Shifting demographics, sweeping changes to federal health policy, and technology and market forces are reshaping the healthcare industry. On this episode of Policy Outsider, we speak with Rockefeller Institute Senior Fellow for Health Policy Courtney Burke about the healthcare trends for policymakers to watch in 2026. The discussion covers Courtney’s most recent trends blog and details the factors pushing issues like consolidation, affordability, the use of artificial intelligence tools, and pharmaceutical costs into the spotlight.
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Joel Tirado 00:01
Welcome to Policy Outsider presented by the Rockefeller Institute of Government. I’m Joel Tirado. Shifting demographics, sweeping changes to federal health policy and technology and market forces are reshaping the health care industry. On this episode of policy outsider, we speak with Rockefeller Institute senior fellow for Health Policy, Courtney Burke about the healthcare trends for policymakers to watch in 2026 the discussion covers Courtney’s most recent trends blog and details the factors pushing issues like consolidation affordability, the use of artificial intelligence tools and pharmaceutical costs into the spotlight. That conversation is up next.
Joel Tirado 01:00
Courtney, it’s great to have you back on the show. I think it was a couple months ago we had you here with a couple of our other health policy folks. So good to have you back. Great to be back. We’re talking about healthcare trends 2026 trends. You published an analysis recently that looks at the trends. It’s a bit of an update from the 2025 trends, and we’ll dive into that. This is actually your fourth year. The time is flying doing this trends blog. So let me see. It started in 2023 and then we had 10 trends. So I like this. We’re narrowing down from from 10 to five. As attention spans shorten, we also shrink the trends. So 10 trends in 2023 they range from challenges in workforce and staffing to the increasing presence of private equity backed companies in healthcare, and also the entrance of non traditional entities names people have heard of like Walmart and CVS. So are those trends from 2023 still relevant?
Courtney Burke 02:13
They certainly are. There are some that I would say are more prominent now or were more prominent then, because if you think back to January 2023 we weren’t that far away from covid at that point in time, and it was really only 2021 when the vaccines rolled out. So the healthcare industry was at a different place at that point in time. Workforce was probably one of the biggest challenges recovering that workforce, and a lot of people were just getting back to using care that they had postponed during the pandemic, and that was driving a significant increase in prices at the time. And as you recall, covid also drove a very fast acceleration of the use of remote monitoring and telemedicine. And those trends haven’t gone away. I mean, covid accelerated them. They’re still here now. I think they’re still very relevant, but prices have come down. Staffing issues remain a challenge, but not as acute as they were back then. So I do think some of those trends that I’ve written about in the past are still very relevant at this point in time. So and then I know 2024 the following year, we focused more on what I was seeing as more of a mega trend, and I was trying to characterize it as sort of the groups of providers and entities in health care, you were seeing a significant amount of consolidation, and those who had means were tending to get bigger, and those who didn’t were struggling. And if they were struggling, we were hoping that they would be survivors in the future, primarily by partnering with with new entities.
Joel Tirado 04:06
So, another type of consolidation. Yeah. So, yeah. So, so you had, I think the you had, we see the today entities, the tomorrow entities,
Courtney Burke 04:18
driving survivor survivors,
Joel Tirado 04:21
little alliteration for the folks at home. And so those those striving survivors were kind of the combination of trying to fold a tomorrow organization into a today organization, right? Yeah, exactly, yep. And so now we’re at 2025 and you had five trends. You know, we should talk about each one of them, but you know, still talking about the consolidation issue, the emergence of AI shifts in insurance coverage. So let’s start with, you know, what you termed the increasing use of. Data and computational technology, and which, for shorthand, people will just call AI, and it’s, you know, I sort of get mad at myself that we have to talk about AI with everything that we do, but we are in this moment where it is reshaping things. So, let’s, let’s get into it. What was the trend in 2025 that you were seeing as it concerns AI? And then how did that kind of update in 2026
Courtney Burke 05:30
Sure, yeah, I had actually written about AI in 2023 when you started to see the use of large language models. But there was such an explosion of the use, more generally, by the public, and a recognition of the benefits of AI in advancing healthcare in many different ways. So it really felt like last year it was worth focusing on, as you say, the what I termed data and computational technologies, many of which are powered by AI and its use. So since 2025 since I wrote that about it again in January, you did see a continued growth across all sectors, but particularly in healthcare, and that was well documented by JP Morgan, a group called Innova. What I think is interesting is towards the end of 2025 and going into the new year is you’re seeing a lot more use of these, AI powered technologies by people, not just providers and other entities in health care, and people primarily using chat bots to ask questions about their own health care. I also think in terms of what you’re going to see more of in the coming year, as robotics becomes something that’s used more widely, combining the use of artificial intelligence and computational data with robotics at the same time, so that does have impacts on certain industries in the workforce, but it also creates oftentimes better outcomes in healthcare. And so for policymakers, they’re trying to wrap their hands around what is happening in AI and what their role should be in terms of protecting consumers. And so you did see a lot of legislation at the state level trying to protect consumers from perhaps chat bots that they’re they’re using for mental health purposes, and protecting some of their privacy around that as just one example, but more so, you’re seeing states wanting to have an AI strategy, because I think they’ve recognized that it’s something that’s happening. It’s an advancement in society. There’s no way you’re going to stop it. I had, I had read a book about this particular advancement called the coming wave, basically saying that there’s, there’s no way to stop it. So you, you might as well learn as much as you can about it really lean in. And I think you’re definitely seeing that, not only in the health care provider space and the use of it, but now you’re seeing it with consumers as well. Yeah.
