Ask ten people in Washington what "healthcare reform" means and you'll get ten different answers — most of them about systems, budgets, and institutions. Ask a patient, or the caregiver sitting beside them, and the answer is simpler: reform means I can get the care my doctor prescribes, afford it without going broke, and trust that the treatments and cures being developed today will actually reach me.

That's patient-centered healthcare reform. It isn't a bill or a slogan. It's a standard — a way of judging every policy, payment rule, and regulation by one question: does this improve outcomes, access, affordability, and the well-being of patients?

In 2026, that standard matters more than ever, because this is a year when healthcare policy is moving fast — some of it toward patients, some of it away from them. Here's the framework we use at Patients Rising, and how it maps to what's actually happening right now.

The framework: six principles, one standard

Our Principles for Healthcare Reform come down to six commitments:

1. Patients come first. Every policy gets judged by its impact on patients — not on hospitals, insurers, pharmacy benefit managers, or government budgets.
2. Patients deserve choice and control over their providers, treatments, and insurance options.
3. Healthcare should protect patients from financial harm. Insurance should be a true safety net, not a maze of cost-shifting.
4. Financial incentives must serve patient health — rewarding better outcomes, not more middlemen.
5. New treatments, cures, and technologies must reach patients. A breakthrough a patient can't get might as well not exist.
6. Transparency and accountability strengthen healthcare. Patients and taxpayers deserve to see where the money goes and what it buys.

Three threads run through all six: access, affordability, and better care — from new treatments and cures to a system that works faster and smarter. Patient-centered reform is what happens when policy advances all three together — instead of trading one away for another.

Affordability: real wins, with fine print

Medicare drug price negotiation is now real. On January 1, 2026, negotiated prices took effect for the first ten drugs selected under the Inflation Reduction Act. The price cuts are not projections — they're in effect right now. Januvia's negotiated price is $113 for a 30-day supply, down from a $527 list price. Eliquis fell from $521 to $231. Every one of the ten drugs came in at least 38% below list price, and CMS projects these prices will save seniors $1.5 billion out of pocket this year. A second round of 15 drugs, including blockbuster GLP-1s, takes effect in 2027. Paired with the Part D out-of-pocket cap — set at $2,000 in 2025 and indexed annually, it's $2,100 in 2026 — this is meaningful relief for seniors managing chronic conditions.

But here's what nobody can tell you yet: what patients have actually saved at the pharmacy counter since January. That accounting won't surface until claims data is analyzed months from now — and whether the savings truly reached patients depends on how each plan structured its cost-sharing and formularies. A lower negotiated price that never shows up in a patient's copay is a policy that sounds good, not one that works. Patient advocates should be first in line demanding that accounting.

Federal PBM reform finally passed. In February 2026, Congress enacted landmark pharmacy benefit manager reform in the Consolidated Appropriations Act — requiring PBMs to pass 100% of rebates through to plans, delinking PBM compensation from drug prices in Medicare Part D, and mandating real transparency and audit rights. Patients Rising fought for this for years, and it directly serves Principle 4: financial incentives should reward patient health, not middleman markups. The catch? Most provisions don't take effect until 2028–2029, and the rules that will govern implementation are being written now. The advocacy job is making sure they aren't watered down — and that savings reach patients, not just plans. (New to PBMs? Start with our explainer.)

Copay assistance is still under attack. Copay accumulators and maximizers let insurers pocket manufacturer assistance without counting it toward a patient's deductible — leaving patients exposed to the full cost mid-year. A growing number of states have banned the practice, but most commercially insured patients remain unprotected. Our policy deep dive explains what to look for in your own plan documents.

Access: the front line in 2026

The ACA subsidy cliff is no longer a projection — the numbers are in, and so is a real debate about what they mean. Enhanced premium tax credits expired on January 1, 2026, and Congress has yet to enact an extension. Marketplace enrollment fell from 22.1 million to 19.2 million — roughly 3 million people, a 13% drop in a single year, with declines in 49 states. For those who stayed, the cost of keeping the same plan roughly doubled on average, and deductibles jumped too.

But who actually left the rolls? Analysts like KFF point to affordability: premiums spiked, people dropped coverage. Researchers at the Paragon Health Institute tell a different story — and they have data worth taking seriously. Paragon documented 11.7 million "phantom enrollees" in 2024: people enrolled in exchange plans who filed zero claims all year — 35% of total enrollment, a rate that tripled after zero-premium plans created incentives for income misstatement and broker-driven sign-ups of people who didn't know they were enrolled. By Paragon's estimate, improper enrollment cost taxpayers roughly $27 billion in 2025 alone. And in June, an HHS analysis concluded that the 2026 decline largely reflects the removal of improper and phantom enrollees — noting that enrollment remains 85% above 2019 levels.

