Congress is scrambling to find a solution to the enhanced Affordable Care Act subsidies that expire at the end of the year. Without action, premiums are set to rise sharply for millions of Americans, creating a major health care cliff as 2026 approaches.

Congressional reporters Sandhya Raman (CQ Roll Call) and Robert King (Politico) join hosts Mark Masselli and Margaret Flinter to help make sense of the fast-moving negotiations and what is likely to happen next.

King captures the mood inside Congress as competing proposals circulate without leadership support. As he explains, “But right now, there has not been any indication from Speaker Johnson that he is going to be advocating for any of the compromise legislation that is being discussed in the House.”

Raman looks ahead to the broader forces that will shape the policy debate over the next year. She says, “I think affordability and the forms of that will be a big thing, whether or not we get any sort of deal on ACA or some of the other things that have been in the mix. Congress has been very interested in PBM reform and things like that to bring down health costs. So I think going into next year, regardless of what happens in the next couple weeks, that will be definitely something big to watch here.”

Together, their insights offer a timely look at why the subsidy cliff is proving so hard to solve, why the Senate’s competing plans are unlikely to pass, and how issues like abortion coverage and health savings account proposals are adding new complications to an already crowded landscape.

They also share their predictions for the top health care story of 2026, including the trends they believe will shape the year ahead for patients, providers, and policymakers.

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The doctor who once led the Centers for Disease Control and Prevention sees trouble ahead:

1. There’s been a significant decrease in people taking the COVID and flu vaccines
2. Europe is experiencing the worst flu season in years (an early indicator of problems in the U.S.)
3. CDC data show that Influenza infections are growing or likely growing in 41 states

“It’s not good…what we have seen from Europe is a very early and very severe flu season, something that could mean more hospitalizations.”

Dr. Tom Frieden says confusing vaccine guidance, limited access and weakened public health systems are contributing to fewer shots in arms. He also shares insights from his new book, “The Formula for Better Health: How to Save Millions of Lives—Including Your Own.” He explains his “See, Believe, Create” formula for building a healthier future and his broader call for a public health system that listens to communities and makes vaccination easier. Dr. Frieden now leads Resolve to Save Lives, which works to close the gap between proven, life-saving solutions and the people who need them around the world.

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Leading nutritionist Marion Nestle, Ph.D., has a sobering message as we get ready for Thanksgiving: America’s food system delivers twice the calories we need while wasting 40%. “Thanksgiving provides five times the calories we need,” she points out. Her advice? “It is a week in which you just have to do the best you can.”

But once we've cleared the dishes after Thursday’s meal, Nestle offers practical advice for people trying to make healthy, budget-conscious choices as food prices continue to rise.

“If there is anything that is a superfood, it is a bean. If you want to save money on food, you have to cook.”

Nestle discusses the dramatic changes in our food system over the last 20 years, the growing influence of social media on what we buy and eat, and the rise of ultra-processed foods. She joins hosts Mark Masselli and Margaret Flinter to discuss her new book, “What to Eat Now,” an updated and expanded guide to navigating today’s food landscape.

Watch the full interview now.

Nestle’s earlier appearance on Conversations on Health Care is also available, where she discussed artificial food dyes, food industry marketing and the need for a food system that puts public health first.

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