Colombia enters the 2026 presidential election with a health system that looks strong on paper and fragile in practice. The country reached near-universal coverage after Law 100 of 1993, and the OECD still describes Colombia’s system as one that protects people from catastrophic spending better than many Latin American peers. Yet the same model now carries unpaid debts, slow payments, legal disputes, and deep distrust between the public sector, the EPS insurers, and the hospitals that actually deliver care.
That tension explains why health has become one of the election’s central issues. Voters do not debate abstract institutional design alone, because they feel the system through the appointments they wait for, the medicines they cannot get on time, and the bills hospitals struggle to collect. The left sees those failures as proof that Colombia should reduce the role of private intermediaries, while the right argues that the system needs firmer discipline, not a full redesign.
What the Left would change
If Iván Cepeda wins, Colombia would likely revive and deepen President Gustavo Petro’s stalled health reform. Public descriptions of that reform show a stronger State role in financing, planning, and direct provision, with ADRES taking a larger role in managing resources and paying providers directly, while EPS would lose much of their traditional insurer function and shift toward territorial managers, service providers, or mixed entities tied to primary care networks such as CAPIRS. In practical terms, that would mean more State control over health funds, more emphasis on prevention and territorial care, and a deliberate retreat from the insurer-centered logic that Law 100 established three decades ago.
That vision appeals to sectors that believe EPS have become weak health managers and powerful financial intermediaries at the same time. Public analyses of the current system and the OECD review of Colombia’s health model agree that the country reached high coverage, yet still struggles with efficiency, governance, and uneven purchasing of care, while recent reporting on Sura and other EPS has highlighted the financial fragility that now affects providers and insurers alike. Under a Cepeda government, Colombia would likely try to answer that crisis by expanding primary care teams, strengthening public and mixed territorial networks, and improving labor conditions for health workers, all within a model that places prevention and public planning above competition among insurers.
Still, the left path would not come cheap or fast. A reform that changes the role of EPS would likely trigger more legal fights, more transitional chaos and more pressure on patients with chronic or high-cost conditions if the State moves faster than its own administrative capacity. That makes the left’s promise attractive in theory, but difficult to execute without disruptions along the way.
What the Right would preserve
If the right wins, Colombia would probably keep the mixed architecture built around EPS, IPS, and ADRES. Paloma Valencia and Abelardo de la Espriella both frame Petro’s reform as a risky attempt to replace a functioning system with a more politicized one, and their camps defend Law 100’s basic logic of insurance, competition, and regulated access. That means the right would likely protect private insurers, avoid a full centralization of funds, and focus instead on solving solvency problems and payment delays.
This path would appeal to actors who fear a sudden redesign more than they fear the current flaws. Business groups and EPS associations argue that Colombia needs stability, not another structural overhaul, and they warn that eliminating EPS could deepen bureaucratic inefficiency and create gaps in service delivery. Under a right government, the likely plan would involve tighter supervision, more solvency rules, better accounting, and maybe some consolidation, but not the disappearance of the current insurance model.
The advantage of that route lies in continuity. A right-wing government could slow the pace of interventions, reassure investors, and preserve the institutions that already move money through the system every day. Yet that same continuity also carries a cost, because if the State only adjusts the edges and leaves the debt problem unresolved, patients in poor and rural areas could keep facing the same delays, the same gaps, and the same lawsuits that already crowd Colombia’s health courts.
What will not disappear
The core problem does not change with the winner. Colombia still needs a fix for unpaid debts to hospitals and clinics, because those arrears strain providers and make day-to-day service harder to sustain. Colombia also still shows a sharp territorial split, with stronger service networks in large cities and a much weaker reach in rural, indigenous, and Afro-Colombian areas. No administration can ignore that geography, because geography already shapes who gets care first and who waits longest.
The other persistent issue is trust. Courts, tutelas, and public protests already show that Colombians use every available channel to demand access when the system fails them. That pressure will remain no matter who governs, because the public now expects health not as a privilege, but as a right that the State must deliver in practice. The election will decide which philosophy leads the system, but the next president will still inherit a country that wants better care now, not after another long reform war.