Democrats' sweep of the U.S. House and Senate in Tuesday's elections has positioned the party to push to restore expired health insurance subsidies, reverse cuts to Medicaid and step up scrutiny of Trump administration health officials when the new Congress takes control in January.1,2,3,4
Democratic leaders say voters, who named health care affordability a top concern in preelection surveys, gave them a mandate to overturn cuts that President Donald Trump and Republicans made to public health programs. Any legislation would still need Trump's signature, setting up a clash over health policy. Ahead of the election, Trump said he would brand himself "Mr. Veto" if Democrats took Congress; on Wednesday he said he will "probably" get along with Democrats.1,4
An early priority would be restoring the enhanced Affordable Care Act premium tax credits created during the covid-19 pandemic as part of economic relief programs, which ended last year after Trump and the Republican-controlled Congress declined to extend them. House Minority Leader Hakeem Jeffries has said restoring the credits would be a primary objective in 2027, and Jeffries told CNN on Wednesday that the party should bring them back to help struggling families.1,4
When the subsidies expired at the end of last year, millions of people saw monthly premium bills double or even triple, forcing about 3 million people to walk away from coverage altogether, while others switched to cheaper plans that offered worse coverage. Premiums for benchmark plans are set to increase by an average of 13% for 2027, according to KFF researchers, with premiums jumping by double digits for the second year in a row, and lower enrollment and rising costs are driving some major insurers to pull out of the market. Larry Levitt, executive vice president for health policy at KFF, said if Democrats negotiate a deal with Trump to restore the subsidies, relief could be backdated to the beginning of 2027 so anyone who paid higher premiums would get that money back as a refund. "That could both increase enrollment and provide cost relief to current ACA enrollees," he said.1,4
Sabrina Corlette, a co-director of the Center on Health Insurance Reforms at Georgetown University, said of the subsidies, "My guess is it would be rolled into a broader budget negotiation or package that may or may not involve other healthcare priorities, like restoring Medicaid cuts or other things that are priorities for Democrats." Leslie Dach, who chairs the Democratic-aligned advocacy group Protect Our Care, said Democrats could both renew the expired subsidies and extend the enrollment period for 2027 coverage, which ends in most states on Jan. 15, shortly after the new Congress is scheduled to be sworn in, but they would need to act within days of assuming control. "Congress will be sworn in during open enrollment, at a time when people will be having to make difficult and horrific choices about their healthcare, given the further increases in premiums due to the Republicans," he said.4
Democrats also plan to challenge the Medicaid changes in the Republicans' One Big Beautiful Bill Act, especially work requirements for many adults enrolled in Medicaid, the state-federal program for low-income and disabled people. The requirements are expected to strip coverage from millions of people, not for lack of employment but because of paperwork and other administrative requirements, and a number of states have already started implementing them ahead of the national Jan. 1 deadline. Last week, a federal judge in Boston blocked a Centers for Medicare & Medicaid Services policy that would have forced "medically frail" patients and people with disabilities to prove they are too "significantly impaired" to meet the mandates, and granted states an additional six months to implement a more lenient version.1,4
Levitt said Trump is bound to veto any bills rolling back the Medicaid cuts. "Then the game of chess between Democrats and Trump will begin to figure out what healthcare can actually get enacted," Levitt said. He also said, "Democrats will put forward an expansive healthcare agenda, including reversal of cuts to Medicaid and the ACA, but achieving all of that will be impossible with President Trump still in the White House." With Congress likely to pass another short-term government funding bill in December, Rodney Whitlock, a health care consultant who previously worked for Republicans in Congress, said the stage will be set for a fight over Medicaid spending cuts in the spring. "If you've got the opportunity for a battle in March over fiscal year funding — and Democrats picking and choosing what they want to make this first battle about with a unified, controlled Congress with the president — damn, doesn't it scream healthcare?" Whitlock said. "Doesn't it scream repeal or delay all the Medicaid cuts?" It is also possible a number of states could expand Medicaid; 10 states have not adopted the full Medicaid expansion under the Affordable Care Act, including Georgia, Texas and Wisconsin.1,4
Republicans touted their overhaul of Medicaid and other health program changes in the One Big Beautiful Bill Act as signature achievements in midterm campaigns. Democrats, including newly elected senators such as James Talarico in Texas, Abdul El-Sayed in Michigan and Annie Andrews in South Carolina, campaigned on ideas ranging from major overhauls like Medicare-for-all to targeted changes like ending prior authorization for some services, and the breadth of the wins is likely to embolden some Democrats to advance proposals such as expanding Medicare, the federal insurance program for people age 65 and older, to cover all Americans as the party seeks to present itself as focused on lowering costs for the 2028 presidential election.2,4
Democrats also plan to use oversight powers to examine administration health policies, including those led by Health Secretary Robert F. Kennedy Jr., who has dismantled U.S. vaccine recommendations, reduced staff at federal health agencies and cut public health funding. The incoming Democratic majority will include three doctors who have criticized Kennedy, including Sen.-elect Andrews of South Carolina, Sen.-elect El-Sayed of Michigan and Rep.-elect Richard Pan of California. During her campaign, Andrews criticized Kennedy for overhauling the federal vaccine schedule and promoting medical disinformation, calling him an "archnemesis" to public health. "We've seen a real transformation of the healthcare state over the last two years and it's been immensely damaging," said Miranda Yaver, an assistant professor of health policy and management at the University of Pittsburgh. "We can absolutely expect to see a lot of oversight into these changes and unpacking what those harms are."1,4
Dr. Ezekiel Emanuel, a special adviser for health policy during the Obama administration, said he supports reimplementing the subsidies as long as Democrats can find the money and do not lose sight of rising insurance costs for other Americans. "One of the dangers of big election victories is people get cocky and they overreach and they fail to deliver on what people actually care about," he said. "Half of all Americans get their insurance through employer-sponsored insurance." John Barkett, a former White House policy adviser under the Biden administration who covered drug pricing, said, "The way I think about this is hunting versus farming," adding, "Next Congress, there's going to be a lot of farming. Hunting, you go for a big kill. If those pass, probably not going to happen [with Trump]. But can you sow seeds and prepare land for growth over time? Yes."1
Trump, who has veto power, may be interested in brokering legislative deals as he seeks to cement his legacy and deflect fallout from investigations into his administration's handling of the war against Iran, mass deportations, contracting scandals and other controversies. As results came in early Wednesday, Trump said in a phone interview with Politico that he had spoken with Democratic leaders and that voters had sent a message he must work with them "to make sure things go well for our country." "I don't want to just be sitting there for two years vetoing everything," Trump said. "They want to see things happen, too." How that conciliatory position will affect efforts to undo changes such as Medicaid work requirements remains to be seen.4,1
Democrats were projected to win at least 237 of 435 seats in the House and at least 54 Senate seats as of Wednesday afternoon, according to The Associated Press, with several races including Senate contests in Alaska and Mississippi remaining unresolved. Congress is scheduled to be sworn in during open enrollment, and Democrats will have to decide within days whether to move on subsidies and an enrollment extension, then face funding negotiations in the months that follow.4
