Policy Update Impacts on Employer Health Plans in 2026

J Clin Pathways. 2025;12(1):e004.

In the last Transformative Business Trends column of 2025, predictions for US commercial health care landscape cost trends and expected employer market actions for 2026 were discussed.¹ While the health care industry will experience much change in 2026, non-health care business leaders will have to navigate shifting legislative and economic policies impacting health care marketplace operational risk, adding decision complexity to health care affordability and coverage.

Throughout 2025, significant shifts in the health care sector were complicated by regulatory and legal challenges.  Federal administrative actions such as the Social Security Fairness Act and the looming expiration of the Affordable Care Act pandemic era subsidies (at the time of writing) reshaped benefits and financial planning for millions of Americans. As a result of these changes and rising drug claim costs, direct-to-employer or direct-to-consumer models to improve affordability had to evolve.

Businesses navigated similar challenges, including high-profile settlements, cybersecurity breaches affecting millions of patients, and antitrust legislation emerging in Congress aimed at curbing insurer vertical integration or provider consolidation. Significant health care-centered policy and economic shifts impacting business leaders included the following:

• The establishment of Most Favored Nation (MFN) drug pricing, a voluntary public sector model to address the affordability of drugs.
• Increased costs in the commercial insurance sector due to the Inflation Reduction Act (IRA) and Medicaid reform as manufacturers and care providing entities shift their pricing.
• Affordable Care Act (ACA) tax credit extensions in risk of not being extended in 2026, which will likely lead to higher premium costs and cost shifting for commercial insurance plans.
• The rapid growth and investment of Artificial intelligence (AI) into the health care sector with uncertain savings for commercial health plans in 2026.
• A dramatic increase in use and costs of GLP-1 inhibitors beyond forecasted risk, resulting in the raising of 2026 plan costs.

White House driven trade tensions, federal tariffs, and investment market volatility also affected retirement portfolios, highlighting the interconnectedness of health care, policy, business, and personal finances.² 

Reports by workplace legal advisors have provided insight into non-health care related policy changes impacting business operations effective for January 1, 2026.^{3, 4} These include the following:

• Nineteen states have increased minimum wage levels.
• Over 30 states have updated paid leave requirements.
• Five states have tightened workplace safety requirements and inspections.
• The United States Department of Homeland Security (Homeland Security) has increased border closures and deportations.

Homeland Security Policy Changes

In 2025, Homeland Security began tightening up immigration policies, including visa systems. As such, employers can anticipate more changes, pauses, or closure within the H-1B visa system.⁴ Other issues they may face include: increases in federal and state workplace compliance investigations for employees hired through a visa system; implementation of new and/or higher fees related to visa hires; and potential caps and weighted vs random issuance of a visa being implemented. Such changes will cause difficulties in recruiting, hiring, and retaining employees. As a result, business balance sheets and profitability will be impacted, complicating coverage policies due to the smaller and unstable workforce.

Rapid Adoption of Artificial Intelligence in Business

As mentioned above, the year 2025 saw increased investment in and acceptance of adopting AI into business operations. This shift has caught the attention of federal and state legislators/agencies. However, with no current federal legislation and mostly regulatory guidelines or suggested coordination through Executive Orders at the national level, that leaves businesses mostly on their own to determine how best to adopt and use AI.

Regardless, businesses anticipate facing increased state workplace enforcement—such as AI bias audits and mitigation—due to government efforts to address employee concerns. ⁴ While states tend to have a more anti-business stance toward AI integration, federal agencies generally offer a more business friendly approach. Such a dichotomy in the business landscape can effect occupational health care, wages, and overall workplace rule enforcement with many unknown risks for a business.

At a gathering hosted by Yale School of Business in December 2025, companies reported  slow-to-no new hires in 2026 as they anticipate more clarity and known risks for AI in the business operations landscape.⁵ While a pause in hiring started in 2025, the lack of job movement—whether in or out of a business— is likely not sustainable as the economy adapts to the Big Beautiful Bill legislation,⁶ initiating changes in investment, legislation, and incentives for tax reductions. Nobody knows for certain when the market will correct but it is certain that non-health care business operation issues have and will continue to impact decision-making for health care plans for all employers.

Non-health care business regulation or legislation impacts health care decision-making directly and indirectly. Based on 2025 trends and shifts already taking place in 2026, employers will have to continue navigating a complex US marketplace. That complexity is enhanced by increased state and federal legislation, regulation, or guidelines for certain policies that impact businesses including immigration and AI integration.

The effects of these policies and economic changes and subsequent decisions will likely spill into decisions for the 2027 health benefit plan accessibility and affordability landscape.

1. Vogenberg FR. Trends and issues for US employer insurance: forecasting 2026-2030 health care coverage. J Clin Pathways. 2025;11(6):38-42. 
2. Peterson L. 2025 year in review: from the GLP-1 boom to the One Big Beautiful Bill Act. BenefetsPRO. December 22, 2025. Accessed December 22, 2025. https://www.benefitspro.com/2025/12/22/2025-year-in-review-from-the-glp-1-boom-to-the-one-big-beautiful-bill-act
3. Fisher Philips. Employer cheat sheet for workplace laws taking effect January 1, 2026: top 5 trends and your quick list of 50+ new laws. December 11, 2025. Accessed December 22, 2025. https://www.fisherphillips.com/en/news-insights/employer-cheat-sheet-for-workplace-laws-taking-effect-january-1-2026.html
4. Fisher Phillips. FP’s top 10 workplace predictions for 2026: key trends for employers to track. December 17, 2025. Accessed December 22, 2025. https://www.fisherphillips.com/en/news-insights/fps-top-10-workplace-predictions-for-2026.html
5. Cutter C. Companies are outlining plans for 2026. hiring isn’t one of them. Wall Street Journal. December 27, 2025. Accessed December 29, 2025. https://www.wsj.com/economy/jobs/2026-job-hiring-growth-plans-10bc3470?mod=hp_lista_pos5
6. Internal Revenue Service. One, Big, Beautiful Bill provisions. July 4, 2025. Accessed January 16, 2025. https://www.irs.gov/newsroom/one-big-beautiful-bill-provisions