A keynote address at the National Academy of Medicine’s 2026 Annual Meeting on chronic disease identified three pressing issues in U.S. health policy: reversing Medicaid and Affordable Care Act coverage losses, restoring federal health agencies, and controlling health care costs for those with chronic illnesses. The event took place on October 19, 2026, shifting from traditional speeches to an informal discussion led by Brendan Lee, MD, PhD, chair of Baylor’s Department of Molecular and Human Genetics. The speaker, with decades of experience in health policy, framed chronic illness as central to the affordability crisis.
The first challenge involves the largest federal health spending cut in U.S. history: nearly $1 trillion in reductions to Medicaid and the ACA over the next decade. Estimates suggest these cuts will result in about 14 million more uninsured people over the decade, reversing recent progress and bringing the uninsured total back to nearly 40 million.
States will attempt to mitigate losses, but budget trade-offs are unavoidable. The largest single cut—$330 billion—targets Medicaid work requirements, a policy that produces no employment gains while increasing administrative burdens. The Congressional Budget Office projects it will remove 5 million people from Medicaid rolls, worsening coverage gaps.
Federal health agencies face Marshall Plan rebuild
The second issue is rebuilding federal health agencies, which have faced staffing shortages, mission erosion, and politicization. The speaker, who previously led a major health agency, compared the task to a Marshall Plan and warned that meaningful progress could take two years to materialize under a new administration. Without early planning, urgent needs may go unmet.
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A recent example of agency strain is the HHS research arm’s claim that coverage losses stemmed from fraud, a claim contradicted by available data. Meanwhile, the Centers for Medicare & Medicaid Services (CMS) has avoided severe cuts due to political protections, leaving other agencies, such as the Agency for Healthcare Research and Quality (AHRQ), under significant pressure. AHRQ, in particular, has suffered cuts and mission drift, impairing its role in evidence-based policy.
To address these challenges, the speaker proposed creating a nonpartisan commission, potentially involving organizations like KFF or the National Academy of Medicine, to develop a coordinated reconstruction plan for agencies including the CDC, FDA, and NIH. The speaker, who had been offered the role of HHS secretary, emphasized that no single leader could resolve this alone. Updating HHS’s commitment to equity was also described as a necessary but difficult task.
Chronic illness drives affordability crisis deeper
The third challenge is the rising cost of health care, though its impact varies by stakeholder. Voters consistently rank affordability as their top economic concern, surpassing food, housing, and gas. A KFF poll found that 25% of Americans struggle to pay medical bills, but for those with chronic conditions, such as cancer, diabetes, or heart disease, the figure rises to 40%. Nearly 60% of chronically ill patients report delaying or skipping care, with 25% worsening as a result.
National health spending as a share of GDP has remained steady at around 18%, but the affordability crisis persists due to high prices rather than increased utilization. The speaker stressed that the problem is not just spending but access, particularly for the chronically ill and uninsured, who face the most severe consequences of a failing system.
