Health policy topics are always evolving. New clinical evidence, shifting administrative priorities and technological innovations change constantly, affecting current public health issues day by day. It’s up to physicians and other healthcare professionals to stay informed.
This article will discuss some ongoing debates and key developments regarding healthcare policy issues in 2025, in three main areas:
1. Healthcare affordability and access
Millions of Americans struggle to access timely, effective healthcare—even if they have insurance. From long wait times to administrative hurdles like prior authorizations, systemic barriers make it harder for patients to receive the care they need. As policymakers roll out new regulations aimed at reducing delays and improving provider accountability, physicians continue to navigate a fragmented system that puts access at risk.
When asked what key healthcare policy issue will shape the future of medicine the most, 39% of physicians on Sermo said affordable care and universal coverage—a higher result than any other response. A resident from the U.S. adds, “Many patients are hesitant about seeking care due to concerns about costs. I think having more transparency would help to keep prices low and competitive. Similar to gas prices being displaced on gas stations. This allows patients to shop around for the best deal, and to come for care sooner rather than later.”
There are also social determinants, like limited access to healthcare, nutrition and housing that create adverse health outcomes for low-income youth. Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program provides healthcare coverage for eligible U.S. children and youth.
While EPSDT aims to detect and treat health conditions early, many states fail to meet program requirements. House Republicans also propose $2.3 trillion in Medicaid cuts for 2025. Their plan includes reduced Affordable Care Act (ACA) expansion funding, federal spending caps and eliminated expansion incentives. These health policy changes may force states to markedly reduce coverage.
According to a global Sermo poll, physicians believe implementing universal healthcare is the most important step to enhancing care equity, receiving 50% of the vote. But the reality doesn’t match that belief. Millions of people don’t have access to healthcare, and those who do often face roadblocks like long wait times.
Prior authorizations
Prior authorizations historically cause care delays, with response times sometimes reaching 30 days. Starting in 2026, a new Centers for Medicare & Medicaid Services (CMS) rule—Interoperability and Prior Authorization Final Rule (CMS-0057-F)—sets maximum response times for prior authorization requests: 72 hours for urgent cases and 7 days for standard requests.
The rule requires healthcare payers (like insurance companies and Medicare) to provide denial rationales and approve care actions faster, reducing administrative overhead and improving delivery efficiency. Multiple states have enacted prior authorization regulations, with analysts expecting more states to follow.
The CMS Medicaid Access final rule also mandates that states create Beneficiary Advisory Councils (BAC) and integrate BAC members into 25% of Medicaid Advisory Committee positions. States must prove adequate access when submitting state plan amendments that could reduce fee-for-service rates or limit service access.
The influence of workforce and infrastructural shortages
The Medicaid Access rule also requires 80% of certain Home- and Community-Based Services (HCBS) rates to fund direct health professionals’ wages. This provision targets the national shortage of personal care and home health aides, many of whom are women and people of color. HCBS programs enable beneficiaries with disabilities and complex health needs to receive care in their homes and communities.
While Medicaid’s workforce investment aims to stabilize care access through targeted wage support, Medicare faces its own payment reform debate centered on financial sustainability. Medicare will likely advance site-neutral payment policies—such as those in the Lower Costs, More Transparency Act—amid rising bipartisan support. Advocates assert these policies could reduce healthcare costs, while critics contend they risk lowering hospital revenues enough to destabilize rural facilities.
Uncertainty surrounding ACA Medicaid expansion
Enacted during the Biden administration, the Inflation Reduction Act expanded eligibility for ACA subsidies:
- Individuals with incomes between 100% and 150% of the federal poverty level can enroll in silver-tier plans—among the lowest-priced options on the exchanges—at no cost.
- Individuals earning above 400% of the federal poverty level qualify for premium tax credits if their premiums exceed 8.5% of household income.
These subsidies expire at the end of 2025.
Policymakers may repeal the ACA Medicaid expansion, which currently provides coverage to childless adults earning under 138% of the federal poverty level. If Congress cuts reimbursement rates, some states may re-evaluate their Medicaid expansion programs, and others might withdraw as healthcare costs rise. This may result in millions of people becoming uninsured.
2. Equity, federal healthcare protections and political pushback
On the topic of equity and equality, one Sermo member shares, “Healthcare disparities impact millions across various demographics, manifesting as differences in health outcomes and access among groups influenced by race, ethnicity, sexual orientation, gender identity, religion, and socioeconomic status… Addressing these requires increasing diversity in the healthcare workforce and implementing culturally competent care.”
While equity in healthcare includes race, class and other social factors, sexual orientation and gender repeatedly come up in modern policy issues. Through the U.S. Department of Health and Human Services, the Biden administration enacted a rule under Section 1557 of the ACA to extend civil rights protections to sexual orientation and gender identity. Federal courts have since paused this rule due to ongoing legal challenges.
By extension, in early 2025, the new Secretary of Health and Human Services issued guidance to key stakeholders regarding the sex-based definitions the Trump administration established in a January 20, 2025, Executive Order. The order states: “My Administration will defend women’s rights and protect freedom of conscience by using clear and accurate language and policies that recognize women are biologically female, and men are biologically male.”
Regardless of political opinion, many physicians agree that this order is exclusionary and could reduce quality of life for thousands of people. Research shows that 1.3 million adults in the U.S. are transgender and about 276,000 receive Medicaid, and their care is at risk due to potential policies this order may inspire.
Annual inflation adjustments to Medicare physician payments
In 2025, physicians are closely watching efforts to secure annual inflation updates to Medicare reimbursement. After five straight years of payment cuts, including a 2.83% reduction in 2025, physicians’ overhead costs continue to grow faster than Medicare reimbursements. When Medicare payments stagnate while operating costs rise, physicians may increasingly prioritize patients with higher-paying private insurance, amplifying inequities between those who can afford premium insurance and those who rely on Medicare.
