Now that midterms are over, public health researchers and practitioners may find it helpful to consider the results and what they might mean for federal health policy over the next two years.
For me, the biggest takeaway is that healthcare will likely be front-and-center in the next Congress, even if major legislative changes remain unlikely.
With Democrats winning control of both the House and Senate, we should expect a more aggressive focus on healthcare affordability, coverage, and oversight of federal public health agencies and the healthcare industry.
The results also set the stage for a broader debate over the future of healthcare heading into the 2028 presidential election. Here are a few key takeaways:
Affordability will drive the agenda
Healthcare costs were an important part of voters’ broader economic concerns. I expect Democrats to prioritize restoring Affordable Care Act (ACA) subsidies, reversing Medicare cuts, lowering prescription drug prices and addressing rising premiums and out-of-pocket costs. I also expect increased attention to underlying cost drivers, including hospital prices, healthcare consolidation and insurer practices.
“Medicare for All” is back in the conversation
With Senator Bernie Sanders expected to chair the Senate’s Health, Education, Labor & Pensions committee, and Senator Ron Wyden taking over the Senate Committee on Finance, proposals to fundamentally rethink health coverage will likely receive more attention. However, significant divisions remain between Democrats advocating for sweeping reforms, like Medicare for All, and those focused more on incremental changes to the ACA, Medicaid and Medicare, such as extending enhanced ACA premium tax credits, strengthening Medicaid coverage and access and expanding traditional Medicare benefits to include dental, vision and hearing coverage or establishing an annual cap on out-of-pocket spending.
Oversight may have the biggest near-term impact
With President Trump still in the White House, sweeping legislation will face substantial obstacles. However, Democratic control gives Congress new investigative and oversight authority. For this reason, we should expect increased scrutiny of federal public health agencies, including Health & Human Services Secretary, Robert F. Kennedy, Jr.’s vaccine policy and research funding provided by the National Institutes of Health. Health insurers, Medicare Advantage plans, pharmaceutical companies, pharmacy benefit managers (PBMs) and large health systems could also face continued investigations and hearings.
Targeted bipartisan reforms remain possible
Despite divided government, opportunities may exist to advance narrower policies through government funding negotiations and other legislative deadlines. Areas worth watching include No Surprises Act reforms — which has helped protect consumers from unexpected medical bills but continues to face challenges with its independent dispute resolution (IDR) process — as well as Medicare Advantage payment reforms, price transparency, site-neutral payments, prescription drug reforms, and policies addressing healthcare consolidation.
Public health and scientific research will receive greater attention.
The election of several candidates with medical and public health backgrounds, combined with Democratic control of congressional committees, could bring renewed attention to scientific independence, federal research funding and the role of evidence in public health policymaking.
What this means for our work at Brown
The start of a new Congress creates significant opportunities for Brown public health researchers to inform congressional healthcare debates with evidence-based information, particularly around healthcare affordability, Medicare Advantage, consolidation, drug prices, price transparency and the relationship between healthcare spending and patient outcomes.
One important question will be whether policymakers focus primarily on lowering costs for consumers or pursue reforms that address the underlying drivers of spending. Brown researchers can provide evidence-based information to inform both approaches.
Overall, I expect the next two years to be defined more by oversight, accountability and efforts to shape the 2028 health policy agenda than by major legislative accomplishments. As the new Congress takes shape, changes in committee leadership and emerging legislative priorities will help determine which health care issues gain traction and where opportunities for bipartisan cooperation may emerge.