider who can manage the crisis team and is trusted to make key decisions. This person should have both the institutional knowledge and the credibility to lead in high-stakes situations. Oftentimes, this leader is the general counsel or key member of the legal team. 

Build a culture of readiness and resiliency.  

A crisis should not be the first time your crisis response team works together or considers how to prioritize response efforts. Conduct crisis simulations to hone these skills. Choose realistic scenarios—such as one drawn from the news or that has recently occurred at a peer company—to assess how your team would respond.

Emphasize the importance of getting the facts.  

When a crisis occurs, organizations are often faced with internal and external pressure to issue a public statement. Rarely is the information that trickles in on day one of a crisis the full picture. Resist the urge to act prematurely so you can avoid making mistakes publicly. It is imperative to act with speed and precision but don’t separate the two. Prioritize gathering the facts before you align on any messaging or strategy. And then only communicate what you know and your organization’s steadfast commitment to transparency and resolution in the matter. 

Ensure that your communications team can work in lockstep with legal counsel.

Working with legal counsel ensures legal considerations are embedded into every facet of crisis response. You don’t want a crisis to be made worse by triggering regulatory scrutiny or introducing litigation risk. A communications team experienced in working with legal stakeholders will understand the nuances of privileged communications, regulatory risk and reputational sensitivity.

Consider stakeholder needs.

Customers, investors, partners and employees will want to hear from you. If you don’t speak, someone else will, and your stakeholders will wonder why you aren’t engaging. Effectively communicating with them is critical to any crisis management strategy.  

Engage experienced crisis counsel.  

An outside perspective is crucial in avoiding blind spots internally. Traditional public relations teams are skilled in promoting positive narratives but may not be equipped to manage complex, multifaceted crises that involve immense scrutiny from regulators, media, investors and the board. Skilled crisis communications professionals can bring a cross-functional, disciplined approach to protect enterprise value and reduce long-term risk.

Organizations that take steps now to build readiness and resilience will be far better positioned when the stakes are highest. Learn how Reservoir helps organizations navigate high-profile crisis situations and complex legal matters.

In the current political landscape, where the federal agenda is evolving rapidly and many of the traditional advocacy channels are in flux, some of the most meaningful movement in health care policy is happening far from the Beltway — in statehouses, ballot boxes, and local communities across the country.

For policymakers, trade associations, and national health care advocates seeking to achieve policy impact, the message is clear: state strategies are no longer a secondary play — they are the front line of influence.

Amid Shifting Federal Dynamics, States Are Leading

Hyper-partisanship and fragmented federal policymaking have opened the door for state legislatures, governors, and even municipal leaders to drive policy change on health care issues ranging from provider reimbursement and Medicaid eligibility to drug pricing and reproductive health.

Whether it’s the growing number of states passing site-neutral payment reforms, introducing 340B protections, or placing constraints on pharmacy benefit managers, state action is setting national precedent. These aren’t isolated efforts — they’re creating a patchwork of policy that increasingly shapes the direction of federal debate.

In many cases, the state-level approach allows for greater experimentation, localized coalition-building, and faster responsiveness to community needs. These attributes make states not only laboratories of innovation, but also battlegrounds for influence.

Building Coalitions Where It Counts

Effectively advancing health care policy at the state level requires more than model legislation or talking points. It demands authentic, cross-sector coalitions that bring together local providers, patients, civic leaders, and policy experts with a real stake in the outcome.

These stakeholders aren’t just mouthpieces; they bring credibility, lived experience, and the kind of trust that can’t be manufactured in a Beltway press release. Whether testifying before a committee, speaking at a local town hall meeting, or sharing their stories in the media, local champions often make the difference between a policy gaining traction or fading out.

Crucially, state coalitions also help to counterbalance national political polarization. Many state efforts gain bipartisan support not because the issues are simple, but because they’re framed in terms of community impact and practical solutions.

Local Messaging, Tailored Impact

Health care policy may be national in scope, but it’s experienced locally. This makes it essential to localize both the message and the messenger.

