Elevated POV (January ‘26)

January 2026 marks a decisive moment in American healthcare leadership

by Jocelyn Hines, MD, MBA, FAAFP

Millions of Americans are entering 2026 facing the loss of affordable health coverage. With enhanced Affordable Care Act subsidies no longer funded, marketplace premiums are rising sharply, and millions are expected to drop insurance altogether. Health policy analysts warn that healthcare coverage loss at this scale will destabilize the individual insurance market and deepen access gaps nationwide.

At the same time, Medicaid funding reductions are already underway, threatening access not only for individuals but for the clinics, hospitals, and care teams that depend on stable reimbursement to remain financially viable. These Medicaid cuts will have system-level consequences, particularly for safety-net providers, rural hospitals, and community-based clinics.

These shifts are happening against a dangerous public health backdrop. Preventable diseases like measles are resurging as vaccination rates decline nationwide. In many regions, herd immunity thresholds are no longer being met, reversing decades of progress and increasing public health risk for children and vulnerable populations.

Layered on top of this is a rapidly changing information and healthcare technology environment. On one hand, we are seeing meaningful advances through artificial intelligence, health data analytics, and digital care delivery. On the other, healthcare disinformation is spreading at scale. Paid influencers, algorithmic amplification, and low-quality AI-generated content are eroding trust in evidence-based medicine and public health guidance.

These forces are not separate. They are converging.

What the pre-ACA era teaches us about healthcare system resilience

I trained and practiced medicine before the Affordable Care Act, during a time when too many patients were uninsured or excluded from coverage due to pre-existing conditions. Preventive care was delayed. Chronic disease went unmanaged. Treatable conditions progressed into avoidable morbidity. Clinicians carried the emotional and ethical weight of knowing what patients needed while watching healthcare systems fail them.

One patient from that time still comes to mind.

He was a white working-class family man in his mid-50s from Baltimore. He had spent most of his adult life working construction, operating a jackhammer. He had a heart attack that changed everything. He survived, but he could no longer do the work his body had carried him through for decades.

Similarly to now, health insurance was very much tied to employment. He was too young for Medicare and not considered fully disabled because, on paper, he could still work, just not at the only job he had ever known. He was not eligible for Medicaid either. He had too many assets, and more importantly, he was unwilling to dismantle his family’s financial stability just to qualify. Private insurance was out of reach. After his heart attack, there was no premium that would have removed him from the pre-existing condition exclusion list at the time.

He wanted to work. His identity was deeply tied to providing for his wife and children. He talked about work the way other people talk about family, as something that gave him structure and pride. As weeks turned into months, depression set in. He had quit smoking years earlier, but under the weight of fear, loss, and uncertainty, he started again. Eventually, he stopped coming into the clinic. I had little to offer beyond additional prescriptions and a growing list of things I wished I could fix.

In the end, he decided to return to construction and take his chances with his heart.

The federally qualified health center where I worked closed about a year later. Patients scattered. I never learned how his story ended.

That era was painful, but it also revealed something essential about healthcare system resilience. When formal systems fall short, communities adapt. Innovation emerges from necessity. Collaboration expands beyond traditional boundaries. Safety-net clinics, public health departments, nonprofit organizations, and unlikely partnerships came together to meet urgent needs.

We are approaching a similar healthcare inflection point now, but with important differences.

Why this healthcare crisis moment is fundamentally different

We have tools today that simply did not exist before.

Telehealth access is no longer experimental. It is a core healthcare access point for millions of patients, particularly those in underserved and rural communities. Health technology companies are actively building solutions for care coordination, population health management, and operational efficiency. AI in healthcare is being deployed to support clinical decision-making, identify risk earlier, and reduce administrative burden.

We also have unprecedented connectivity. Social media, digital platforms, and professional networks allow meaningful healthcare resources to be shared rapidly and at scale. When used responsibly, these channels can amplify trusted voices, counter healthcare misinformation, and connect people to care faster than ever before.

And for now, we have something else that is rare. We have national attention. There is growing recognition across sectors that the United States is approaching a healthcare crisis that will affect individuals, families, employers, and entire communities.

That attention creates opportunity.

The system-level consequences of healthcare access loss

Loss of healthcare coverage does not stay contained at the individual level. When people forgo preventive care or delay treatment due to cost, emergency departments become default entry points. Uncompensated care rises. Clinics operating on thin margins are forced to reduce services or close entirely. Healthcare workforce strain intensifies, and local economies feel the impact as healthcare jobs disappear.

Public health setbacks compound these effects. Measles is not just a childhood illness. It is a signal. A signal that public trust is fracturing, that health policy decisions have downstream consequences, and that underinvestment in prevention eventually shows up as higher cost, higher risk, and greater inequity.

At the same time, healthcare innovation without accountability carries its own risks. AI tools and digital health platforms deployed without equity, transparency, and clinical oversight can widen disparities rather than close them. Disinformation, left unchecked, can undermine even the most effective public health interventions.

This is a healthcare leadership moment, not a management problem

What we are facing cannot be solved through incremental healthcare management fixes alone. This moment calls for healthcare leadership that operates across silos, sectors, and timelines.

We need leaders who can think at the population health level while remaining grounded in real clinical experience. Leaders who understand that healthcare access, equity, quality, and sustainability are not competing priorities but interdependent ones. Leaders who engage with healthcare technology thoughtfully, partner across sectors, and hold themselves accountable for measurable outcomes.

There is real uncertainty ahead. But there is also real hope.

If we act with clarity and courage, this moment can become a turning point in American healthcare. We have the opportunity to build scalable healthcare systems that expand access, deliver equitable care, and improve outcomes to at least match those of other industrialized nations.

That kind of progress requires intersectional, ethical, and accountable healthcare leadership. Not louder voices. Not faster tools. But wiser decisions, grounded in evidence and guided by responsibility.

This is the work of the coming year and beyond. And it is work worth doing.