Democrats' significant victories in congressional and state elections present an opportunity to address rising healthcare costs and deliver on campaign promises to make medical care more affordable. While President Donald Trump's administration remains, limiting sweeping federal changes in the short term, lawmakers are exploring avenues for bipartisan compromise on specific issues.

Potential Federal Actions

Democrats are expected to push for ambitious healthcare legislation, including measures to counteract Medicaid cuts enacted by the previous Republican Congress. However, any such bills face a likely veto from President Trump. Larry Levitt, executive vice president for health policy at KFF, anticipates a period of negotiation to determine what healthcare policies can realistically be enacted. The upcoming 2028 presidential campaign will also shape the party's long-term healthcare agenda.

Several targeted reforms are considered potential areas for action:

  • Medicare Payment Reforms: Changes to Medicare payments, particularly regarding site-neutral payments, could equalize procedure costs regardless of whether they are performed in a doctor's office or a hospital outpatient clinic. This aims to reduce patient out-of-pocket expenses and potentially curb premium increases.
  • Fixing the No Surprises Act: The existing No Surprises Act, designed to protect patients from unexpected out-of-network medical bills, has faced challenges with its arbitration process. Lawmakers may seek to streamline this system to prevent further premium hikes.
  • Lowering Medication Costs: Both parties have shown interest in reducing drug prices. Potential actions include capping insulin costs for those with private insurance at $35 per month, mirroring Medicare's cap, and addressing drug company practices that extend monopolies on breakthrough medications. Democrats may also pursue policies linking U.S. drug prices to international averages, an idea previously endorsed by Trump.
  • Reversing Medicaid Cuts: Democrats plan to prioritize reversing Medicaid cuts and restoring funding for ACA marketplaces. While a presidential veto is probable, they may use budget reconciliation to advance these proposals, forcing Republicans into difficult votes and setting the stage for future action.

State-Level Initiatives

At the state level, Democrats have more autonomy to pursue healthcare reforms, especially in states where they now hold full government control. Potential actions include:

  • Medicaid Expansion: States like Georgia and Texas, with newly elected Democratic leadership, may expand Medicaid under the Affordable Care Act, potentially covering over a million uninsured individuals in Texas and more in Georgia.
  • Public Health Insurance Options: States such as Wisconsin, Maine, and New Mexico are looking to establish public health insurance options, following models already in place in Colorado and Washington. This could offer more coverage choices for residents.
  • Prescription Drug Price Controls: Several Democratic gubernatorial winners ran on platforms to cap Medicaid drug prices at Medicare-negotiated rates and establish state boards to review drug costs.
  • Medical Debt Cancellation: Initiatives to cancel medical debt and reform how healthcare debt impacts credit scores are being considered in states like Ohio, Nevada, and Michigan.
  • Protecting Abortion Access: Voters in several states supported ballot initiatives to protect abortion rights, and Democratic control in other states could lead to the restoration or preservation of access to reproductive healthcare.
  • Policy Innovation: States can serve as incubators for new healthcare policies, such as limiting private equity ownership of healthcare providers or providing state assistance for individuals purchasing insurance on ACA marketplaces.