Health Policy Roundup: ACA Reform, MedPAC & Conversion Therapy in the Courts

This episode of Health Affairs This Week, hosted by Jeff Byers, dives into three major developments in U.S. health policy as of April 2026. First, the Supreme Court’s landmark decision in Childs v. Salazar, where eight justices ruled that Colorado’s ban on conversion therapy violated a therapist’s free speech rights, despite a powerful 35-page dissent from Justice Ketanji Brown Jackson warning of dangerous, unregulated medical practices. The ruling could undermine 25 state bans on conversion therapy and raise broader questions about the regulation of speech in medical contexts. Next, the podcast explores renewed Democratic momentum for sweeping ACA reform, led by Senator Ron Wyden and a coalition of Senate Democrats, who are revisiting ideas from the failed Clinton health plan—such as purchasing pools, standardized benefits, and expanding Medicare—framed as bold, non-incremental solutions to affordability and access. The political feasibility of such reforms remains uncertain, though some bipartisan overlap exists, particularly on concerns about health plan consolidation. Finally, MedPAC’s 2026 report reveals that Medicare Advantage plans will receive an average of $16,000 per beneficiary in 2027, with $2.6 billion in rebates used for supplemental benefits. MedPAC attributes a narrowing of the payment gap between MA and fee-for-service care to a new risk adjustment model, V28, which reduces the impact of favorable beneficiary selection and intensive coding. The episode closes with anticipation for the upcoming CMS final rule on Medicare Advantage payment increases.