The Senior Citizens League (TSCL) Monthly Washington Update for the end of January 2026
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Congress is facing a large agenda in 2026, but the first thing it is dealing with is the unfinished work from 2025. For part of January, the country was under a partial government shutdown due to ICE (Immigration and Customs Enforcement) operations in Minneapolis and other cities. The central dispute was over funding for the Department of Homeland Security, with Democrats demanding reforms to immigration enforcement (ICE) and Republicans opposing them.
With respect to seniors, we examine ongoing challenges related to prescription drug costs, growing pessimism among Medicare Advantage insurers, and a new experimental rural health care program.
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The Good and Bad News About the Administration’s New Rural Health Initiative
Many of TSCL’s supporters live in rural America. And while getting health care can sometimes be frustrating in higher population areas, seniors in rural America often find getting the health care they need to be a much more daunting task.
Tradeoffs, a nonprofit news organization that reports on health care’s toughest choices, notes that January marked the start of an experiment to make significant changes in health care in rural America. This occurs because of a provision in President Trump’s “One Big Beautiful Bill,” passed by Congress last summer. The legislation will give each state a guaranteed $100 million a year over the next five years.
The rest of the money is awarded based on a series of factors — including how rural a state is, what states propose to do with the money, and whether the states adopt policies aligned with the administration’s Make America Healthy Again priorities.
Research shows people are more likely to die younger in rural communities compared to cities, and the disparity has grown over the last three decades.
However, the same legislation that created the Rural Health Transformation Program also cut federal Medicaid spending by nearly $1 trillion over the next decade. One analysis estimates that $137 billion of those cuts will hit rural areas — nearly triple the amount of the new rural health fund.
Rural health advocates say the looming cuts will leave hospitals struggling to survive, making it difficult to fully take advantage of the rural funding opportunity.
Democrats and many health policy experts argue that this temporary $50 billion infusion pales in comparison to the roughly $1 trillion in cuts to Medicaid and Obamacare, also passed by Congress last year. Critics also worry about a lack of transparency and the administration’s decision to give an edge to states that adopt White House policies.
Some of the money comes with strings. States could get bigger awards by promising to adopt health policies favored by the administration. But if states fail to pass those policies, they will receive less money in future years and could be forced to repay funds they already received.
According to one analyst, “If you look at where funding per rural resident is going under this program, it’s not going to states that have the highest rural mortality rates. It’s not going to states that are projected to have the greatest reductions in federal Medicaid spending. It’s not going to places that are losing the most hospital beds.”
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Prescription Medication Problems Continue to Plague Seniors and Other Patients
According to the online newsletter BenefitsPro, “More than half of patients experience challenges when filling prescriptions and are uncertain about who to trust for prescription medication information or costs, a new survey from Surescripts found. As a result, one in four patients has abandoned a prescription because it was too expensive.”
The article reports that both price transparency and affordability are problems, as patients struggle to find prescriptions they can afford. It also points out that only 26% of survey respondents discuss medication costs with their provider at least half of their visits, and just more than half believe their needs are fully met in these conversations.
The requirement for prior authorization also contributes to the problem, with 29% of patients who have filled a prescription in the past 12 months reporting delays due to prior authorization. This rises to 36% when patients take 2 or more prescription medications daily. The impact of these delays extends beyond inconvenience, with 13% of patients reporting that their health has worsened because of delays caused by prior authorization processes.
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Medicare Advantage Insurers Distressed About Their Future
According to Politico online news service, “While President Donald Trump went easy on insurers in his broader health plan, he’s drawing the line at trouble-ridden Medicare Advantage. Health insurers cheered last year when the Trump administration agreed to pump $25 billion more into private Medicare plans in 2026, hoping it signaled a turnaround from the Biden administration’s more modest yearly increases. Instead of the big boost the insurers say they badly need, the Trump administration on Monday offered an increase of less than 1 percent, or $700 million, in 2027.”
The 0.09 percent payment increase to insurers for 2027 compares to a 5 percent bump in 2026. This comes as the Medicare Advantage program has come under increased scrutiny in recent years.
An independent congressional agency has found Medicare Advantage is overpaid by about $76 billion a year compared with traditional Medicare. That is largely driven by a process called upcoding, as MEDPAC has found, in which insurers inflate the severity of patients’ health conditions to secure higher federal payments. Trump wants to crack down on that as well, requiring billing codes to be linked to patient appointments.
The announcement has left insurers distressed about the future of Medicare Advantage, the privately run alternative to traditional Medicare, amid seniors’ skyrocketing medical costs over the past few years. About half of seniors have enrolled in Medicare Advantage plans. Insurers said the meager pay raise Trump has proposed could prompt more of them to pull out.
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Next Round of Drugs up for Price Reduction Negotiations Announced
The Trump administration on Tuesday announced the next round of prescription drugs up for Medicare price negotiations. The list includes Botox and the GLP-1 drug Trulicity, as well as Anoro Ellipta, Biktarvy, Cimzia, Cosentyx, Entyvio, Erleada, Kisqali, Lenvima, Orencia, Rexulti, Verzenio, Xeljanz, and Xolair.
The negotiations stem from President Joe Biden’s Inflation Reduction Act of 2022, which gave the Centers for Medicare & Medicaid Services the authority to negotiate prices on the costliest prescription drugs each year. The results from the first round of negotiated prices went into effect this year. The drugs selected for this round of negotiations accounted for about $27 billion in total prescription drug spending under Medicare Parts B and D, according to CMS. The reduced prices will take effect in 2028.
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As Congress moves deeper into 2026, the issues outlined in this update make one thing clear: seniors remain caught in the middle of major policy debates with real-world consequences. From uncertainty surrounding rural health care funding, to persistent problems with prescription drug affordability, to growing instability in Medicare Advantage, the stakes for older Americans could not be higher.
The Senior Citizens League will continue to monitor these developments closely and fight to ensure that seniors are not asked to shoulder the burden of budget cuts, policy experiments, or industry failures. Your voices matter, and your engagement strengthens our advocacy. We encourage you to stay informed, share your concerns with your elected officials, and watch for future updates as these critical issues continue to unfold in Washington.