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Happy New Year (I think I can still say that!?)
Welcome to this month’s ADVOCATE BRIEF
December showed where healthcare pressure continues to build and who feels it first.
December made one thing clear. Policy debates accelerated. Costs stayed sticky. Communities absorbed the fallout. Innovation moved forward while coverage rules dragged behind. This Brief pulls those threads together so advocacy leaders can see the system as it actually operates, not how press releases describe it.
POLICY PULSE: POLITICAL
Policy decisions decide who gets care long before a prescription fills or a claim clears.
December delivered several signals that regulators plan to intervene more aggressively, often without fully accounting for downstream patient impact. As we ended the year, there was still much up in the air, but we’re more hopeful as we move into January with Congress passing an ACA enhanced subsidies extension for 3 years. Now onto the Senate.
Key Insights:
CMS proposed sweeping changes to Medicare Advantage star ratings, signaling tighter oversight and potential disruption for plans and beneficiaries. CMS proposed overhauling Medicare Advantage star ratings with changes that could significantly affect plan payments and benefit design. While the goal centers on quality improvement, rapid implementation risks confusing beneficiaries and destabilizing coverage options.
Lawmakers and regulators continued pressing PBMs and insurers on transparency and incentive alignment.
Oncology policy leaders reinforced the need to protect early phase research access amid shifting regulatory scrutiny. ASCO reaffirmed the therapeutic importance of Phase I oncology trials, pushing back on outdated perceptions that early phase research lacks patient benefit. The statement reinforces policy arguments for preserving trial access and reimbursement pathways.
Looking Forward
Policy never lands softly. Advocacy teams should treat these signals as early warnings and prepare patient-centered responses before implementation locks in consequences.
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COST OF CARE: ECONOMIC
Affordability continues to define whether care happens.
This section focuses on the economic pressures patients face when coverage appears adequate on paper but fails in practice. Premiums, deductibles, and benefit design drive behavior more than any mission statement ever will. Coverage still fails when affordability breaks down. December data reinforced the idea that patients continue to make trade-offs between health and basic needs as costs remain stubbornly high.
Key Insights:
Insurance design keeps shifting costs downstream to patients. Rising out-of-pocket exposure continues pushing patients to delay or skip care, even when coverage exists. High deductibles and complex cost-sharing structures undermine treatment adherence across chronic conditions.
Employer-sponsored and government programs struggle to balance cost containment with access.
Financial toxicity remains a leading driver of delayed care. Analysts warned that benefit complexity, not just headline premiums, drives patient anxiety and disengagement. Simplifying cost structures emerged as a recurring solution across multiple reports.
We Must Prevail
Cost conversations must move beyond pricing rhetoric. Advocacy leaders should focus on how benefit design choices translate into real patient behavior.
COMMUNITY LENS: SOCIOCULTURAL
What the system looks like from the patient side.
Healthcare outcomes reflect lived experience, not policy intent. This section centers the voices, realities, and trust dynamics that determine whether systems work for real people. Community insight exposes gaps data alone never catches.
Key Insights:
Patient voice remains central to care quality and outcomes.
Communities feel system failures first and longest. Community-focused analyses showed that patients value transparency, consistency, and human connection more than system complexity or optimization narratives.
Advocacy credibility grows when grounded in lived experience.
A physician perspective piece emphasized the sacred trust between patients and clinicians, warning that administrative burden and misaligned incentives continue eroding that relationship.
In 2026 We Must Double Down on SDOH
Advocacy works best when it starts with lived experience. December reinforced that patient trust remains the most fragile and most valuable asset in healthcare.
TECH TRENDS: TECHNOLOGY
Innovation advances while policy struggles to keep pace.
Technology continues moving faster than reimbursement and regulation. December underscored the tension between innovation potential and system readiness.
Key Insights:
Clinical innovation outpaces coverage frameworks. Emerging clinical tools and research pathways demonstrated strong patient value, but inconsistent reimbursement and regulatory clarity threatened broader adoption.
Technology adoption remains uneven across populations. Experts emphasized that technology without equitable access widens gaps rather than closing them.
Policy alignment lags clinical reality.
Innovation Alone Does Not Improve Outcomes
Advocacy teams must connect technology to access, coverage, and patient reality. As we head into 2026, we look forward to deeper engagement and sharper action to elevate the patient voice across healthcare. We are in the midst of fielding this year’s ELAVAY Intelligence Report and excited for results in the spring!
To elevate the impact of realizing the lived experience of patients, Matt Toresco will begin delivering keynotes to healthcare professionals across the sector and directly to the patient community, because real change requires both sides in the same room. You can find more at matttoresco.com.
The System to Empower the Patient Voice to Maximize Efficiencies & Revenue
We will keep publishing our monthly PEST recap to track the forces shaping care, and I will introduce a weekly article focused on issues that matter to me personally and demand honest attention.
Matt Toresco helped in founding We The Patients at the end of the year with Matthew Zachary & Sally Neely Nix. We're building America's first cancer patient voter bloc – the first national bipartisan single-issue electorate of 19M cancer survivors and 20M caregivers. This is unprecedented in American politics
Matt will host the first of many WE THE PATIENTS LIVE events in the Raleigh Durham area of North Carolina on January 29th. This event is the first of dozens of community pilots testing districts as we grow the company into a domestic polling engine, media platform and data/Ai insights universe. Matt & his cofounders invite you to join us. You can find full details and registration information at www.wethepatients.org. (Flyer Above)
1 All references for this newsletter can be found at the Google Sheets link below for your own review, and access to the original article text. https://docs.google.com/spreadsheets/d/1DN8QyfRGTCwNOypwUr-a8exTPTiCLh4HzgVhtB_6OOQ/edit?usp=sharing