Joel Tirado 08:25
And I think, you know, you bring up the chat element of of AI, and I think that’s, you know, how a lot of people are engaging with AI, whether it’s you know, specifically for healthcare and asking questions about their health. But we’re also seeing the use of of AI in, you know, fields like biology. Can you just, like, give us the brief, like, high level view of the different different places AI is being used that are maybe not what people are thinking of, you know, just in terms of chat, yeah.
Courtney Burke 09:03
I mean, sure. I mean things that probably people don’t necessarily think about because they they think about now that they can use AI, they think about the chat and that that that’s AI, but it’s advanced things in other areas. Some of last year, some of the Nobel laureates that went out were specifically in things like chemistry and physics that had been linked to the use of AI, and without AI, they would not have accelerated or been able to win those Nobels for their advancements. So you’re seeing that too with genomics and precision precision medicine when it comes to things like health care, it’s more and more being built into everything. I think people sometimes think that they can go to a hospital, and if they don’t want AI to be used in their health care, you can just shut it off or take it out, but you really can’t. It’s being built into almost. Everything that we’re we’re doing now, so
Joel Tirado 10:04
yeah, so lots of consumer protection questions. There naughty stuff that policymakers will have to dive into. We talked in 2025 you talked in 2025 about the shifts in insurance coverage. I would say that that conversation, that topic, is accelerated in 2026 with, you know, the implementation of the one big, beautiful Bill act. So, yeah, can you talk a little bit about, you know, at the start of 2025 what were we looking at and then, how did that shift over the course of the year? Right?
Courtney Burke 10:44
Right? Well, I felt it was important to highlight this issue last year because we knew that the lapsing and ending of the what they’re called, enhanced premium tax credits, was going to happen if there wasn’t action on the part of the federal government and Congress to renew them or extend them further. So we that’s why I put it on as something to watch last year, and indeed, it ended up being a very big issue in congressional debates about whether or not it should be continued and what should happen with health care, and there wasn’t resolution by the end of 2025 there seems to be some recent movement in agreement at the congressional level for some type of compromise. So I think it’s something that people are going to continue to watch this year, because with that expiration, people had to choose their insurance at the end of 2025 and they saw the costs go up. And so because of that, some of them were choosing not to have insurance because it was not going to be affordable, affordable for them, or choosing an insurance plan that perhaps covered fewer services for them. And all of that has really made people pay a little bit more attention to how expensive insurance is, and states also looking at changes in what the federal government is helping match if they’re covering people, and those shifts of what the federal government will pay for or not pay for has also caused people to focus on the issue in this in this year, and I think that you’ll continue to see debates and differences in how state policymakers approach coverage for people Who they may not be receiving as much federal reverse reimbursement for, or no federal reimbursement whatsoever, and those are people who may be residing here under the color of law, but are immigrants and so again, the debate will be be something to watch in 2026
Joel Tirado 12:59
Yeah, Certainly. And good time to sort of plug some of the work that you and some of our other health policy folks have been doing on this front health policy series that really looks at the implications of changes from the one big, beautiful bell act and how that will affect New York, both the state and New Yorkers, and that that series is on our website. And I also want to, you know, mention, you know, you brought up the some folks, you know, seeing those costs and premium increase, and choosing not to, choosing not to get insurance in some cases. And I think, you know, it’s, it’s a scary terminology, terminology, but it’s one that I found interesting. I I’m hoping you can help me remember the name of this phenomena where underinsured, yeah, well, you have the underinsured, but the, know the phenomena where the where enough folks don’t choose to get insurance in the risk pool shrinks, and insurance costs more, and then more folks choose not to get insurance. Yeah.
