Health Care AI’s Rules Are in Flux. The Burden of Proof Isn’t.

Election Day will determine which party controls Congress for the next two years. But party control alone won't tell us where health policy is headed.

Across both parties, affordability concerns and growing skepticism of large institutions are reshaping policy debates, creating unexpected areas of convergence alongside familiar partisan divides. Regardless of the outcome, the 120th Congress will also bring new members, committee dynamics, policy priorities and oversight agendas.

For health care organizations, the weeks surrounding Election Day should be less about predicting the outcome and more about preparing for what comes next.

Control of Congress matters, but it’s not the only thing

A Democratic majority in either chamber could significantly change the health policy landscape. New committee leaders would set different legislative and oversight agendas and gain leverage in negotiations over must-pass legislation.

Continued Republican control would provide greater continuity, but new members and evolving Trump administration priorities would still change the environment.

Beyond the topline results, organizations should watch who will lead key committees, which incoming members bring health care experience or interest, and where influence within each party may be shifting.

If Democrats gain power, consider the agenda already taking shape

Democratic policy activity in 2026 offers clues about where congressional attention could turn.

• Drug pricing and affordability would likely remain central. Democrats could pursue efforts to build on the Inflation Reduction Act's Medicare drug negotiation provisions, address manufacturer pricing and patient out-of-pocket costs, and scrutinize the administration's Most Favored Nation (MFN) drug pricing initiatives.

• Coverage and access could return to the forefront, with renewed attention to Affordable Care Act (ACA) affordability, Medicaid coverage and public coverage alternatives.

• Health system accountability may result in broader coalitions. Pharmacy benefit managers (PBMs), insurer practices, provider consolidation, private equity, 340B and questions about where health care dollars flow have attracted interest across the political spectrum.

Watch for convergence, not just conflict

Some of the next Congress's most consequential health policy debates may not follow traditional partisan lines.

Recent polling suggests voters across the political spectrum are receptive to government intervention framed around affordability and fairness. That could reinforce momentum around drug affordability, PBM and insurer scrutiny, hospital costs, price transparency and policies giving consumers greater visibility into health care spending.

Republicans and Democrats may favor different solutions to these challenges. But concerns about cost, access, transparency and institutional accountability increasingly cross partisan lines, potentially creating unexpected coalitions.

That means reconsidering whether messages built around traditional partisan priorities will resonate with a changing political audience.

Oversight could matter as much as legislation

Election scenarios are often evaluated by asking: What legislation could pass? But that misses the broader context.

If Democrats gain control of at least one chamber, congressional oversight could become an immediate priority. Existing concerns could translate into hearings and investigations involving HHS and federal health agencies, Medicaid and coverage policy, vaccines and public health, and the administration's MFN initiatives and TrumpRx.

Even organizations not directly targeted could become part of broader debates through information requests, hearings, media attention or scrutiny of industry practices.

The question isn't only “What could Congress legislate?” but also “What could Congress investigate, and where might our organization or industry intersect with that scrutiny?”

Regardless of who wins, the audience is changing

New members, staff and committee assignments will create opportunities for organizations to educate policymakers on complex health policy issues. Materials developed for experienced audiences may not resonate with a freshman member or staffer encountering IRA implementation, 340B or reimbursement policy for the first time.

That changing audience extends beyond the Beltway. State elections will also bring changes in governors' offices, legislatures and committee leadership that could reshape debates over drug affordability, coverage, 340B and rural health priorities.

As affordability and accountability gain prominence across party lines, organizations must also be prepared to explain how their organizations and their policy positions deliver tangible value for patients and the health care system.  

Now is the time to ask: Is our corporate narrative ready for 2027? Can new policymakers quickly understand our role and priorities? Are our messages relevant across different political environments?

Don’t wait until after November 3 to prepare

Organizations don't need election results to begin preparing. Many of the most valuable steps are “no-regret” actions that will remain relevant regardless of the outcome.

The weeks ahead offer an opportunity to refresh corporate narratives and policy messages, assess materials for new policymakers, and develop scenario-based stakeholder maps. Organizations can also identify potential legislative and oversight exposure, pressure-test positions against questions from both parties, and strengthen their arguments with additional evidence, patient perspectives or credible third-party voices.

The goal isn't to develop a separate strategy for every possible outcome but rather to understand what could change, who will need to be engaged and how to communicate value in the new environment.

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More than 66 million Americans live in rural communities, where access to care depends on far more than insurance coverage. Long distances, workforce shortages, limited broadband and transportation, and hospital and pharmacy closures can delay everything from routine screening to specialized treatment.

Rural health is a critical test of whether policy delivers care patients can actually obtain. State policymakers influence that access through Medicaid, state-regulated commercial insurance, and state employee health plans. As the 2027 legislative sessions approach, several issues will challenge their ability to turn policy commitments into practical improvements.

Rural Americans face worse outcomes and a fragile care infrastructure.

Rural residents are more likely than urban residents to die prematurely from heart disease, cancer, stroke, respiratory disease, and unintentional injuries. The CDC estimates that tens of thousands of these deaths may be preventable. Provider shortages and closures make these conditions harder to prevent, diagnose, and treat.

Policymakers must protect the resources that sustain rural care while ensuring they benefit patients. The 340B Drug Pricing Program, for example, can support eligible rural hospitals, but its savings do not automatically lower patients’ costs. The challenge is balancing financial support for local services with transparency and accountability for how those savings improve access.

Access begins long before treatment.

