PBM reform, Medicare Advantage exits, and the 340B rebate pilot are reshaping drug access. Here is what payers need to know heading into 2027.
News|Articles|November 3, 2026
4 Things for Payers and Consumers to Watch on Election Day
Author(s)Sabrina McCrear
Fact checked by: Rose McNulty
Medicare Advantage exits, rising ACA premiums, a Medicare for America bill, and a Medicaid work rule ruling frame health policy on Election Day.
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As voters head to the polls for the 2026 midterm elections, several health policy developments are shaping what payers and consumers can expect heading into 2027.
From Medicare Advantage plan exits and rising Affordable Care Act (ACA) marketplace premiums to a newly reintroduced Medicare for America bill and a federal ruling on Medicaid work requirements, here are 4 things to watch on Election Day.
Medicare Advantage Plan Exits Leave Nearly 400,000 Minnesotans Weighing 2027 Coverage
Minnesota Attorney General Keith Ellison
Many insurers are cutting or reducing their MA plans, and the share of stand-alone prescription drug plan enrollees affected by terminations doubled from last year.2 The ACA marketplace 2027 open enrollment began on November 1, 2026, and many beneficiaries are left to reevaluate their coverage plans, switch to another plan, or potentially go without insurance, as many have in the past year following major policy changes.3 Ellison's announcement aimed to "raise the alarm" on MA plan rollbacks to prepare Minnesotans for 2027 and serve as an advisory for how to navigate alternative options.1
Multiple candidates on both sides of the aisle, in House and Senate races, are championing equitable access to affordable health care. Minnesota Lt. Gov. Peggy Flanagan, the Democratic nominee for US Senate, states on her campaign website that she will "fight for Medicare for All," work to ban prior authorization, and reverse the health care cuts made by President Donald Trump and Republicans.4
During the North Mankato, Minnesota, debate in early October between incumbent Rep. Brad Finstad (R-MN) and his Democratic-Farmer-Labor challenger, Jake Johnson, both agreed the health care system needs an overhaul, despite clashing on trade, immigration, and rural health care funding.5 Finstad cited $50 billion the Trump administration put toward rural health care, and Johnson countered that the administration cut $137 billion from rural health care through Medicaid.
2027 ACA Open Enrollment Begins Without Enhanced Premium Tax Credits
Open enrollment has begun with the enhanced premium tax credits expired and with provisions from the 2025 budget reconciliation law and regulations changing marketplace coverage set to take effect in 2027, all of which will affect enrollees this enrollment period.3
Benchmark silver
Some candidates and incumbents from both parties have pushed to restore the enhanced ACA premium tax credits. In January 2026, the House voted 230-196 to extend them for 3 years, with 17 Republicans joining all Democrats, but the extension has not become law, and the enhanced credits remain expired.3,6
Medicare for America Act Would Open Medicare to Every US Resident
On October 30, 2026, Rep. Rosa DeLauro (D-CT) reintroduced the Medicare for America Act, which aims to achieve universal health care in the US. She first introduced the bill in 2018 and has reintroduced it in several Congresses since, most recently in December 2024.7,8
The act would open Medicare to every US resident and automatically enroll anyone without coverage. Employers could offer Medicare for America to their employees, and workers who choose it over their employer plan would still have their employer pay its share of the premium.7
It would cap out-of-pocket costs at $3,500 for individuals and $5,000 for households. Premiums would be capped at 8% of a beneficiary's income, and those earning less than 200% of the federal poverty level would be exempt from paying premiums and out-of-pocket costs.7
"The bill also takes on hospital price gouging, drug company profiteering, and insurance company overpayments that are driving up costs for everyone," DeLauro said in a
Federal Judge Strikes Down Part of CMS' Medicaid Work Requirement Rule
In
The 2025 reconciliation law exempts from the community engagement requirement "[a]n individual . . . who is medically frail or otherwise has special medical needs," including individuals who are blind or have a disability, have a substance use disorder, have a disabling mental disorder, have a disability that significantly impairs activities of daily living, or have a serious or complex medical condition.9 The IFR CMS issued in June, however, defined these individuals as those "whose physical, mental, or other behavioral health condition significantly impairs the individual's ability to comply with the community engagement requirement."
US District Judge Richard G. Stearns ruled in favor of the states on this point, finding that CMS overstepped its authority. He vacated the language and permanently blocked the agency from enforcing it.9,10 However, the court rejected the states' challenges to the IFR's 12-month lookback period for claims data and its limit on self-attestations of medical frailty. It also gave states a 6-month stay, meaning they cannot end coverage for individuals claiming a medical frailty exemption until 6 months after the requirements take effect. The broader work requirements still take effect January 1, 2027.
Regardless of which party controls the House and Senate in 2027, payers and beneficiaries face near-term deadlines, starting with the end of Medicare open enrollment on December 7.1
References
1. Attorney general alert: Changes to Medicare Advantage plans dramatically changing care options for nearly 400,000 older Minnesotans. News release. The Office of Minnesota Attorney General Keith Ellison. November 2, 2026. Accessed November 3, 2026.
2. McCrear S. Medicare plan terminations hit 4.3 million as Part D market shrinks. AJMC. October 27, 2026. Accessed November 3, 2026.
3. McGough M, Wallace R, Lo J, Pestaina K, Cox C. 9 things to watch for the 2027 ACA open enrollment period. KFF. October 30, 2026. Accessed November 3, 2026.
4. Priorities. Peggy Flanagan for Minnesota. Accessed November 3, 2026.
5. Castle Work M, Bakst B. GOP Rep. Brad Finstad, DFLer Jake Johnson debate in congressional race drawing big spending. MPR News. October 9, 2026. Accessed November 3, 2026.
6. Botelho JA. House passes ACA subsidy extension with GOP supporters, defying Trump and Johnson. The National News Desk. January 9, 2026. Accessed November 3, 2026.
7. DeLauro unveils Medicare for All plan that preserves private health insurance. News release. Office of Rep. Rosa DeLauro. October 30, 2026. Accessed November 3, 2026.
8. H.R.10526 - Medicare for America Act of 2024. Congress.gov. December 19, 2024. Accessed November 3, 2026.
9. Commonwealth of Massachusetts v Oz, No. 1:26-cv-12962-RGS (D Mass October 29, 2026). Memorandum and order on cross-motions for summary judgment.
10. Hall H. NC Attorney General wins federal lawsuit blocking Medicaid rule for seriously ill. WECT News 6. October 29, 2026. Accessed November 3, 2026.
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