Courtney Burke 14:04
Well, they call it the death spiral, where
Joel Tirado 14:07
a name straight out of Star Wars for
Courtney Burke 14:09
sure, yeah, yeah. And you have seen that happen in insurance markets, where really the only people buying it are people who really have to have it, and they they use it, and so it’s expensive, and for those that don’t have to who are oftentimes cheaper and health help even out the risk leave that insurance pool. And yes, that is that is something to keep an eye on. I don’t know if it will be as as significant this year, whether it will happen over time, but you’re definitely going to see shifts in the number of people who are insured, or the number of people who are considered under insured, where they’re not getting enough insurance to really cover the services that they need.
Joel Tirado 14:53
Let’s get back to consolidation. This was Trend number three, so obviously this extends. Back, as we discussed 223, and before that, obviously, even consolidation has been this phenomenon. But given that, why is it notable as a trend, or why in 2025 did you choose to bring that back as a thing to pay attention to?
Courtney Burke 15:17
Because it’s continuing to happen significantly in healthcare. It’s, it’s happened in a lot of industries, and I don’t see a lot of forces reversing that trend right now. And you have, certainly in the insurance sector, I mentioned the sort of five big insurers previously you have, if you look at the top seven, those insurers have about 70% of the market that they insure. So to me, that’s pretty significant consolidation. If you then look at on the provider side, you’re seeing smaller entities, particularly rural health providers, who really have a hard time financially being acquired by larger systems, and even those larger systems taking on in order to want to be competitive with the big insurers when they’re negotiating rates that they get paid, wanting to also consolidate, and in New York, you’re seeing those systems cross state lines. For example, this year, one of the entities in New York that’s a large down state provider of acute care and outpatient care, known as Northwell. They’re actually the biggest private employer in the state, joined forces with a system that is based in care. Based in Connecticut called nuance. But you’re also seeing some of that go across state lines, with University of Pittsburgh, Medical Center, University of Vermont, also crossing state lines. So I expect to see that consolidation continue, and it’s something that policymakers are paying attention to, because there are also private entities coming in that are driving some of that consolidation. And the state, I think it was last year or the year before, and then again, in the budget that New York state’s governor just proposed, they’re looking at what they call material transactions. So these are transactions that are non traditional entities in health care, coming in and buying up physician practices, for example. And the states wanting to get a better sense of how much that is happening, and so monitoring that and reporting on that to understand, really, who is entering the marketplace of some of these non traditional providers, as was pointed out in previous trends. But also, what are these looking like, and what does it mean for healthcare? Because healthcare is changing. It’s not always the entities that have traditionally been regulated by state governments in the federal government.
Joel Tirado 18:04
Want to go back just briefly, because you know you said that you had these consolidations happening across state lines. As a person who has not followed this space obviously as closely as you have. Why is that? Why is that significant? Is that not a thing that has been happening? Is it? Is it new that these different firms are seeking to like to me, I would think it would always be regional, but, but why is that? Why is that of note?
Courtney Burke 18:39
I think it’s of note, because it in terms of crossing state lines for health systems that has that has not been something that’s been that common. You certainly have had national systems like Trinity and ascension groups like that have been around for a long time, but here in the Northeast, where we tend to have not for profit systems. It hasn’t been as common and and I think it is going to become more common as these entities look to survive into the future,
Joel Tirado 19:14
not to press the issue too much. I don’t want to get bogged down on it. But is it because they is because states have different regulations, and so maybe it hasn’t been as profitable for them to seek that kind of consolidation.
Courtney Burke 19:26
Well, it’s also more complicated, because the rules and the regulations and the laws are different across state lines, and so they typically to fulfill a transaction across state lines, they would have to get approvals in both states, and so it’s just a lot of extra work for them. But you can see if it, if it makes sense, if your patients are coming from another state, you want to better serve them, they certainly want that market share. And so there’s an incentive to if you. Have the resources to go across state lines.