Covered treatments offer little benefit to patients who are never screened, diagnosed, or connected to a provider. Rural access therefore starts with primary care, prevention, and timely diagnostic testing.

Complex chronic conditions, including cancer, Alzheimer’s disease and cardiometabolic care, reflect this challenging dynamic. Biomarker testing can help identify patients likely to benefit from targeted therapies, while emerging blood-based tests offer new possibilities for early detection.  

State coverage policies for biomarker testing are expanding, with opportunities to address additional conditions. Yet rural patients may still struggle to reach testing facilities and specialists. These laws also vary in which plans and tests they cover and what utilization management they permit. Policymakers must consider how prior authorization, appeals, cost-sharing, and provider availability affect whether patients receive timely testing.

Coverage does not automatically create access.

A medication can appear on a formulary yet remain difficult to obtain because of prior authorization, step therapy, or coverage changes that prompt non-medical switching. Patients may face paperwork, additional treatment trials, and appeals before receiving their prescribed therapy.

Immunology provides a clear example. A study of 17 large commercial health plans found that, across the medications studied, an average of 78.6% of plans restricted psoriasis coverage beyond the FDA label; for psoriatic arthritis, the figure was 66.8%. Medications were most commonly covered as second-line treatments. Not every restriction is inappropriate, but these findings show why formulary coverage alone is an incomplete measure of access.

Within the insurance markets they regulate, state legislators can establish timely authorization standards, workable step-therapy exceptions, and continuity-of-treatment protections. These measures can help patients obtain clinically appropriate care without avoidable delays.

Policy choices can reduce or deepen rural disparities.

The federal budget legislation enacted in 2025 will put Medicaid at the center of state debates in 2027. New eligibility requirements and financing changes will force difficult choices about coverage, services, and provider payments. More frequent eligibility reviews and work requirements for certain adults also create a risk that eligible patients will lose coverage because of paperwork barriers.

Lawmakers will need to weigh additional Medicaid funding against competing budget priorities. Reducing services or provider payments could make care harder to obtain, while underfunding eligibility systems and enrollment assistance could increase coverage losses. Their budget decisions will shape both who remains insured and whether providers can continue serving them.

Rural health presents a major policy and advocacy opportunity.

The federal Rural Health Transformation Program will direct $50 billion to states from 2026 through 2030, supporting investments in prevention, chronic disease management, workforce, technology, and new care delivery models.

Stakeholders can help shape funding priorities, implementation, and measures of success. Their involvement can keep state decisions grounded in patients’ needs across prevention, diagnosis, treatment, and follow-up care.

The test for 2027 is whether these decisions make timely, effective care easier to obtain. How states meet that challenge in rural communities will offer an early indication of whether broader health policy is improving access in practice.

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Health care organizations have more data than at any point in history. Claims data, electronic health records, patient-reported outcomes, and real-world evidence have transformed our ability to understand what happens within the health care system. Yet patients continue to delay diagnosis, abandon treatment, and disengage care for reasons that often remain invisible. The challenge isn't a lack of data; it's understanding what happens outside the health care system, before a patient ever enters care or after they quietly fall out of it.

That challenge was the focus of the 2026 Reservoir Advocacy and Alliance Network (RAAN) annual convening, where Reservoir’s network of experts and strategic partners explored emerging approaches to advancing patient access. The RAAN brings diverse perspectives and thoughtful insight to some of today's most pressing health challenges, while providing strategic counsel that supports Reservoir's commitment to reducing health disparities and expanding opportunities for better health.

This year’s conversation reinforced that barriers to health care access extend far beyond affordability. Participants noted that while claims and utilization data can show what blocked access, understanding the reason why requires a deeper dive into patients’ lived experiences including trust, stigma, cultural factors, health literacy, and competing responsibilities.  

Uncovering The “Why” in Patients’ Experiences

The discussion featured Patient Access Pathways, a tool that addresses the “why.”  Patient Access Pathways is Reservoir's proprietary survey and analytics methodology for uncovering access and affordability barriers from the patient's point of view. It uncovers complex and often invisible barriers that influence whether people seek screening, enter care, start treatment, and remain engaged throughout their care journey.  

RAAN members pointed to Patient Access Pathways’ ability to change the way they view barriers to patient care, which for many is primarily through a financial lens. One member pointed to the fact that “it is easier to define issues of cost [and] issues of physical access than it is to think about things like emotional, cultural and logistical barriers.” But uncovering those less apparent barriers can shed critical insights into the patient journey.

Going Deeper to Improve Patient Access

RAAN members also emphasized the importance of understanding whether patients have access to health information, as well as what factors motivate them to act on it. Exploring patient perspectives and beliefs can better inform why some individuals do not seek care even when they have perceived access. To this point, members of the RAAN highlighted the value of trusted health messengers and adequate health literacy education to connect with populations that are not effectively served by broader campaigns and messaging.  

The discussion also raised the importance of examining access through specific patient populations. For example, people who are uninsured, underinsured, enrolled in Medicaid, or covered through an employer may encounter very different challenges. RAAN members raised prior authorization as one specific example: even after successfully reaching a provider and receiving a diagnosis and prescription, patients may face complicated approval processes and may not know how to challenge a denial or request an exception. Taking the holistic patient experience into consideration helps inform solutions for populations that often face the greatest barriers to care, including people living with rare diseases, marginalized patient communities, veterans, and individuals with disabilities.

This year’s RAAN convening demonstrated that health care access is not defined by a single barrier or moment in the patient journey. Understanding why gaps in care persist requires looking at patients’ lived experiences alongside traditional health care data.

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