2026 Policy Forecasts: Healthcare
Welcome to Capstone’s annual forecast of unappreciated policy and regulatory themes companies, investors, and, industries should expect to play out over the course of the year in the healthcare sector.
Provider Pressure: The Looming Headwinds for Medicaid Exposed Providers
Capstone expects Medicaid-exposed providers to face incremental, rather than severe, headwinds in 2026. While rate growth is likely to remain constrained, we see broad reimbursement cuts as unlikely given relatively strong state budget conditions and political pressure to protect providers serving vulnerable populations. However, as the Centers for Medicare & Medicaid Services (CMS) Medicare market basket growth slows, providers may remain exposed to ongoing inflationary pressures.
The Great Coverage Shakeup: Medicare Advantage Stability, The Shrinking of the ACA, and Implications for Healthcare Payors
Capstone believes Medicare Advantage (MA) carriers, such as UnitedHealth Group Inc. (UNH) and Humana Inc. (HUM), will benefit in 2026 from program stability under the Trump administration. However, payors exposed to Affordable Care Act (ACA) exchanges and Medicaid, such as Centene Corp. (CNC) and Molina Healthcare (MOH), will face headwinds as reforms to ACA subsidies (and their potential expiration) and Medicaid take effect.
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Bitter Pills: Pharma's Turbulent Year Ahead
Capstone believes 2026 will mark a fundamental power shift in pharma economics. Policy interventions are redistributing value across the supply chain as pharmacies and wholesalers bear margin compression and drugmakers seek leverage through Most Favored Nation (MFN) frameworks. Execution risk is high as untested systems, pending litigation, and regulatory uncertainty determine whether the transition unfolds gracefully or chaotically.
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The EU’s Healthcare Policy Moment: Why Policy Will Drive More Opportunities and Risks in the EU Healthcare Sphere
Capstone expects three key developments to shape European healthcare markets in 2026. First, tariff threats from the Trump administration are likely to push modest increases in EU drug prices, benefiting manufacturers and pharmacies while raising costs for payors. Second, the European Union will advance the details of its pharmaceutical reform agenda, with mixed implications across the sector. Third, regulators are expected to maintain close scrutiny of private equity ownership.
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The Great Rewiring of Healthcare IT: Policy-Driven Opportunities
Capstone expects healthcare information technology opportunities in 2026 to be shaped by three converging pressures: litigation, regulatory deadlines, and legislation. Information blocking enforcement and lawsuits should favor analytics vendors, Fast Healthcare Interoperability Resources (FHIR) application programming interface (API) mandates are driving procurement of interoperability solutions, and Medicaid work requirements are creating tailwinds for Eligibility and Enrollment and revenue cycle management (RCM) vendors.
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