MedPAC recently recommended tying future payments to the Medicare Economic Index (MEI) minus one percentage point, beginning in 2026, to better align with rising practice expenses. If Congress adopts this change, it would offer much-needed stability for practices, particularly those in rural or underserved areas operating on narrow margins and would help ensure all patients, especially the most vulnerable, retain access to consistent, high-quality medical care.
Trump’s “One Big Beautiful Bill”
Meanwhile, the recently passed “One Big Beautiful Bill” includes sweeping cuts to Medicaid and ACA marketplace funding, totaling nearly $800 billion over a decade. Nonpartisan estimates suggest the legislation could lead to as many as 12 million Americans losing health insurance by 2034. Primary care physicians and hospital-based clinicians—especially in rural and safety-net settings—may see a rise in uninsured patients, delayed care, and increased uncompensated services. This shift threatens to deepen health disparities and significantly strain clinical workflows.
3. Emerging public health policy issues and debates
Private equity’s (PE) and artificial intelligence’s (AI) involvement in healthcare—and collateral implications—are two prevalent policy debates.
The collateral implications of private equity in healthcare
When asked for their opinions on private equity in healthcare, 40% of physicians on Sermo said it would have a negative impact. Only 19% felt positively.
American healthcare institutions are increasingly prioritizing profit over patient care standards. In 2024, the Federal Trade Commission (FTC) and U.S. Department of Justice (DOJ) reaffirmed their focus on private equity’s influence in healthcare, exploring transactions that could harm health and safety for both patients and healthcare workers. These efforts faced setbacks: On May 13, 2024, the U.S. District Court for the Southern District of Texas dismissed all claims against Welsh, Carson Anderson & Stowe (Welsh Carson) in a lawsuit challenging its portfolio company’s strategy to consolidate anesthesiology practices. The court ruled that Section 13(b) of the FTC Act doesn’t extend antitrust liability to minority investors.
Following the Texas court’s decision, regulatory scrutiny continued as the FTC addressed antitrust concerns in a subsequent case. On January 17, 2025, the FTC announced a settlement with Welsh Carson. The proposed order requires the firm to reduce its board membership to one non-chair seat, seek prior FTC approval for future anesthesia investments and provide 30 days advance notice for certain hospital-based physician practice transactions, among other provisions.
Meanwhile, the Senate Budget Committee’s January 2025 “Profits Over Patients” bipartisan report critiques private equity’s impact on care quality, patient safety and hospital finances. A January 15, 2025, report from the Department of Health and Human Services (HHS) titled “HHS Consolidation in Health Care Markets RFI Response”—issued in response to a joint FTC, DOJ and U.S. Department of Health & Human Services Request for Information—echoes these concerns about healthcare consolidation.
The collateral implications of AI in healthcare
A GP on Sermo shares, “The most impactful healthcare policy issue shaping the future of medicine and healthcare systems is likely technology adoption and its implications for access, cost, and quality of care. This includes artificial intelligence, telemedicine, electronic health records, and data analytics, which are poised to revolutionize how care is delivered, managed, and accessed.”
Under the Biden administration, the federal government prioritized regulatory oversight of AI development to balance innovation with risk mitigation. The administration cited national security and consumer protection concerns as the basis for measures such as agency reviews, policy directives and the Executive Order on the “Safe, Secure and Trustworthy Development and Use of Artificial Intelligence.”
A key component of the Executive Order invoked the Defense Production Act, mandating that leading AI developers share safety test results with federal authorities and disclose plans for developing advanced AI systems. Concurrently, the administration launched the AI Safety Institute under the National Institute of Standards and Technology to craft voluntary guidelines for ethical AI deployment, particularly in digitized healthcare services. During its final year, the administration intensified efforts to strengthen consumer safeguards in response to rapid technological advancements.
In January 2025, the HHS released an AI Strategic Plan to guide the adoption of emerging technologies in human services and public health issues. The plan establishes a strategic framework and operational roadmap to advance safety, effectiveness, equity and access. It outlines four primary objectives: catalyzing AI innovation, ensuring trustworthy and ethical use, expanding AI resources and building a skilled workforce. As AI evolves, HHS will update the Plan, conduct ongoing risk assessments and implement protective measures to ensure responsible and equitable AI deployment.
Global comparisons and lessons learned from other countries
The Commonwealth Fund’s Scorecard on State Health System Performance and State Health Disparities Report indicate that U.S. states emphasizing quality and health equity initiatives, a strong safety net and universal health insurance demonstrate better performance in outcomes and access. One GP from Peru adds, “Universal health coverage is essential to treat every person who comes in with an illness. It should be more flexible for low-income people.”
However, 2022 data shows that the U.S. is the only high-income country that doesn’t guarantee health coverage. This lower investment correlates with persistent challenges in health outcomes and primary care capacity.
A GP from Spain adds, “In the 21st century, it is still unacceptable that there are people who do not have access to healthcare simply because they were born in one country or another.”
Learn how other physicians navigate evolving healthcare regulations
Healthcare policy will continue to evolve, particularly as health and politics intersect. And while consistent changes are hard to track, communicating updates and opinions with other physicians can help.
A pediatrician from Germany shares on Sermo, “It’s troubling to see healthcare increasingly treated as just another market sector, with growing emphasis on cost-efficiency over the psychosocial and economic needs of patients. The real measure of quality should be rooted in equity, accessibility, and the dignity of both patients and providers.”
Sermo is the world’s largest online platform for doctors, with a community of 1 million physicians. Sermo’s message boards connect physicians in the United States and across the globe, fostering communication on a range of topics—including navigating regulatory shifts.
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