The US healthcare industry is set to face continued financial, regulatory and workforce pressure in 2026, but accelerating adoption of artificial intelligence (AI) could help offset mounting challenges, according to McKinsey & Company.

Rising costs, reimbursement pressure, staff shortages and the needs of an ageing population continue to strain payers, providers, and pharmacy services. These pressures are being intensified by federal policy changes enacted in 2025, including the One Big Beautiful Bill Act (OBBBA, H.R.1), which is expected to reshape funding flows and competition across the sector.

McKinsey says technology, particularly AI, represents a rare source of optimism. “Just as the industrial revolution mechanised muscles and the internet revolution digitised information, the AI revolution is augmenting cognition itself,” said Adi Kumar, McKinsey Senior Partner.

Payers and providers under strain

For payers, McKinsey expects 2026 to be a year of retrenchment as organisations reset risk portfolios in response to Medicaid, Medicare, and Affordable Care Act (ACA) changes. Kumar said regulatory action, demographic shifts, and rising distrust of institutions were converging with rapid technological change.

H.R.1 could either weaken payer financials or accelerate productivity gains, depending on execution. “There is a real productivity imperative facing our industry,” he said.

Providers are expected to face continued margin pressure, with operating margins still below pre-pandemic levels. Rupal Malani, McKinsey Senior Partner, said ageing demographics and reimbursement mix shifts were compressing margins, while workforce shortages remained acute.

“The talent shortage is a real challenge for health systems… and is exacerbated by the burnout still experienced by workers in healthcare,” she said. McKinsey estimates ACA and Medicaid disenrollment linked to H.R.1 could reduce margins by around 2.5 percentage points in expansion states.

AI boosts services, investment, and pharmacy change

Health services and technology companies are expected to benefit from growing demand for AI-enabled, end-to-end solutions. Neil Rao, McKinsey Senior Partner, said the OBBBA created headwinds for providers but tailwinds for technology firms that could drive cost savings or revenue improvement.

Private capital activity is also expected to rebound. “It’s been a challenging few years… but I think we’ve turned a corner,” said Prashanth Reddy, McKinsey Senior Partner.

Pharmacy services are facing rapid change, with store closures, pricing reform, and regulatory action accelerating. Adam Apfel, McKinsey Senior Partner, said the number of US pharmacy counters could “drop materially” over the next 12–24 months, reshaping access and competition.

McKinsey concluded that healthcare leaders must balance near-term resilience with long-term reinvention, with AI-led productivity gains central to navigating 2026.

The ITIJ team recently explored issues caused by poor cybersecurity and what healthcare providers could do to address them.

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