Regulatory turbulence and legal fights cloud U.S. health policy ahead of 2026 midterms, experts warn

Policy whiplash is rippling through the U.S. health system as the 2026 midterms near, with rapid regulatory shifts, courtroom battles, and leadership churn making long‑term decisions harder for payers, providers, and manufacturers, experts said Tuesday at the Academy of Managed Care Pharmacy (AMCP) 2026 meeting in Nashville, Tennessee.

Adam Colborn, JD, vice president of government affairs at AMCP, described the landscape one year after the inauguration as a blend of business as usual and atypical turbulence. On the steadier side, statutory changes are moving forward and traditional Republican priorities and broadly popular “80/20” issues remain intact, he said.

But he stressed that aligning stakeholders across federal, state, and local levels is a heightened priority amid elevated turnover at agencies including HHS, the CDC, and the FDA. The scale and timing of departures this far into an administration are unusual, he noted, complicating policy continuity.

Colborn also pointed to a surge in litigation around managed care, with courts in different jurisdictions taking divergent approaches to the same health policy questions. These circuit splits are fragmenting the legal environment for health plans, manufacturers, and providers, adding another layer of uncertainty to legislative and regulatory processes.

He said former President Donald Trump added to the complexity in the early months of his second term with a rapid burst of executive orders and a high‑volume "flood zone" messaging strategy that emphasizes keeping health and economic concerns top of mind for voters over detailed policy development and consistent messaging.

He added that Democrats have begun adopting a similar communication style. As a result, he said, policy priorities are harder to anticipate, increasing planning risk across the sector. “There is business as usual that’s going on, but there’s also a lot of turbulence that is atypical, especially this far into an administration,” Colborn said.

He and Geni Tunstall, JD, AMCP’s associate vice president of regulatory affairs, outlined several areas to watch at the federal level: vaccine reform and the restructuring of the Advisory Committee on Immunization Practices (ACIP), ongoing shifts in tariff regulations, and pharmacy benefit manager provisions in the Consolidated Appropriations Act (CAA) of 2026.

Tunstall said recent changes to vaccine policy at HHS have been particularly disruptive. She said HHS Secretary Robert F. Kennedy Jr removed the previous 17 ACIP members and appointed 12 new ones, some of whom have antivaccine political leanings.

She said those moves, combined with staffing changes at the CDC, FDA, and HHS, have eroded public trust in federal vaccine recommendations and disrupted continuity in vaccine policy development. She emphasized that ACIP recommendations are not merely clinical guidance; under the Affordable Care Act, they generally trigger mandatory coverage with no cost‑sharing for many plans.

Instability at ACIP therefore creates uncertainty for payers, providers, and patients about when and how to implement new recommendations. Tunstall added that a federal district court ruling has significantly disrupted ACIP’s work, saying the court found issues with HHS actions.

She said the decision adds to the policy uncertainty already stemming from personnel changes and shifting priorities. With the midterms approaching, the speakers said coordinated engagement across agencies and stakeholders will be essential. But they cautioned that the combination of staff turnover, litigation, and evolving communications strategies means the health policy outlook is likely to remain unsettled in the months ahead.