Democrats Target Healthcare Costs and Medicaid After Midterm Wins

Democrats are preparing to challenge major healthcare policies under President Donald Trump after securing victories in the midterm elections, with priorities ranging from insurance affordability to Medicaid coverage and prescription drug costs. Their congressional majority could give them greater influence over healthcare legislation and the administration's policies, although cooperation from Trump will remain essential for major changes to become law.

Among their priorities are restoring enhanced Affordable Care Act (ACA) subsidies, reversing Medicaid reductions and increasing oversight of Health Secretary Robert F. Kennedy Jr. The incoming Democratic majority will also include three doctors who have criticized Kennedy: Sen.-elect Annie Andrews of South Carolina, Sen.-elect Abdul El-Sayed of Michigan and Rep.-elect Richard Pan of California.

Andrews previously criticized Kennedy's changes to the federal vaccine schedule and his promotion of medical misinformation, describing him as an "archnemesis" to public health.

Miranda Yaver, an assistant professor of health policy and management at the University of Pittsburgh, described the consequences of recent healthcare policy changes as significant.

"We've seen a real transformation of the healthcare state over the last two years and it's been immensely damaging," said Yaver.

"We can absolutely expect to see a lot of oversight into these changes and unpacking what those harms are," she added.

However, Democratic control of Congress does not guarantee legislative success because Trump retains the power to veto bills. Before the election, Trump said he would become "Mr. Veto" if Democrats gained control of Congress. On Wednesday, he indicated he would "probably" work well with them.

John Barkett, a former White House policy adviser during the Biden administration who worked on drug pricing, expects Democrats to prioritize groundwork and incremental policy development rather than major legislative victories.

"The way I think about this is hunting versus farming," Barkett said. "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."

One immediate priority is restoring enhanced ACA tax credits. House Minority Leader Hakeem Jeffries has identified reinstating the expired subsidies as a central Democratic objective for 2027.

The subsidies expired at the end of last year, causing millions of Americans to face significantly higher monthly insurance premiums. According to the article, approximately 3 million people abandoned their coverage, while others moved to cheaper plans with less comprehensive benefits.

Insurance costs are expected to increase further in 2027. ACA premiums are rising by double digits for the second consecutive year, while declining enrollment and increasing healthcare expenses have prompted several major insurers to leave the marketplace.

Larry Levitt, executive vice president for health policy at KFF, said a negotiated agreement with Trump could restore financial assistance retroactively to the beginning of 2027.

"That could both increase enrollment and provide cost relief to current ACA enrollees," Levitt said.

Under that arrangement, people who already paid higher premiums could receive refunds. However, Dr. Ezekiel Emanuel, a former Obama administration special adviser for health policy, emphasized that Democrats must identify sustainable funding and address insurance costs affecting 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," Emanuel said.

He also highlighted the importance of employer-provided insurance, noting that "Half of all Americans get their insurance through employer-sponsored insurance."

Medicaid represents another major area of potential conflict. Democrats are expected to challenge reductions included in Trump's "big, beautiful bill," particularly new work requirements that could remove millions of people from coverage because of administrative burdens and documentation requirements.

Several states have already begun implementing the requirements ahead of the national Jan. 1 deadline. A federal judge in Boston recently blocked a Centers for Medicare & Medicaid Services policy requiring "medically frail" patients and people with disabilities to demonstrate that they were "significantly impaired" before receiving exemptions from the work mandates.

The judge also gave states an additional six months to implement the less restrictive version of the requirements.

Levitt expects Trump to oppose legislation reversing Medicaid reductions.

"Then the game of chess between Democrats and Trump will begin to figure out what healthcare can actually get enacted," Levitt said.

Democrats could also pursue Medicaid expansion in states that have not fully adopted the ACA program. Ten states have not implemented the complete expansion, including Georgia, Texas and Wisconsin, which elected Democratic governors in the midterms. Kansas also held a closely contested gubernatorial race.

Yaver questioned whether further expansion would be achievable after Trump's "big, beautiful bill" eliminated financial incentives that previously encouraged states to participate.

"I think we're absolutely going to see efforts to increase Medicaid access," Yaver said.

"I just don't know what Medicaid expansion looks like without the increased financial incentive," she added.

Prescription drug affordability offers another potential area of agreement between Democrats and Trump. Emanuel identified opportunities to build on the president's existing efforts to reduce medication costs, including his TrumpRx prescription drug website and "most favored nation" pricing agreements.

Democrats could pursue additional measures to reduce drug prices while expanding existing initiatives.

"I think there is probably a very big agreement you could reach with him," Emanuel said.