Both of these problems are real — and both fail patients. Subsidies paid for coverage nobody uses helps no patient; it drains dollars that could fund actual care, and it's exactly the kind of waste Principle 6 exists to root out. At the same time, legitimate patients — people with chronic conditions who need their coverage — saw their premiums double, and some of them are dropping out. That's the financial harm Principle 3 exists to prevent. The patient-centered demand for Congress is both at once: program integrity that removes ghosts from the rolls, and affordability protections that keep real patients covered. 

What we don't know yet is how many real patients ended up uninsured — that survey data comes later. The next test arrives at open enrollment this November, when 2027 premiums will bake in the full effect unless Congress acts first. Advocates should press lawmakers on any path — extension, restructuring, or replacement — that passes both tests.

Prior authorization reform is gaining ground. CMS finalized rules requiring faster, electronic prior authorization decisions with specific denial reasons, and this spring proposed extending those requirements to prescription drugs — including decisions in as little as 24 hours for Medicaid and CHIP. The comment period on that proposal closed in June with more than 700 comments filed; the fight now is making sure the final rule keeps its teeth. For patients who've waited weeks for approval of a medication their doctor already prescribed, this is overdue — and pledges aren't enforcement. Patient advocates should hold plans publicly to their promises.

Insurance hurdles still stand between patients and care. Step therapy (being forced to "fail first" on a cheaper drug), non-medical switching (being moved off a medicine that's working for reasons that have nothing to do with your health), and narrow drug lists remain everyday barriers for patients and the caregivers fighting alongside them. Patient-centered reform means the default answer to a doctor's prescription is yes — with exceptions that are rare, fast, and explained.

Innovation on patients' terms: the long game

Patient-centered reform doesn't stop at prices. And it isn't just about whether the system delivers better medicine — it's about whether the system delivers better, period. New treatments and cures, yes. But also diagnostics that catch disease earlier, when it's more treatable and less costly. Records that follow the patient instead of trapping them in fax loops and repeated tests. Less paperwork, less waste, faster answers.

When industry says "innovation," it usually means its own pipeline. When patients say it, we mean the whole system getting faster, better, and cheaper — because every one of those improvements lowers costs and improves outcomes for the people the system exists to serve.

Delivering on that means protecting the pipeline of new treatments and cures while insisting they reach patients: reforming the 340B program so its discounts actually benefit the patients it was created for; scrutinizing state Prescription Drug Affordability Boards so cost reviews don't quietly become access restrictions; rejecting discriminatory cost-effectiveness metrics like the QALY that devalue the lives of people with disabilities and chronic illness; and demanding accountability from every player — including nonprofit hospitals whose community benefit should be more than a tax filing.

What patient advocates can do right now

Patient-centered reform isn't a spectator sport. In 2026, the highest-leverage moves for advocates are concrete:

• Tell your story. Legislators and regulators respond to real patients with real receipts. Share your story — it becomes evidence in every fight above.
• Comment on the rules. Federal agencies are required to read what patients submit. Right now, comment periods are open on Medicare's 2027 physician payment and hospital outpatient rules — both of which shape access to care — and new dockets open every year on drug pricing, prior authorization, and PBM implementation. When patient voices are absent from the record, the only comments regulators see come from industry.
• Follow the savings. Negotiated prices, PBM rebates, accumulator bans: every 2026 win depends on whether savings actually reach you at the pharmacy counter. Ask your plan. Ask your legislators. Demand the accounting — and publish the answers.
• Join us. Become an advocate and get the training, community, and alerts to act when it counts.

Healthcare reform in 2026 isn't one big bill — it's a hundred smaller decisions being made right now, in rulemakings and state houses and plan documents. Patient-centered reform is simply the discipline of asking, every single time: what does this do for patients?

That's the question we exist to ask. Join us in asking it louder.

Sources & further reading

• • CMS: Medicare Drug Price Negotiation Program — Negotiated Prices for 2026
  • AARP: First Medicare-Negotiated Drug Prices Debut in 2026
  • Medicare.gov: Part D costs and the 2026 out-of-pocket cap
  • Mintz: Congress Passes Landmark PBM Reform in 2026 Spending Bill
  • KFF: ACA Marketplace Enrollment Is Down by 3 Million After Big Jump in Premium Payments
  • KFF: ACA Marketplace Enrollment Is Down in 2026 — But All of the Data Isn't in Yet
  • Paragon Health Institute: Ghostbusting ACA Fraud — Millions Who Don't Use Their Health Insurance
  • Paragon Health Institute: New HHS Report Finds Decline in ACA Enrollment Results From Removal of Improper and Phantom Enrollees
  • CMS: 2026 Interoperability Standards and Prior Authorization for Drugs Proposed Rule
  • CMS: CY 2027 Medicare Physician Fee Schedule Proposed Rule
  • CMS: CY 2027 Hospital Outpatient Prospective Payment System Proposed Rule
  • Avalere: State Copay Accumulator Bans Now Affect At Least 17% of Commercial Lives