February 2026
Wesley G. Bradford, MD, MPH
In the midst of the Federal budget wars, the Congress passed a short-term funding bill for HHS with most policies intact, but it did not include an extension of the enhanced Affordable Care Act (ACA) premium tax credits, which expired at the end of 2025. Individuals and families had until January 31 to enroll in a health plan on Covered California for 2026, but the expiration of federal subsidies drove up premiums. About 90% of Covered California enrollees received federal subsidies last year, so many patients now face unaffordable premiums. Some are dropping coverage and delaying or forgoing necessary care, which drives up unpaid emergency and hospital services that increase costs for everyone.
Federal decreases of $300 million in Medicaid funding to California this year include additional work requirements, tightened eligibility checks, and restricted coverage for some immigrants. This will push 1-2 million Californians off Medi-Cal and increase costs for others by increasing utilization of unpaid emergency & hospital services. (There’s no free lunch, except in politics!)
California’s increased budget squeeze has limited the ability of the state budget to make up for the shortfall. The Governor’s budget maintains Song-Brown funding for residency training slots, and most other health programs remain intact. The legislature is considering a $90 million one-time general fund support to reproductive health clinics, in addition to the $140 million appropriated last year, to prevent clinic closures.
Federal health officials announced unprecedented decreases in federal vaccine recommendations. The new vaccine schedule includes fewer vaccines for most American children. The AAFP and other physician organizations have recommended maintaining the previous schedule for now. The US has already seen a dramatic increase of measles cases, which had been considered eradicated except for an occasional import by foreign travel. There is concern that other preventable diseases may also continue to spread, posing an additional danger to the more-vulnerable members of the population, as well as increased health care costs.
The West Coast Health Alliance (WCHA) was formed in September 2025 by California, Oregon, Hawaii, & Washington, to coordinate public health guidelines separate from the CDC, including safeguarding access to vaccines.
The AAFP notes a growing threat to physician compensation and the viability of small and independent family medicine practices: insurer’s growing use of down-coding algorithms to reduce payment. Instead of claim denials which can be appealed, insurers simply pay lower rates for primary care services without meaningful input from doctors. Following years of vertical integration, down coding creates unfair advantages for payer-owned sites of care (the increasing corporatization of medical practice).
The AAFP maintains up-to date details on many Federal & state healthcare topics at https://www.aafp.org/advocacy.html.