Campaigns that succeed at the state level do so by crafting narratives that speak directly to a community’s specific needs, experiences, and voices. A discussion about Medicaid redetermination in one state may look entirely different in another depending on population demographics, provider capacity, or political dynamics. Similarly, the argument for or against site-neutral payments lands differently in rural communities than in urban ones.

Why It Matters to Beltway Stakeholders

For policymakers, industry leaders, and advocates based in Washington, understanding and investing in state strategies is a strategic necessity.

• State wins set policy precedent. Once a few states act, others often follow — and eventually, Congress may too.

• State losses carry national implications. Policy setbacks in key states can stall momentum or weaken federal arguments.

• Local coalitions bolster federal advocacy. When constituents from across the country bring aligned, locally resonant messages to Capitol Hill, it strengthens the national narrative.

In other words: what happens in the states doesn’t stay in the states.

The Bottom Line: Meet the Moment with State-Based Strategy

If national health care stakeholders want to move the needle on the most pressing policy issues — from coverage expansion to payment reform — they need to meet the moment with coordinated, localized, and strategic state-level action.

The path to federal change increasingly runs through state capitals. The smart move now is to build the infrastructure, relationships, and messaging necessary to shape outcomes where momentum is building.

Because in today’s environment, those who organize locally are the ones shaping policy nationally.

What Public Affairs Leaders Need to Know

Public discourse on health care today is being shaped more and more by algorithms. As generative AI platforms – like ChatGPT, Claude and Perplexity – and new search engine tools like Google’s AI Overviews become trusted sources of information for the public, the way narratives form and evolve around critical health policy issues is changing fast. The rise of AI-powered web browsers, drawing even more directly on user data, will only accelerate the influence of algorithms in shaping these narratives.

This shift has major implications for public affairs teams. Consider the following recent data on Google searches:

• More than 57% of search prompts now yield AI-generated overviews;
• 52% of pharmaceutical keywords trigger an AI overview; and
• 60% of searches now end without a single click.

This means that if your message or perspective isn’t reflected in AI summaries, it may never be seen by patients, policymakers, the press, and other key audiences.

That’s where Generative Engine Optimization (GEO) comes in.

GEO is the emerging practice of crafting and amplifying content in ways that increase the likelihood of being accurately reflected in generative AI outputs. Unlike traditional search engine optimization (SEO), which relies on keyword rankings and backlinks, GEO emphasizes structured, trustworthy, and conversational content that AI algorithms are more likely to cite or summarize.

New research shows GEO should inform not just how you structure content, but how you amplify it. A recent Muck Rack analysis of how AI platforms cite sources found that these models are rarely influenced by paid placements: fewer than 5% of sources in AI summaries are ads or sponsored content. Instead, 95% of citations point to non-paid sources that are earned, timely, and authoritative content. Government reports, recent articles from mainstream news outlets, and credible third-party stakeholder analyses and statements carry the most weight, especially on health care topics.

This suggests that in the age of AI-shaped information, reaching audiences requires more than just the precision of paid media and sponsored content; it also continues to demand the credibility of earned media, the influence of thought leadership, and the reach of strategic amplification to shape understanding of key issues.

What Public Affairs Leaders Need to Do

For public affairs professionals planning and leading campaigns around today’s hot-button health care issues, GEO isn’t just a trend – it’s a strategic imperative. Here are four best practices we recommend incorporating into your content strategies to enable greater AI model engagement going forward:

1. Ensure your digital content is structured for readability by AI models. Leveraging an FAQ approach to blog posts, including transcripts for video content and incorporating alt text into graphics are small steps you can take today to optimize your content for AI.
2. Incorporate structured data markup on the backend of your websites. This ensures search engines can accurately interpret and lift your owned content into summaries. Open-source tools like schema.org provide effective HTML attributes that allow you to embed structured data directly on your page.
3. Ensure earned media and strategic thought leadership remains an integral part of your amplification efforts, especially among trusted outlets and credible experts.
4. Test and track issue visibility and sentiment in AI summaries as part of ongoing campaign evaluation to understand how your perspective shows up in summaries pre and post key activations.

In a world where AI is increasingly shaping the first impression of complex policy debates, GEO is no longer optional. For public affairs teams working to advance or defend health policy priorities, GEO must become a key component of their advocacy playbook.

