From Pinnacle: EMS Regulatory Updates for 2026
The midterm elections this November will be critical for EMS. Healthcare and affordability are top voter priorities heading into November, and the outcome of the elections may influence whether and how EMS-related legislation can advance, or be stalled.
Lisa Hawke, partner at Holland & Knight LLP, and Larry Bucshon, MD, presented “Inside the Beltway...And Beyond: The 2026 EMS Policy & Regulatory Outlook” Wednesday morning July 15, 2026 at the Pinnacle EMS Conference in San Diego.
“The direction of heathcare is going to be a top issue,” said Bucshon of the upcoming midterms. In summary, Hawke and Bucshon outlined three potential scenarios resulting from the elections:
- Republican trifecta (GOP holds the House and Senate). This would result in continued deregulation and reconciliation-driven policy tools, which mean cuts and limited legislative negotiation on healthcare. “If we have a Republican trifecta, plan on Medicare cuts. Period,” Hawke said.
- Democratic Congress (Democrats win one or both chambers). This would mean increased oversight and investigations of administration policies. Pressure on healthcare affordability would mount. However, legislation would still largely be blocked by presidential veto, Bucshon said.
- Split chamber. This may result in the most favorable environment for targeted healthcare reform, according to the presenters. EMS legislation may find a lane through consensus-building between the parties.
Regardless of who wins in November, there are ongoing structural shifts already shaping healthcare, said Hawke.
- State and individual choice over federal standards. The administration is devolving healthcare decision-making to states and individuals. Medicaid work requirements, block grants, and flexible plan designs are expanding state latitude.
- Reduced federal healthcare spending. The One Big Beautiful Bill includes $1 trillion in funding reductions which is already leading to more uninsured patients presenting to EMS and healthcare facilities.
- Financial incentives redirected toward national priorities. Federal dollars are increasingly tied to national priority areas. EMS agencies that are reliant on federal support must monitor shifting eligibility criteria.
- Deregulation alongside increased enforcement. Traditional rulemaking is being replaced by direct agency action, executive deals and targeted enforcement, reducing transparency and increasing uncertainty for long-term planning.
The presenters finished with a call to action to their audience to get involved on the state and federal levels. Don't think you can just "wait out" the current legislature and hope things will change in your favor during the next election cycle—partisanship in politics is not going away anytime soon. "Advocacy is a marathon," Buchson said. The key is consistent, long term and repetitive messaging.
"Advocacy does matter," said Bucshon. "It does make a difference."
Presented by Fitch & Associates, the 21st Pinnacle EMS conference is taking place July 13-17 at the Sheraton Resort San Diego.
