This year brought substantial health policy reforms that will impact access and affordability for millions of Americans. These changes create uncertainty at both the federal and state level and are likely to affect the sustainability of America’s healthcare system. CareFirst BlueCross BlueShield (CareFirst) recently hosted a virtual thought leadership event, The Health Policy Horizon: A Look Back and Glimpse Ahead, to examine recent policy changes and consider what they mean for stakeholders across the healthcare continuum.
This fireside chat featured perspective from two industry experts with decades of experience analyzing health policy and advocating for solutions that address our nation’s largest healthcare challenges. David Schwartz, Vice President of Public Policy & Federal Affairs at CareFirst, provided opening remarks and moderated the discussion with panelists:
- Edwin Park, Research Professor, Georgetown University McCourt School of Public Policy
- Monica Popp, Founding Partner, Marshall & Popp
A Look Back: What Changed in 2025?
The One Big Beautiful Bill Act (H.R. 1), enacted July 4, 2025, introduced significant reforms to our healthcare system, with the most profound changes occurring in Medicaid. These reforms include tightening program eligibility, imposing new work and cost-sharing requirements for certain enrollees, and restricting how states fund their Medicaid programs. The law also limited ACA premium tax credit eligibility and enhanced verification processes, made health savings accounts more flexible, and made Medicare policy reforms.
Separately, enhanced advance premium tax credits (eAPTCs)—more generous ACA subsidies established during the pandemic—expired at the end of 2025, prompting continued calls on Congress to extend them.
Prescription drug prices also remain a key concern for policymakers, both federally and in the states. For example, Edwin noted that prescription drugs account for roughly 10 percent of Medicaid spending and said he expects states to increase their focus on innovative approaches prescription drug payment measures over the coming years.
A Glimpse Ahead: Policy Reform and Impacts on the Future
Changes in H.R. 1 are projected to result in 10 million more Americans being uninsured by 2034. Although these coverage losses would be significant, Monica noted that the law’s Medicaid reforms are intended to address concerns about the rapid growth in program spending and ensure it continues to focus on the program’s intended populations, rather than taking a "one size fits all" approach to coverage. Edwin, however, warned that coverage rollbacks will not only increase uninsured populations, but also destabilize the individual insurance market, reduce insurer participation, create spillover effects impacting other insurance markets, and create barriers for those leaving Medicaid and transitioning to other forms of insurance coverage.
Similar to H.R. 1 changes, expiration of the eAPTCs could result in 4.8 million people losing coverage next year. Both panelists agreed that expiration of the enhanced tax credits and rising drug costs pose major challenges to state lawmakers already bracing for broader disruptions across the entire health coverage landscape.
The Path Forward: Solutions for Sustainable Healthcare
As federal policymakers consider bipartisan approaches to ensure healthcare remains accessible and affordable for all, states are searching for ways to mitigate the impact of federal cost shifts and preserve coverage. Edwin believes states facing Medicaid financing changes have three options: cut Medicaid programs, cut other budget areas like education, or raise revenue. To avoid a “cuts-only” approach and mitigate the impact of federal cuts, Edwin implored states to seek out new opportunities to increase and preserve coverage and access.
At the same time, Monica highlighted the need for increased flexibility for states to build out their healthcare programs to best meet the needs of those living there. She believes challenges at the federal level have made it very difficult for states to manage healthcare challenges. This leaves states caught in the middle and in need of either collaborative federal solutions or more autonomy to address their own needs.
Hope for the New Year
While the new year will usher in a new set of challenges for state and federal policymakers, there are opportunities as well. For example, Monica expressed optimism about the potential for artificial intelligence (AI) to make meaningful, lasting improvements to patient outcomes, higlighting that AI technologies, especially those related to behavioral health, continue to progress and be adopted in the private sector.
Regardless of what comes next, this timely discussion emphasized why navigating the challenges ahead will require partnership and innovation across the healthcare system. With new reforms, fiscal pressures, and looming uncertainty on the horizon, CareFirst believes all stakeholders must work together to ensure our healthcare system continues to serve the most vulnerable populations and adapts to future needs. The path forward may be complex, but the commitment to progress and patient-centered solutions must remain at the core of future policymaking.