TL;DR
Get oils, diffusers and self-care delivered free with Prime
- Fast, free delivery on millions of items
- Prime Video, Amazon Music and more included
- Member-only deals all year
Health policy experts say Congress could consider a Medicare physician payment adjustment and routine health program extensions when lawmakers return after the November 2026 midterms. Major changes to the No Surprises Act and the 340B drug discount program appear less likely, but the agenda will depend on election results, negotiations and must-pass legislation.
Congress could take up a Medicare physician payment adjustment and routine health program extensions after the November midterms, while broader changes to the No Surprises Act and the 340B drug discount program may be postponed, according to health policy experts interviewed by MedPage Today. The agenda is not settled: experts say election results, congressional leadership plans and the availability of must-pass legislation will shape what lawmakers attempt before the end of 2026.
Michael Baker, director of health policy at the American Action Forum, said that lawmakers may attach health measures to legislation Congress needs to pass, including appropriations bills, the National Defense Authorization Act and the Farm Bill. He said which members are returning and who may take committee leadership roles in the next Congress could affect whether lawmakers advance a proposal now or defer it.
Joe Antos, a senior fellow emeritus at the American Enterprise Institute, said Congress could face pressure to counter a proposed 1%-plus reduction in Medicare physician payments and a Centers for Medicare & Medicaid Services plan to limit payment for same-day physician services. He said a payment change could be included in a final budget measure, but it is a possibility, not an agreed outcome.
Experts described routine program extensions as more likely than major policy changes. Wendell Primus, a visiting fellow at the Brookings Schaeffer Initiative on Health Policy, said an extenders package could include community health centers, which he put at a cost of $4.4 billion. Baker said authorities for Medicare telehealth and acute hospital care at home have already been extended beyond this year, leaving other standard extensions for lawmakers to address.
Possible Medicare Payment Changes
A Medicare physician payment decision can affect the revenue physicians receive for treating beneficiaries, while payment rules can shape how practices organize and bill for care. Antos’s concern centers on a proposed reduction and a separate proposed limit on same-day services; neither proposal is described in the source as a final policy change.
Congress’s choices also matter for community health centers and other programs whose funding or authority depends on extensions. If lawmakers bundle health measures into must-pass legislation, policies that might not advance on their own could become part of negotiations over a larger bill. That creates a possible route for action, but does not mean any particular provision will be included.
For patients and providers, the immediate distinction is between routine extensions or targeted payment fixes and broader reforms. The experts cited expect limited changes at most, rather than a major redesign of health policy before year-end.
Products Worth Considering
Bowflex SelectTech 840 Adjustable Kettlebell
Levoit Vital 100S-P Air Purifier
Garmin Forerunner 70 GPS Running Smartwatch, 43 mm, Black
As an affiliate, we earn on qualifying purchases.
The Post-Election Legislative Window
The midterms are scheduled for November 2026, and the incoming members elected in the contest will not yet have taken office when the current Congress returns to finish the year. Even so, Baker said projected party control and prospective committee assignments could influence decisions by sitting lawmakers about what to advance before the new Congress begins.
Congress often uses must-pass measures to carry additional provisions. Baker identified appropriations legislation, the defense authorization bill and the Farm Bill as possible vehicles. Those bills may provide an opportunity to include health policies, but each would still require agreement on the specific provisions and the larger legislative package.
The No Surprises Act bars surprise bills for out-of-network care received at an in-network facility. Its arbitration process has drawn complaints from payers and providers, even as Antos said the law achieved its main goal. Separately, the administration has proposed changing 340B, which provides outpatient drug discounts to eligible hospitals, from an upfront discount model to a rebate model. The source reports disagreement and uncertainty over whether either issue will be addressed this year.
“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 health policy at the American Action Forum
No Agreed Package Yet
No final legislative agenda has been announced in the source material, and it is not clear which must-pass bills will move or what health provisions, if any, will be attached. The election outcome and possible committee leadership changes could alter priorities, but do not determine what will pass.
Experts differ in emphasis and are offering forecasts rather than reporting settled deals. Baker said bipartisan transparency bills that have cleared committee could potentially be reconciled and added to a package alongside a physician payment fix. Antos said the political conditions make new policies unlikely. The source does not identify a negotiated text, a confirmed vote schedule or commitments from congressional leaders.
It is also unclear whether Congress will address the No Surprises Act arbitration process or the administration’s proposed 340B rebate approach this year. The specific design of any physician payment adjustment, its cost and the scope of possible community health center extensions remain unsettled in the reported material.
Congress Returns After Voting
After the November midterms, lawmakers are expected to return for the remaining legislative days of 2026. Their immediate focus will include funding and other must-move bills, which could provide a vehicle for health provisions. Watch for negotiations over a possible Medicare physician payment fix, community health center funding and other standard extensions, as well as any committee-approved transparency proposals that could be combined into a package.
The next concrete signals will be the bills leaders schedule, the text they release and whether negotiators include health provisions in year-end legislation. If agreement does not emerge, the No Surprises Act and 340B questions could carry into 2027. For now, the outlook described by the experts is a possible set of targeted fixes, not a confirmed package or sweeping reform.
Key Questions
What health issue is Congress most likely to address after the midterms?
Experts cited a possible Medicare physician payment fix and routine program extensions as more plausible than major reforms. No measure is confirmed for passage.
Could Medicare physician payments be cut?
Antos said CMS has proposed a reduction of more than 1% and a limit on payment for same-day physician services. Congress could act to change those policies, but the source does not report a final decision.
Will Congress change the No Surprises Act this year?
That remains uncertain. Experts said the law’s arbitration process causes friction, but they questioned whether lawmakers can agree on a fix before year-end. Primus predicted action would wait until next year.
What is being proposed for the 340B program?
The administration has proposed shifting the outpatient drug discount program from upfront discounts to a rebate model. The source says a change may be delayed, but Congress has not announced a final decision.
When could lawmakers act on these measures?
Congress is expected to return after the November 2026 midterms to finish the year. Health provisions could be attached to must-pass legislation, but the schedule and contents of any package are not settled.
Source: medpagetoday.com
