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Congress could consider a Medicare physician payment adjustment and routine health program extensions when lawmakers return after the November 2026 midterms. Policy experts say broader changes to surprise billing and the 340B drug discount program are less likely to pass before year-end because lawmakers lack agreement on the solutions.
Congress may use its remaining legislative days after the November 2026 midterms to adjust Medicare physician payments and extend health programs, while larger disputes over surprise billing and the 340B drug discount program could be left for next year. The likely agenda remains uncertain and may depend on election results, committee leadership changes and whether lawmakers can attach health provisions to must-pass bills.
Michael Baker, health policy director at the American Action Forum, told MedPage Today that post-election activity could be shaped by projected party control and by which current members are returning in 2027. Members anticipating committee chair or ranking member positions may prefer to postpone some decisions until they take up those roles in the new Congress. Baker said health measures could be attached to legislation that Congress needs to advance, including appropriations bills, the National Defense Authorization Act and the Farm Bill.
A Medicare “doc fix” is among the possibilities. Joe Antos, a senior fellow emeritus at the American Enterprise Institute, said Congress could face pressure to counter a proposed 1% or greater reduction in Medicare physician payments and a Centers for Medicare & Medicaid Services plan to limit payment for same-day physician services. Antos said a change could be included in a final budget bill, but no agreement or legislative outcome has been confirmed.
Experts described extensions of existing health programs as more plausible than major policy changes. Wendell Primus, a visiting fellow with the Brookings Schaeffer Initiative on Health Policy, said an extenders package could include community health centers, which he said would cost $4.4 billion. Some prominent authorities, including Medicare telehealth and acute hospital care at home, have already been authorized beyond this year, according to Baker; he said more routine extensions remain to be addressed.
Medicare Payments Could Lead the Agenda
The outcome matters to physicians and Medicare patients because a payment reduction or a limit on same-day service payments could affect how practices are reimbursed. Congress could change those policies before the end of the year, but the source report describes that as a possibility, not a settled plan. The extent of any adjustment, if lawmakers act, is unknown.
Decisions on extensions may also affect health centers and other programs that rely on federal authorization. At the same time, the prospect of postponing contested issues means patients, hospitals and insurers should not assume that outstanding problems will be resolved in the post-election session.
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Must-Pass Bills Offer Possible Routes
The post-election session is the short period in which current lawmakers return after the midterms to finish the year’s work. Newly elected members do not take office until the next Congress, but the election can still affect how sitting lawmakers approach legislation, including whether potential future committee leaders want decisions made now or later.
Congress often combines health provisions with bills that must advance for other reasons. Baker identified appropriations, the defense authorization bill and the Farm Bill as possible vehicles. That provides a route for health measures, but it does not guarantee agreement: provisions still need support and can be left out of a final package.
Two disputes highlighted in the report illustrate the difference between a possible adjustment and a ready-to-pass policy. The No Surprises Act bars surprise bills for out-of-network care at an in-network facility, but its arbitration process has drawn complaints from insurers and providers. The administration has also proposed changing 340B, under which participating hospitals currently receive drug discounts upfront, to a rebate model. Analysts said neither issue appeared to have a broadly agreed solution for quick action.
“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 Final Package Is Assured
Congress has not announced a final health care package, and the post-election agenda will depend on the midterm results, lawmakers’ plans and negotiations over must-pass legislation. The source report does not establish whether a Medicare payment adjustment, community health center funding or transparency measures will be included in a bill.
It is also unclear whether lawmakers can agree on changes to the No Surprises Act arbitration process or the proposed shift in 340B drug discounts. Baker said there may not be enough agreement for either issue to move quickly, even if attached to a larger bill. The possibility of price-transparency provisions, raised by Primus and Baker, is also speculative.
Lawmakers Return After Election Day
Congress is expected to return after the November midterms to complete its remaining legislative work for 2026. Attention will turn to which spending and other must-pass bills advance, and whether lawmakers attach a Medicare payment adjustment, health program extensions or bipartisan transparency provisions.
If agreement does not emerge in that limited session, the disputed policy questions may carry into the next Congress in 2027. The report does not specify a scheduled vote or confirm a deadline for any of the health proposals discussed.
Key Questions
What health care issues could Congress address after the midterms?
Analysts point to a possible Medicare physician payment adjustment, routine program extensions and perhaps bipartisan price-transparency provisions. None is confirmed as part of a final bill.
What is a Medicare “doc fix”?
It refers here to a possible congressional change to Medicare physician reimbursement. Joe Antos said lawmakers could face pressure to respond to a proposed payment reduction of 1% or more and a CMS plan affecting same-day physician services.
Will Congress change the No Surprises Act this year?
That is uncertain. Experts cited in the report said the law’s arbitration process is causing friction, but lawmakers may lack agreement on a fix and could defer the issue until 2027.
What change has been proposed for the 340B program?
The Trump administration has proposed moving from upfront hospital discounts to a rebate model. The report says experts expect action could be delayed; it does not confirm that Congress will adopt the proposal.
When will Congress decide what to include?
Lawmakers are expected to return after the November 2026 midterms and work on the remaining legislative agenda for the year. No specific vote date or final health package has been announced in the source report.
Source: medpagetoday.com
