Blue Wave Could Lead to Health Policy Changes

Democrats’ stunning midterm victories give them the chance to make major changes in health care policy. Health care was a major concern for voters, with 85% saying they are concerned about healthcare costs and 58% saying Trump administration policies have worsened Americans’ health and well-being, according to exit polls. (Those exits polls also showed that most Americans think Trump lacks the mental capacity to lead effectively, as we reported yesterday.)

The big blue win could give them more leverage to reverse Medicaid cuts, restore Obamacare subsidies, and reexamine the Trump administration’s health policies, according to a Tradeoffs interview with Katie Keith, director of the Center for Health Policy and Law at Georgetown Law.

Next year, Democrats will control both chambers of Congress and can challenge the President’s health care agenda during his last two years in office. Wins at the state level could also affect how states handle Medicaid and might restart the debate about expanding coverage.

“The way I think about the healthcare debate is in the context of overall affordability. And this was an election hugely focused on people’s economic struggles,” said Keith, who served as a deputy assistant to President Joe Biden. The election of several doctors, researchers and public health advocates to state and federal offices could also shape health policy nationwide, affecting vaccine mandates, reproductive health and access to health insurance, the Guardian reported.

In South Carolina, Annie Andrews will be the first pediatrician in the U.S. Senate, and Abdul El-Sayed, a former public health official who ran on a Medicare-for-All platform, won a contentious Senate race in Michigan. Andrews focused her campaign on raising vaccination rates and impeaching Health and Human Services Secretary Robert F. Kennedy Jr.

Democrats pledge to use their new majorities in Congress to restore funding for food assistance, bring back higher subsidies for people buying insurance through Affordable Care Act marketplaces and reverse almost $1 trillion in planned Medicaid cuts and coverage limits over the next few years. But to do this, Democrats would need to cut deals with Republicans and Trump.

“What is the trade that could bring a, you know, President Donald Trump along to agree to that?” Keith asked.

Keith pointed out that Democrats might reach smaller deals through the must-pass spending bill, such as delaying some Medicaid cuts that worry both parties. They could also use their majority to investigate the administration and private health companies. Congressional hearings could reveal deals, now hidden from view, that the White House made with drug companies to lower some prescription drug prices, and look at cuts to federal health research and the administration’s anti-vaccine policies, she added.

At the state level, Democratic victories could change Medicaid. New governors and attorneys general in states like Iowa and Ohio might adjust work requirements, eligibility, and coverage reviews, while Democratic gains in Wisconsin, Georgia, and Texas could make Medicaid expansion an option again. The final decision will depend on negotiations in each state legislature.

“We have never pulled $1 trillion out of Medicaid before,” Keith said. She called the next few years a period of great uncertainty for a program that states must manage with tight budgets and new federal rules.

Election results could also shape state debates about reproductive and transgender health. Voters in Virginia, Missouri, and Nevada supported abortion rights again, while Idaho kept its abortion ban. Keith predicted legal challenges to abortion access, including medication abortion, will continue.

For Democrats, the next two years may be a chance to plant the seeds of the broader health care changes they’ll pursue after the 2028 presidential election. Members of Congress could use hearings and investigations to show voters they are listening to concerns about the health care system, even if they pass no major laws.