Healthcare Affordability Access

CMS under the Trump administration is tightening federal control over affordability levers in public programs: proposed limits on Medicaid state-directed payments would materially reduce supplemental funding flows to hospitals and safety-net systems, while OBBBA-related Medicaid/CHIP changes raise near-term coverage and access risk for VBC organizations managing low-income populations. At the same time, Medicare Advantage remains a major pressure point for providers and patients, with 2026 plan design showing continued reliance on prior authorization, supplemental benefits, rebates, and out-of-pocket structures that can shift utilization and care-management burden onto delivery systems (KFF on MA in 2026). CMS is also using targeted affordability and program-integrity tools—such as the proposed $50 monthly access pathway for certain GLP-1s and a national moratorium on new Medicare hospice and home health enrollments—signaling that ACOs, MA plans, and risk-bearing providers should expect tighter scrutiny of high-growth spend categories, network adequacy, and downstream post-acute capacity (Medicaid payment crackdown).