NEW STATE HEALTH POLICY TRENDS REPORT: 30 States Took Action on Medical Debt, 12 States Considered Facility Fee Reforms in 2026

With federal action on hospital prices yet to happen and H.R. 1 changes looming, states stepped up to lower costs, limit harmful consolidation, and protect people’s access to care

Washington, DC — Today, United States of Care released its 2026 State Legislative Wrap-Up Report, offering in-depth analysis of key state health care policy trends and a roadmap for state and federal policymakers to address the nation’s growing health care affordability crisis. 

The report found that 30 states considered or enacted legislation to protect people from medical debt, 21 states considered or enacted measures to strengthen health care price transparency, 19 states considered or enacted prior authorization reforms, 18 states considered or enacted legislation to protect access to no-cost preventive care, 12 states considered or enacted facility fee reforms, and 12 states considered or enacted reference-based pricing reforms and/or site-neutral payment policies. 

As states continue to advance innovative policy solutions, addressing health care affordability has emerged as a key area of bipartisan cooperation in state legislatures. These trends reflect both the growing consensus from state lawmakers on both sides in addressing the underlying cost of health care, and the demand from people across the country for all states – and Congress – to follow suit.  

“In 2026, states were swept into a perfect storm – federal changes threatening coverage for millions, budget shortfalls, and health care costs that continue to outpace what people can afford,” said Eric Waskowicz, Senior State Policy Manager at United States of Care. “And yet, across the country, bipartisan coalitions of lawmakers refused to wait for Washington. They took the initiative and passed commonsense, people-centered solutions – from capping hospital prices through reference-based pricing to protecting people from medical debt and helping keep families covered. States across the nation and of every political shade are showing us what’s possible when policymakers put people first – and they’re laying the groundwork for even bolder action in 2027.”

Some of the ways states are addressing affordability challenges include:

• States took action to lower high prices charged by hospitals – with 30 states considering or enacting legislation to protect people from medical debt, 21 states considering or enacting stronger hospital price transparency requirements, and 12 states considering or enacting facility fee reforms. Through requiring reference-based pricing, establishing limits on facility fees, and pursuing site-neutral payment policy, states like New Mexico, Virginia, Maine, and North Carolina considered or enacted meaningful relief to people struggling with sky-high hospital costs. Similarly, states like Wyoming and Hawaii also considered or enacted legislation to strengthen hospital price transparency requirements, and states like Indiana and Louisiana considered or enacted legislation to protect people from the burden of medical debt.
  
• States supported policies to limit harmful health care consolidation and the corporatization of health care – with nine states considering or enacting legislation to strengthen controls on health care consolidation. By expanding oversight and review of health care transactions, pushing back against the growing role of private equity and other corporate actors, and requiring greater ownership transparency, states like California, Maine, and Washington considered or enacted legislation to protect people’s access to affordable care in increasingly consolidated markets.
  
• States responded to federal health care policy changes by preserving and expanding people’s coverage options – with most states deploying Rural Health Transformation Program funding to support health care access. Facing the fallout of H.R. 1 and the expiration of enhanced premium tax credits, states like Connecticut, New Mexico, and South Dakota explored new coverage programs, expanded state-level subsidies, and leveraged federal partnership opportunities like the Rural Health Transformation Program to protect or strengthen coverage. In addition, six states continued to move ahead with the CMS Innovation Center’s Achieving Healthcare Efficiency through Accountable Design (AHEAD) Model to lower costs and deliver whole-person care for people through patient-first care.
  
• States pursued legislation to ensure people’s health insurance provides high quality, low cost care – with 19 states considering or enacting reforms to the prior authorization process and 18 states considering or enacting protections for no-cost preventive services. From restricting the use of harmful prior authorization to increasing investment in primary care and reinforcing access to no-cost preventive care, states like Vermont, Maryland, and Kentucky considered or enacted policies to ensure people can access the care they need without unnecessary barriers or costs.

View the 2026 State Health Policy Trends Report here.

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