The biggest health storylines of 2026

Here are five storylines we'll be watching:

1) Health care costs: Health insurance premiums are surging in ACA markets, thanks to the expiration of enhanced subsidies, and for workplace coverage. Drugmakers are raising prices for hundreds of medicines, despite President Trump's strong-arming.

• The question is whether Republicans can even agree on what to do about an issue that's ratcheting up voter anxiety.
• Their first chance will come this month in the run-up to the government funding cliff, when there's the opportunity to use a spending deal to retroactively extend the Obamacare subsidies for about 20 million patients, many of whom live in red states.
• The other option would be for the GOP to go it alone with another megabill filled with conservative ideas aimed at lowering health care costs. While that could help endangered incumbents, it would mean another draining health care debate without a clear path for passage.

2) Medicaid: This is the year when states will have to implement the changes that congressional Republicans passed in last summer's tax-and-spending law — and it's not clear that they'll be ready.

• Among other things, they have just one year to build and test systems to make sure able-bodied recipients are working at least 80 hours a month and gather supporting data for people who are exempt.
• The millions more uninsured Americans arising from all of the changes are expected to drive up unreimbursed care costs for hospitals and threaten those with shaky finances.

3) Vaccine restrictions: More regional outbreaks of measles, whooping cough and other vaccine-preventable diseases could test the Trump administration's resolve to adopt a new childhood vaccine schedule, especially without going through an established rulemaking process.

• The Food and Drug Administration has also signaled it may impose tougher requirements on new vaccines and the annual flu shot, which medical professionals say would make it impossible to test and manufacture a vaccine in time for each year's flu season.
• And Health Secretary Robert F. Kennedy Jr. wants to revamp the federal liability protections that shield drug manufacturers from being sued for vaccine-related injuries.
• This would likely trigger a huge court fight over whether the administration could unilaterally act without Congress.

4) Drug sales: Drugmakers and the government are increasingly using direct-to-consumer platforms to reshape how medicines are sold, with the promise of lower prices and less red tape.

• The immediate focus is on the pending launch of the TrumpRx portal, which many experts say will have minimal effect on what most insured Americans pay. But drugmakers' direct sales may be a better barometer of the concept's staying power.
• "Pharm-to-table" sales could be convenient for GLP-1 weight-loss drugs that may not be covered by health plans. They could also help uninsured or self-pay customers access blood thinners and other popular meds.
• But doctors say the new marketing arrangements bring the risk of conflicts of interest. Some in Congress are itching to get involved, which could trigger a free speech fight.

5) Patients and AI: The Trump administration and states are on a collision course over who gets to regulate AI in health care settings. And the first clash could be over the use of chatbots for mental health support, especially among teens.

• An FDA advisory committee met in November about the increased use of "AI therapists," and one study found 13% of youths aged 12 to 21 used generative AI for mental health advice.
• One question is how much state actions — like a new Illinois law aimed at preventing bots from producing harmful responses or not reliably detecting crises — complicate Trump's efforts to create a single national framework on AI policy.