Joel Tirado 20:04
Let’s talk about drugs now. Sure, pharmaceuticals topic that has been on top of mind for many folks for a long time. What can we do to bring drug prices down? Is a question that everyone, I think, has been asking, and people put forward different ideas. But again, this is a thing that you wanted to note in 2025 so what? What kind of movement was happening there that makes you feel like it’s a trend that’s really worth paying attention to?
Courtney Burke 20:37
Yeah, well, I had noted it in 2025 because there was a lot of conversation, particularly at the federal level, for the Medicare program, of how to control costs, and the presidential candidates were both talking about it. So I knew it was going to be a prominent issue in 2025 but I think it’s going to continue to be a prominent issue in 2026 because during the course of the last year at the federal level, they focused on how to negotiate better prices for some of the drugs that had been growing in terms of the volume and use and costing the Medicare program, but also looking at new ways to try to control those costs. So couple examples were two models from the Centers for Medicare and Medicaid Innovation that came out late in 2025 one was related to reference pricing, so that you have a price that you reference to try to keep prices at a certain level, as well as one that looks at how to get bigger gains through rebate programs. So they were called the guard in the globe model, which stand for these, these new programs that they’re proposing, and states oftentimes try to do similar things, and I think that they will continue to do that, because they’re looking for ways to control the costs. So they’re looking for how they can get more rebates through the Medicaid program at the state level, how they can better negotiate prices and potentially take advantage of some of the models that are coming out federally.
Joel Tirado 22:23
We didn’t talk about pharmacy benefit managers and that, you know, under this topic, under this trend, but it does show up in the blog a few times. What? What is their role in drug costs and and coverage for pharmaceuticals?
Courtney Burke 22:39
Well, a lot of policymakers believe that they may be contributing to the increase in costs. And so, yes, that is true. I mentioned that in the blog that one of the ways that states are are looking to to reduce costs is, is that an extra administrative costs and and how to, how do they focus and regulate the role of pharmacy benefit managers so that it’s beneficial to consumers and it’s actually lowering costs and not increasing them.
Joel Tirado 23:11
The fifth topic is exponential advancements in life sciences. This is cool to me. I studied a little bit of I should say I really liked my biology courses in college. I thought they were fascinating, and CRISPR came online as a phenomenon during my time in college. So I’m all ears for this one, and I’m very curious. This is AI driven in part, but are there other things that are moving these advancements in life sciences?
Courtney Burke 23:52
Yes, absolutely. Artificial Intelligence is helping to accelerate Life Sciences overall. And like you, I am very interested in life sciences. I just find it fascinating. It’s not my professional background. I’m much more focused on public insurance programs, the provider market services for people with complex needs. Life Sciences has just been one of those areas that I just find fascinating. As an outsider, not considering myself a complete expert, but it has been amazing to read about the advancements in things like you. You mentioned the CRISPR technology because it it, it’s literally life changing for people, the you can suddenly no longer have a disease that’s been something that’s been incurable for since the dawn of time, the things, the advancements in genomics, all of the precision medicine that is being developed, the gene therapies, the ability to look at the interactions of different drugs and how you might adjust those for people. Specific needs 3d bio printing, and it’s a very big life sciences is a very big area of different things and and I just like reading about it, because I find it fascinating. But I think why you saw an acceleration is in part due to AI. But I also think it’s an area where states see it, state policy makers see it as economic development. So I see it really more as, in many ways, economic development than I do health policy. But I couldn’t not mention it last year, just because I was so impressed with what was going on. Sure, yeah.
