The year on the health beat

As 2025 closes out, Montana Free Press reporters are reflecting on the work they’ve done over the course of the year — and what they expect to be writing about heading into 2026.

Looking back on the year, the issue that defined my beat coverage more than any other was health care access. And, as is the case in any gripping saga, there were plenty of twists and turns along the way that I didn’t anticipate. 

Going into the 2025 Legislature, many health policy advocates told me they were preparing for a big fight over whether lawmakers would renew funding for the state’s expanded Medicaid program. That health care program — jointly funded by the state and federal governments — uses taxpayer funds to cover a range of health services for about 75,000 low-income Montanans between the ages of 18 and 65. 

As it turned out, the bill passed by a wide margin, powered along by a bipartisan bloc. The legislation, House Bill 245, also benefited from the support of Gov. Greg Gianforte and sponsorship from Rep. Ed Buttrey, a Great Falls Republican allied with major health care industry groups. (Shortly after the Legislature adjourned, the Montana Hospital Association announced it had tapped Buttrey to be its next president and CEO.)

Conservative Republicans who voted against Medicaid expansion repeatedly acknowledged that they were in the minority, even while arguing passionately against the bill. Many decried the program for its weighty burden on taxpayers and the inherent threat that they see government-run health care programs posing to individual liberty. 

Some of those opponents also gestured to the national political landscape. The administration of President Donald Trump and the Republican majority in Congress could very well restructure the Medicaid program, they said, making it unwise for Montana and other states to continue relying on it as a stable avenue for health care access.

About halfway through the year, congressional action did shake the national Medicaid system. House Resolution 1, the budget resolution passed over the summer by Congressional Republicans — including all four members of Montana’s delegation — gave the program strict “community engagement” requirements, including work hours. (Montana lawmakers had previously drafted work requirements for the state program, but the administration of President Joe Biden never approved those changes.) As H.R.1’s new paperwork and eligibility requirements begin to take effect in 2026, policy analysts expect the legislation to strip more than $900 billion in Medicaid spending from the federal budget and reduce Medicaid enrollment growth in many states. It’s unclear currently how Montana will be affected.

Another major national health care access debate this year has been over renewing enhanced subsidies for health insurance premiums purchased through the Affordable Care Act marketplace, an insurance option for millions of Americans who make too much to qualify for Medicaid and don’t receive insurance through an employer. In September and October, Congressional Democrats voted against a continuing resolution to fund the federal government because the package didn’t include those subsidies, which were originally rolled out during the COVID-19 pandemic and had for years helped make health insurance affordable for thousands of Montanans. 

As the subsidy cliff loomed, we spoke to Montanans about how the change in health care premiums for 2026 was putting them on the financial ropes and — in some cases — prompting them to forego health insurance altogether. Again and again, I heard Montanans talk about the financial bind of affording insurance coverage, even if it meant robbing from other parts of their monthly budgets.

WHAT’S ON THE HORIZON IN 2026?

Major policy shakeups in the Montana Legislature or Washington, D.C., often take months — or even years — to start rattling the windows and floorboards around everyday people. In 2026, I’m keeping a close eye on how the tremors radiating from H.R. 1 and other state and federal legislation shake out at home.As always, hearing directly from Montana residents is my preferred way of making sense of large-scale shifts in the health landscape. If you have a story to share, I’d love to spend some time listening to you. Reach out to me at [email protected] with your health care forecast for 2026.