If AI’s rewriting the narrative on key health care issues, let’s make sure it reflects your perspective. Reach out to learn about how Reservoir can help you stay ahead.

Media has always reflected how people get their information, but in recent years, there has been a rapid and profound shift. Traditional, one-directional communication has given way to a dynamic ecosystem where stories emerge, evolve, and are reshaped in real time – both by media voices and, in this current landscape, their audiences. For organizations aiming to ensure their voice is heard in policy, public opinion, or industry dialogue, this shift requires more than adjusting tactics – it demands a rethinking of strategy.

Shifting from Talking to Audiences to Talking with Them

The original strategic communications model relied on developing a message and then distributing that message as widely as possible, hoping it would resonate with the intended audience. Today, successfully communicating with key audiences depends on identifying the audiences who matter most, understanding the conversations they are already having, and engaging in ways that feel timely, relevant, and authentic. New media, referring to more recent online mediums where information is created, shared and consumed, offers countless ways for organizations to engage with their audiences, but only when guided by a clear sense of purpose and an understanding of the surrounding landscape.

Putting Strategy First to Maximize Impact

The abundance of new media platforms and formats – from podcasts to social media channels like Instagram or TikTok – can tempt organizations to jump straight into execution. But without a clear strategy that brings the objective to life, identifies which audiences need to be reached, and determines which messages will resonate, these efforts risk becoming scattered or reactive. Effective use of new media begins with asking several important questions:

• Goal and audience: What change needs to happen? Who can make it and how do they consume information? New media has grown so significantly that there are now podcasts, YouTube channels, influencers, and social media pages for almost every profession, hobby, interest area or like-minded group.

• Environmental considerations: What narratives already exist, and where does white space exist to contribute meaningfully? User engagement makes new media unique. If the story has already been told in traditional media, are there aspects to highlight via new media that will motivate your target audience to actively engage with your message and the issue at hand?

• Channels and messengers: Which outlets, platforms, voices, and formats match both the message and the moment? For example, if key messages can be effectively relayed via audio-only, getting your message featured on a podcast that reaches your target audience is worth consideration – but if there is a visual element, a video format such as a YouTube or TikTok channel may be more suitable.

And depending on the answers, new media may not be the only route to consider. Traditional media continues to offer value, especially for audiences who consume it most.

Leveraging Agility as a Core Capability

The speed and crowded nature of modern news cycles mean timing is as important as content and channels. Strategies need to build in the ability to act quickly, whether that means responding thoughtfully to breaking developments, reframing a conversation, or seizing an unexpected opportunity to relay a key message. This requires not only monitoring and analysis but also leveraging the tools and relationships in place to move when it matters most.

Building Long-Term Influence

While agility is important, it should serve a longer-term vision that it is measured against. New media should be used to reinforce a consistent narrative over time, building credibility and trust with stakeholders. That means every quick-turn piece of content, every timely comment, and every appearance in a new media outlet ladders up to a broader story about who the organization is, what they stand for, and the value they bring to their audiences.

In the past decade, Medicaid has undergone a quiet but profound transformation—not only in its scope and operations but in how voters perceive and prioritize it. Given the passage of the One Big Beautiful Bill, the future trajectory of the program will become a top issue in Washington and the states—_­particularly as patients and providers contend with seismic shifts in coverage and access to care. Understanding the political and programmatic dynamics of Medicaid is crucial for navigating an ever-evolving health care and electoral landscape.

The Changing Voter Landscape

Historically, Medicaid expansion under the Affordable Care Act was a dividing line: enthusiastically adopted in Democratic-leaning states and fiercely resisted in Republican strongholds. However, recent trends suggest that voters, even in areas that lean more conservative, are recalibrating their stance.

Several ballot initiatives—from Maine to Missouri to South Dakota—have seen voters bypass legislatures to approve Medicaid expansion directly. This dynamic underscores a growing public consensus: access to affordable health care is increasingly viewed as a mainstream expectation rather than a political wedge issue.

This shift is not just ideological but demographic. As rural hospital closures mount and access to critical services through the Medicaid program becomes table stakes for patients and family members, voters across the political spectrum recognize Medicaid as as a defining program that changes the trajectory of patients’ health.

