The second half of 2026 opens with health system leaders facing a split mandate. Policy-driven financial headwinds like Medicaid cuts, Medicare Advantage payment disputes and federal research funding uncertainty are arriving at the same moment many organizations have committed to growth, access expansion and technology transformation.
Across conversations with nine system CEOs, a consistent pattern emerged: no organization is operating purely on offense or purely on defense. The question is how they’re managing both at once.
Defense
The fiscal threat is very real. Erik Mikaitis, MD, CEO of Cook County Health in Chicago, said the proposed Medicaid changes are expected to result in 5 million people losing coverage and nearly $1 trillion in federal funding reductions over the next decade.
“Protecting Medicaid coverage for eligible individuals must be a top priority this year,” Dr. Mikaitis said. “The fiscal impact alone is a major concern of nearly every hospital CEO. But we have an opportunity to act now.”
Cook County Health is not waiting for the policy environment to clarify. The system and its partners launched Get Medicaid Facts, a free, open-source communications toolkit aimed at educating Medicaid enrollees before new eligibility requirements take effect in 2027. A recent survey found nearly half of enrollees are unaware of the changes, a gap Dr. Mikaitis sees as a patient protection issue and an operational one.
“By working together now, we can help eligible individuals stay covered to protect not only their own health, but the health and sustainability of our healthcare delivery ecosystem,” said Dr. Mikaitis.
The payment pressure extends beyond Medicaid. Erik Wexler, president and CEO of Providence in Renton, Wash., has made the Medicare Advantage Prompt Pay Act a primary focus of his year, joining lawmakers and hospital leaders on Capitol Hill in June to advance legislation that would require commercial payers to settle Medicare Advantage claims on a defined timeline.
“When payments are delayed or denied, it is financially destabilizing for hospitals, clinics and physicians, with the potential to limit access to the care patients need,” Mr. Wexler said.
Providence is owed more than $1 billion from commercial payers for Medicare patients, with nearly $600 million outstanding for more than five months.
“I am encouraged by the groundswell of support behind this effort, which now has 19 bipartisan co-sponsors, reflecting a growing recognition that this legislation will protect patients and support the sustainability of care delivery,” he said. “I am grateful to the many lawmakers working to make that a reality.”
At institutions whose financial models rely on federal research support, the horizon is similarly uncertain. Boris Pasche, MD, PhD, president and CEO of Barbara Ann Karmanos Cancer Institute in Detroit and oncology department chair at Wayne State University, said government research funding is flat and cannot be assumed to grow, even after Congress pulled back from its steepest proposed cuts.
“Our focus is on expanding other revenue streams, particularly through continued growth in patient volume and selective opportunities in industry-sponsored clinical research, while also improving operational efficiency,” Dr. Pasche said.
Karmanos is deploying AI in insurance verification and billing collections as part of that effort, a targeted, operationally focused application of technology that contrasts with the broader enterprise-level AI investments systems in a stronger financial position are making.
“Taken together, these efforts are aimed at offsetting pressure on research funding and maintaining the organization on a strong growth trajectory,” Dr. Pasche said.
At Harbor UCLA Medical Center, part of Los Angeles County Health Services, CEO Andrea Turner, PhD, JD, has organized her priorities around a framework of compounding efforts: cost containment, staff wellness, reduction of programs outside the core strategic focus, patient satisfaction and quality outcomes.
“Cost containment is exceptionally relevant because of the amount of waste that occurs in healthcare,” Dr. Turner said. “Working efficiently and effectively with a lean perspective helps to track gaps and waste that can be mitigated.”
While many CEOs are committed to staff wellness, Dr. Turner’s view of it as a financial imperative colors the strategy.
“Staff wellness is also equally relevant for financial stability because when staff are extremely stressed, they are likely to go out on some type of medical / psychological leave, of which productivity suffers,” she said.
Offense
Not every organization is approaching the second half of the year from a defensive position. Albert L. Wright, Jr., president and CEO of WVU Medicine in Morgantown, W.Va., is executing one of the more aggressive growth agendas in the country. The system expects to close its acquisition of Independence Health System, a five-hospital system in southwest Pennsylvania, on Oct. 1, while welcoming two additional hospitals by year’s end including a critical access hospital in central Pennsylvania and an acute care pediatric behavioral medicine hospital in Wheeling, W.Va.
“Beyond acquisitions, we remain heavily focused on expanding capacity at our existing facilities,” said Mr. Wright. “We are now executing a board-approved package of hospital expansion projects totaling $350 million that was approved in April of this year, bringing WVU Medicine’s three-year total of capital improvement projects to more than $1.2 billion. Together, these investments will transform many of our hospitals and outpatient facilities.”
For Aimee Brewer, president and CEO of Sturdy Health in Attleboro, Mass., the organizing frame is access, and the investments are concrete. The system’s campus transformation includes the upcoming opening of a Dana-Farber Cancer Institute regional campus, bringing specialist oncology care to a community that has historically had to travel for it. A new, expanded emergency department with dedicated behavioral health capacity is scheduled to open in 2027, also designed to handle demand associated with FIFA World Cup activity at nearby Gillette Stadium.
“The significant transformation underway across the Sturdy Health campus is ultimately about ensuring that patients can receive more advanced specialty, cancer, and emergency care close to home, particularly at a time when healthcare access is becoming increasingly strained and demand for care continues to grow,” Ms. Brewer said.
Access carries the same weight at Baystate Health. Peter D. Banko, president and CEO of the Springfield, Mass.-based system, made the prioritization explicit.
“Access is not just the No. 1 priority for the 2nd half of 2026. It is our top three priorities,” Mr. Banko said. “Members in our health plan and patients in core service lines leave Western Massachusetts for competitors in Boston and Hartford. Improving access to our physicians and hospitals improves community health trust by establishing us as a reliable community partner close to home.”
Expanding access and boosting the system’s reputation isn’t going to be easy, but Mr. Banko is ready to take action.
“We have significant work over the next six months in redesigning the process to be consumer-driven, reducing provider-health plan friction, addressing workforce challenges, expanding digital and virtual care and enhancing our new Oracle Health platform,” he said.
Daniel T. Pickett III, president and CEO of Albany (N.Y.) Med Health System, is focused on execution. He is converting a long-range strategic plan, First Choice 2030, into near-term operational gains. His system serves 3 million people across 25 counties as the only academic health system in northeastern New York and western New England.
“First Choice 2030 is our roadmap, but the work now is execution,” Mr. Pickett said. “We are focused on building a more integrated academic health system that delivers exceptional care today while also strengthening education, research, and innovation for the future.”
The priorities for H2 2026 include improving access, expanding the ambulatory footprint, improving hospital throughput, aligning service lines and making the system easier for patients and physicians to navigate — operational fundamentals Mr. Pickett is treating as the foundation everything else builds on.
Technology runs as a thread through nearly all of these strategic directions. At Texas Children’s in Houston, president and CEO Debra F. Sukin, PhD, has placed enterprise-level AI adoption at the center of how the system pursues its broader goals of extending access, accelerating clinical research and aligning talent with care transformation.
“We are embedding artificial intelligence and machine learning into our DNA at an enterprise level to accelerate our clinical, research, and administrative work,” Dr. Sukin said. “We are uniting our patient care and research missions by improving access and convenience so more patients can benefit from our clinical trials. And we are aligning our talent strategy with our financial planning and care transformation strategies to ensure that we remain the employer of choice. Together, these efforts will enable us to remain agile, adopt new ways to serve our patients, deliver better outcomes and ultimately create healthier futures for women and children in our global community.”
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