Courage Over Certainty: Leading Through Healthcare’s Next Policy Shock

Healthcare leaders will not get policy certainty before they have to make critical decisions.

That’s the hard truth as I watch today’s Senate showdown over ACA subsidies. Both proposals—Democratic subsidy extension and Republican HSA alternative—will likely fail. The subsidy cliff is still coming. And even when Congress strikes a deal, it will be temporary, fragile, and insufficient.

This is the environment we’re leading in. Waiting for perfect clarity is not a strategy.

As Eric Solomon and Anup Srivastava write in Harvard Business Review, “Employees don’t expect the CEO to predict every twist. They want honesty about uncertainty and a story that connects daily work to a durable mission.” The question isn’t whether we’ll face policy whiplash—it’s whether we’ll let it paralyze or prepare us.

Today’s Policy Reality

Democrats want a three-year subsidy extension to prevent premium shock for 20+ million enrollees. Republicans propose HSAs ($1,000-$1,500 annually) tied to high-deductible plans while letting subsidies expire.

For hospitals: coverage losses mean more uncompensated care, high deductibles mean delayed care, and revenue becomes unpredictable even for “insured” patients. Neither proposal addresses our core pressures—labor costs, Medicare rates, MA behavior, drug pricing—but coverage erosion makes all of those worse.

What Courage Over Certainty Actually Looks Like

HBR makes a critical distinction: “Great leadership today won’t be measured by the absence of fear, but by the ability to transform it into clarity, courage, and shared purpose.”

Here’s what that means:

Stay anchored in mission, not political winds
Your North Star isn’t which party wins — it’s whether your community has access to affordable care. When debates shift weekly, mission clarity is your most valuable asset.

Scenario-plan around multiple outcomes
Don’t bet on one scenario. Build optionality: What does payer mix look like if subsidies expire? Where do you strengthen financial assistance? How do you protect margin while maintaining access?

Use your platform to advocate for what works
Leaders who stay silent to avoid friction aren’t leading — they’re managing. Speak clearly about what coverage stability requires, regardless of which party proposes it.

Protect strategic thinking time
“Fear steals the scarcest resource: attention.” Block time for long-horizon planning, even when everything feels urgent.

The certainty-seeking leader waits for Washington. The courageous leader shapes their organization to weather the storm and pushes for better solutions.

Your Move

What courageous choice can you make now, before the next shock hits? I don’t have the answer, but I know we can’t keep reacting to each policy swing, hoping the next Congress gets it right.

This moment demands leadership that acts with courage and conviction even when the future is unclear.

What are you planning? What’s working?

(December 2025)