Medicaid as a Kitchen Table Issue

What was once viewed primarily through the lens of poverty or unemployment is increasingly seen as a middle-class issue. Medicaid now touches a broader cross-section of Americans: from elderly parents in long-term care to disabled adults needing home services and working families caught in coverage gaps.

In recent polling, more voters—especially within the GOP base, independents and suburban residents—indicate that a candidate’s position on Medicaid influences their vote. With inflation and health care costs top of mind for many households, Medicaid’s role as a stabilizer has come into sharper focus.

Partisan Lines Blur, But Don’t Disappear

Although bipartisan voter support is growing, party leadership often lags behind. Republican governors and legislators in some states remain resistant to expansion or attempt to impose restrictions, such as work requirements. However, political pressure is mounting from their own constituents, creating friction between electoral incentives and party orthodoxy.

Democrats, meanwhile, increasingly frame Medicaid as part of a broader economic agenda—emphasizing job creation in the health care sector, rural investment, and financial protection for families. The party’s messaging has also leaned into Medicaid’s role in racial and geographic equity, resonating with younger and more diverse voters.

2026 and Beyond: Policy and Political Implications

Looking ahead to the 2026 midterms and beyond, Medicaid will likely play a more prominent role in political campaigns, especially at the state level. In the immediate term, implementation of far-reaching changes to the Medicaid program from the One Big Beautiful Bill—including the effective dates for contentious funding and eligibility changes—will be a major focus for Congressional candidates back home.

State leaders will be forced to contend with immediate financing and access challenges, including on key health care necessities, such as behavioral health parity, home- and community-based services, and access to new treatments, including vaccines. Bottom line—the future of Medicaid will become a dominant topic in gubernatorial and legislative debates.

A Defining Policy of Our Time

Medicaid may have started as a narrowly defined safety net, but today it serves as a bellwether of how voters view fairness, opportunity, and the role of government in securing health. With seismic changes underway, Reservoir can help organizations and companies lay the groundwork to support robust education and awareness efforts for patients around the new realities of the program, engage policymakers and broader health care influencers around opportunities to strengthen Medicaid, and mobilize constituents around protecting their coverage and access to care – now and in the future.

In health care, no single vantage point ever tells the whole story. Patients, providers, employers, policymakers, and industry leaders each inhabit distinct worlds defined by their experiences, incentives, and challenges. Attempts to collapse these perspectives into one “average” view inevitably miss the nuances that drive real-world decisions.

Health care experiences are intensely personal and emotionally charged. For patients, every policy debate translates into concrete worries about affordability, access, and quality of life—sometimes even survival. Providers must navigate the tension between clinical autonomy and ever-changing reimbursement models, all while striving to deliver the best care. Employers juggle spiraling costs against the imperative to support workforce well-being. Life-science innovators confront complex regulatory pathways and market-access hurdles. And policymakers balance ambitious public-health goals against budget constraints and electoral pressures.

To navigate this health care landscape, defined by fragmentation, nuance isn’t optional—it’s the crucible of true innovation. Our research, led by our Health Analytics & Insights Group (HAIG), reveals several best practices:

• Speak each stakeholder’s language. A chief medical officer and a benefits manager might both invoke “value,” yet assign entirely different meanings. Patients frame “value” in terms of out-of-pocket costs; employers in total cost of care; manufacturers in return on investment; and policymakers in population-level outcomes. Research that overlooks these semantic gaps risks conflating fundamentally distinct concerns. Our stakeholder-centered methodology ensures we listen for—and illuminate—those gaps, turning potential misalignment into opportunity for more effective engagement.

• Practice “dual fluency” – translating insights to reach audiences where they are. We must translate the human stories of families wrestling with chronic illness into data-driven insights that speak to CMS administrators debating reimbursement rules. Likewise, we must distill arcane FDA pathways into clear, empathetic narratives that patients and providers can act on. Only by mastering both registers can communicators foster trust, spur informed action, and keep pace with the rapid innovation of the companies we serve.

