IndigenousNetwork was able to attend this week’s American Community Media national briefing on what 2026 will bring for health care access in the United States. For Indigenous outlets, the conversation did not feel theoretical. Cuts to Medicaid, higher premiums on the Affordable Care Act marketplace, and new limits on immigrant eligibility all land in communities that are already navigating chronic illness, underfunded care, and overlapping jurisdictional gaps.
The first speaker, Tomas Bednar, is a health policy attorney who has worked inside Medicaid and Medicare managed care and now serves as Senior Vice President and Counsel at Healthsperien. He set the frame for the year ahead in plain terms: “Cost increases, access decreases, and gridlock are the forces shaping this next year.” His main warning centered on the return of the “public charge” rule and the larger direction of federal policy on Medicaid. Bednar described a second Trump administration that “seeks to return Medicaid to its perceived initial definitions,” effectively narrowing who is seen as an intended beneficiary. That shows up in two places at once: deep cuts under HR1, and a revived public charge rule that again ties immigrants’ use of benefits to their immigration status. “The net effect is an intentional limitation of access to Medicaid benefits,” he said, adding that immigrant families will once again face a chilling effect, even when they are legally eligible.
Bednar also pointed to the likely expiration of enhanced premium tax credits on the ACA marketplace, the subsidies that currently keep monthly premiums within reach for millions of low income households. If those credits are not extended, he said, premiums could spike so sharply that many will simply drop coverage. He would not attach a precise figure, but his estimate was blunt: “Over time, it is likely to be in the millions,” reversing recent gains that pushed the uninsured rate to historic lows. For Indigenous communities that already rely on a mix of IHS, Medicaid, employer plans, and marketplace coverage, that kind of drop-off would widen existing gaps in cancer care, disability support, and mental health services.
The second speaker, Amber Christ, leads the health advocacy team at Justice in Aging. She is a national Medicare and Medicaid expert whose work grew out of years in legal aid, representing low income older adults struggling to navigate benefits. Christ described HR1 as a transfer of resources from people with the least income to people with the most. For households at the bottom, she said, the bill means a cut of roughly three percent of annual resources. For those with the highest incomes, it delivers an almost three percent gain. “HR1 really paid for tax cuts for the wealthiest people in this country by cutting public programs for the people with the lowest incomes,” she said.
Christ emphasized how exposed older adults are under this model. Many live on around thirty thousand dollars a year and rely on Medicaid to make Medicare usable, since Medicare does not cover long term care and leaves major gaps in basics like dental, vision, and hearing. Medicaid fills those gaps and pays for nursing facilities and home and community based services that allow elders to remain in their homes. Those are all “optional” benefits under federal law, which means they are the first items on the chopping block when states lose federal dollars and start patching budget holes. She also highlighted a quieter provision in HR1 that ends Medicare eligibility for certain lawfully present immigrants, including refugees, asylees, and people with temporary protected status who have already paid into the system. Christ called that “unprecedented,” and warned that it will leave many older immigrants uninsured, shut out of Medicaid, and priced out of marketplace coverage.
Speaking last, Sophia Tripoli, Senior Director of Health Policy at Families USA, turned the conversation toward the structure of the health system itself. Tripoli is a long time consumer health advocate who previously worked inside the Centers for Medicare and Medicaid Services. She argued that the core problem is not overuse, but pricing power. “The number one driver of healthcare costs in America is prices,” she said. “Not overuse, not bad decisions. It is prices.” She pointed to decades of consolidation in hospitals, drug companies, physician practices, and insurance plans, combined with a fee for service model that rewards volume, not outcomes. The result, she said, is simple: bigger corporate health systems with more leverage to raise prices, narrow networks, and push confusing, inflated bills onto patients.
Tripoli called healthcare affordability “the kitchen table issue heading into 2026,” and laid out a set of reforms she said Congress could act on now. They included real price transparency, curbs on drug patent abuses, and closing loopholes that let hospitals bill Medicare more for the same procedure depending on the site of care. She also pressed for tighter oversight of Medicare Advantage risk scoring, and a shift away from pure fee for service toward payment models that reward keeping people healthy. These fights, she argued, are not separate from coverage debates. “Coverage and affordability are directly linked,” Tripoli said. If prices keep climbing, she warned, it becomes harder to sustain existing coverage, let alone expand it.
For Indigenous media, the briefing underscored how national health policy fights are already reshaping local realities. Cuts to Medicaid and SNAP, new work requirements, and more barriers for immigrant families translate into delayed care, higher medical debt, and more emergency room use in Native communities that already stack disparities in housing, environment, and labor on top of health. The speakers urged reporters to document those impacts now, not only when implementation dates hit in statute. That is already the work of Indigenous newsrooms, which tie health stories to land, language, and sovereignty. As 2026 approaches, coverage will need to track another layer: who is pushed out of the system altogether, who is forced to choose between treatment and groceries, and how communities are organizing in response.
