Dear fellow health advocates,

Happy holidays! I write with appreciation for the work done by so many of you— health advocates, analysts, and organizers in all corners of the country—in these difficult times. Even amidst significant losses, we should celebrate the places where we made progress and commit ourselves to building a better future.

In these final weeks of 2025, the failure of Congress to extend assistance for Americans to afford health coverage caps off a historically horrible year for health policy and health justice. Families are just starting to feel the consequences, which will reverberate for years to come.

Over 20 million people who purchase Marketplace coverage will see massive premiums spike in 2026 — by over $1,000 a year, on average, and for many, much more. Over $900 billion in Medicaid cuts will make it harder for people to get on and stay on coverage and will cause future cuts to Medicaid benefits and critical services. In the end, 15 million more Americans could end up uninsured because of the health care cuts in HR 1. At the same time, the administration is engaged in ongoing attacks on some of our most vulnerable communities, including women and their reproductive health, communities of color, immigrants (including those with legal documentation), and the trans community and all LGBTQ people.

In addition to these attacks on coverage, the administration has decimated our public health and scientific research infrastructure, including the systems that ensure we have access and coverage for vaccines and preventive care, track diseases and disparities, and prepare us for the next emergency, much less a pandemic.

Amidst this wreckage, I am grateful that those of us in the health justice and advocacy community didn’t let these attacks go uncontested. When President Trump and Congressional leaders attempted to sneak the biggest cuts to Medicaid in history into their tax bill, we organized and mobilized to make it a deeply unpopular bill, and we prevented a panoply of even worse proposals from being included. While we weren’t able to leverage the government shutdown into an extension of the enhanced tax credits, we made the public far more aware and supportive of them. This work—including that of the next few years to mitigate and document the harms to our health—is the basis for building a backlash to not just undo this damage, but to organize and put forward a vision for a better health system.

A rebuilt and reimagined health system should respond to what Americans actually voted for in 2024: an affordability agenda to address why health care costs are so high already. Even amidst everything else, our movement has made progress in key ways:

HOSPITAL PRICES: CMS finalized new Medicare payment reforms long sought by Families USA and the Consumers First coalition against the unchecked, predatory business practices of large hospital corporations, including “same service, same price” policies for physician administered prescription drugs in outpatient settings, as well as others to improve hospital price transparency. These and other payment rule changes will save Medicare billions of dollars and lower costs for our nation’s seniors. Additionally, the final payment rule included higher and more sustainable pay for primary care providers that will provide a critical step forward in addressing our primary care crisis and support a more robust primary care infrastructure that meets the needs of consumers.

PRESCRIPTION DRUG PRICES: The continued implementation of Medicare price negotiation for prescription drugs will provide savings for a broader range of drugs. This reform shows sustainability across a change of administrations, including to a President who was initially inclined to repeal the entire Inflation Reduction Act, and is an indication of the massive popularity of prescription drug price reform.

STATE ACTIONS: Relatedly, the Prescription Drug Affordability Board (PDAB) in Colorado set limitations based on the Medicare negotiated rate for what the state will pay for key drugs. Maryland is also likely to do so imminently, while half a dozen other states are in the process to try to lower their reimbursement rates for drugs. Several states also passed legislation to rein in health care costs, slow consolidation, and lower excessive hospital pricing, including California, Colorado, Indiana, New Jersey, New York, and Washington. This progress is emblematic of many state advocates and policymakers taking action either to counter federal attacks or to fill in the void of action on affordability—from providing greater oversight on consolidation and private equity, to putting in place overall caps on hospital and health care system prices. We were proud to support state policymakers and advocates in these efforts and looking to do more into the future.

While much more is needed to take on health prices that are inflated and irrational, our polling shows that the public is ready for big, bold reforms. I choose to be optimistic about the future because of the movement we are building, on both defense and offense. We greatly appreciate our strengthened connections with our coalition partners, our state advocate allies, and our storytellers who boldly and bravely describe how they are personally impacted by these policies. These battles are helping us build up our collective capacities, from coalitions to communications, to confront the challenges ahead.

As this year draws to a close, we hope you are able to get some well-deserved rest and find joy in spending time with your loved ones. We look forward to the new year, and we greatly appreciate our partnership with you, as we seek to prevent the worst, but also to organize for the best.

Thanks again and best wishes for a happy and healthy holiday season and 2026.

Peace,

Anthony

P.S. With the major challenges and opportunities ahead, please consider Families USA as part of your year-end giving. Using this link or the button below, you can make a tax-deductible contribution before the December 31st deadline to include on your 2025 filings.

Donate to Families USA

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