• Build ongoing knowledge across the stakeholder continuum. By putting people at the center of every study, we move beyond one-size-fits-all solutions and uncover the subtle patterns that drive meaningful change. In a world where yesterday’s assumptions crumble overnight, it’s important to leverage real-time listening and analytics and deeper-dive insights to ensure an accurate understanding of perspectives from every angle.

True insight demands a broad, stakeholder-centered approach—one that recognizes and respects each group’s unique reality and delivers the tailored intelligence that only deep, health care-focused expertise can achieve. Need support in this area? Our team of clinicians, epidemiologists, statisticians, and other research experts are happy to help, embodying a rare combination of rigorous analytical capability, practical health care expertise, and a deep passion for improving health care.

The U.S. Supreme Court recently issued a 6-3 decision in Kennedy v. Braidwood Management Inc., rejecting a challenge to the authority of the U.S. Preventive Services Task Force (USPSTF)—the expert panel that recommends which preventive items and services must be covered without cost-sharing as required by the Affordable Care Act (ACA). For now, the Court’s ruling maintains the ACA coverage requirement for preventive care—ranging from cancer screenings and cholesterol tests to HIV prevention and maternal health care.

The ruling was met with relief by public health leaders, advocates and millions of patients who rely on access to no-cost screenings, vaccinations and other preventive services. Yet, it introduces a new layer of uncertainty as outstanding questions continue to be reviewed by lower courts and heightens potential for political reach into public health.

As health care public affairs practitioners work to understand the implications of the SCOTUS ruling, we are tracking the policy conversation and unpacking emerging considerations for coverage of preventive services, as the landscape continues to evolve.

What the Decision Says—and Why It Matters

At the heart of the case was a constitutional challenge to whether USPSTF was permitted to make recommendations that result in mandatory insurance coverage.

Plaintiffs argued that the Task Force lacked the constitutional authority to mandate coverage decisions among private health plans. The Court rejected this argument, holding that the Task Force’s recommendations operate under the ultimate authority of the HHS Secretary, effectively preserving mandatory coverage for preventive services given the top two of five ratings.

While the ruling maintains immediate access to no-cost preventive care for more than 150 million Americans with private health insurance, some experts warn that by emphasizing the oversight role of the HHS Secretary, the Court’s opinion could expose the advisory process to greater political interference.

Implications for Health Care Public Affairs Practitioners

Looking ahead, stakeholders across the health system will need to pay greater attention to how future Task Force recommendations are made, and what services might be added, altered or removed from mandated coverage lists.

For health care public affairs practitioners, we see three key implications:

1. Monitoring of the preventive coverage policy landscape will be critical. The SCOTUS decision infuses far more politics into the Task Force, its members and recommendations. Further, while coverage requirements are maintained for now, there could be future challenges to the ACA in lower courts. Taken together, there is a heightened need to monitor ongoing developments in this space to ensure teams are prepared to respond quickly to preserve patient access to preventive care.
2. Policymakers need to hear more about the value of preventive care. Chronic disease prevention is a hot topic in Washington, given the rise of the Make America Healthy Again movement. However, in a world where threats to coverage of preventive care loom and skepticism around pharmaceutical interventions are increasing, tailored messaging around the benefits that preventive services and treatments provide to patients across the country will be critical. Data and storytelling that bring to life the burden of chronic and infectious diseases, as well as the economic benefits of investing in preventive care, can shape decisionmaker perspectives around preserving coverage.
3. Coverage pathways outside USPSTF recommendations will become increasingly important. To preserve coverage, advocates will likely be considering how to safeguard coverage of preventive services via other pathways beyond USPSTF recommendations, such as state and federal legislation, as well as increased employer education and engagement. The SCOTUS decision may be a rallying point for targeted education of local decisionmakers, like insurance commissioners, union leaders and benefits administrators around specific diseases and key preventive services.

At Reservoir, we work with clients across the health care ecosystem to navigate moments like this—when legal clarity intersects with policy uncertainty. The path forward for preventive care will require more than a legal defense; it will demand thoughtful strategy, clear communication, and a shared commitment to protecting health before illness takes hold. Our deep bench of policy and public affairs experts are here to discuss the implications of the Braidwood decision.