Joel Tirado 25:39
I mean, the overlap is undeniable. Yeah, I, I’m a sucker for those rendered images of of molecular things happening, any animation where some, you know, protein is going in and interacting with a cell in some way. It’s, do I? Do I understand it? No. Is it pretty Yes. And the you know, the implications, as you mentioned, for folks who have had conditions that they’ve thought for all of their lives may be incurable. It does in a in a time of maybe some pessimism, it provides a little optimism. Let’s get into the last trend. So this was not something that you’d noted in 2025 but you thought it was important to highlight in 2026
Courtney Burke 26:29
Yeah, it’s really the affordability and cost of healthcare, which is something I honestly, really should have noted earlier when I’ve done my previous trends. I did note it last year, only specifically about the focus on the cost of prescription drugs, but I think the overall issue of affordability, where people are unable to afford housing and things like that, now, has brought the affordability of health care more to the forefront. And I think people feeling more of the cost with the expiration of the enhanced premium tax credits also is bringing the issue more to the forefront. And people seeing it take policymakers seeing it take a bigger and bigger slice of the overall state spending. So I think yes, you’re going to see a lot of focus on this in 2026 both at the federal level and the state level, and there were significant cuts to Medicaid that are happening over over the next decade that were part of the legislation. HR one, the one big, beautiful bill, Act that was passed last year. And those cuts are forcing state policymakers to look at what they can and can’t afford within their Medicaid programs. They’re going to have to be implementing work requirements. There’s coverage cuts for legally resigning immigrants. There’s more frequent certification of people’s eligibility for programs, there’s tightening of what the federal government will match in the Medicaid program, as I mentioned earlier, fewer options potentially for what are considered revenue raisers. So you’re seeing policy makers react with things like looking at price transparency. How much are people paying? So people are looking at this more often. How much are providers getting paid? Where are they getting paid, and for what? So I just think it’s going to be more prominent in 2026 given people’s overall concern about the affordability of things in general.
Joel Tirado 28:43
So throughout the conversation, you’ve brought up different things that policymakers are trying or paying attention to. You know, as we look forward in 2026 what are maybe the top three things? I mean, you could argue that you’ve given me five trends for policymakers to pay attention to, but let’s say that, and let’s, let’s focus on New York State, since that’s where we are, maybe what are the three things that, let’s say that they could take a very active role in shaping some of the outcomes in the health policy space?
Courtney Burke 29:18
Well, I think they could take, take a role in any of those. I find the one in AI to be the one that’s not necessarily always so prominent, because, as I was saying, AI is built into so many things that we don’t even realize. And this is one that I find to be a positive one more than a negative one, and so to the degree that states can encourage the non biased and positive use of AI to advance health care, I think you will see a lot of focus on that, but I think more front and center to. People will be the insurance coverage shifts, and so politicians tend to focus where people focus. So they’ll be focused, I think, on insurance coverage, and I think they’ll be focused on affordability, the other areas that I mentioned, you know, life sciences and those kinds of things are going to are going to proceed either way. But I think again, insurance coverage and affordability will be more a focus, just because that’s what people see and feel more directly.
Joel Tirado 30:30
What did we miss, if anything, from this conversation? I mean, I know that we could put you on a 24 hour marathon talking about health policy and the healthcare industry, and you’d keep going so but in, you know, the limited time, every now and then, we could interrupt it with some cool graphics of Life Sciences advancements. But yes, anything else that we that you know, you think, as we’re moving into 2026 that you know, folks should think about, what should they ruminate on for the next 12 months?
Courtney Burke 31:06
Well, there are, there are larger trends that are driving these trends that are not going to change anytime soon. And one of the biggest ones is the aging of the population in the United States. And that one trend is impacting many of the trends that I mentioned. It’s the one impacting affordability. Because more people are needing care. There’s fewer people available to provide it. It means that you’re going to see advancements, which is again, a positive thing, because people are going to want to live even longer, and they’re wanting they’re going to want to be healthier. So I think just being aware that many of these trends are driven by things outside of health care is important to keep in mind. And I think a second thing to just remember is health care is a business about people at the end of the day and their health, and that’s always got to be something that policymakers focus on. I think in the
Joel Tirado 32:07
future, great. It’s been a pleasure to talk about this issue. It is front and center for so many folks, and we’ll see. I know you’ve done a mid year trend update, so maybe we’ll circle back around in the warm months of June or July to talk more and see how this has changed. So thanks.
Courtney Burke 32:30
I appreciate the time. Thanks, Joel,
Joel Tirado 32:34
Thanks again to Senior Fellow for Health Policy Courtney Burke for joining us on the show to discuss the latest in healthcare trends. A link to Courtney’s blog can be found in the description for this episode. If you liked this episode, please rate, subscribe, and share. It will help others find the podcast and help us deliver the latest in public policy research. All of our episodes are available for free wherever you stream your podcasts and transcripts are available on our website. I’m Joel Tirado; until next time.
Joel Tirado 33:06
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