Democratic sweep sets up fight over healthcare costs and Medicaid

Democrats’ sweep of Congress sets up a push to restore expired Affordable Care Act subsidies, challenge Medicaid cuts and investigate the Trump administration’s health policies. They will control the House and Senate, but turning their plans into law will require President Donald Trump’s signature.

Democrats were projected to win at least 237 of the House’s 435 seats and at least 54 Senate seats as of Wednesday afternoon, according to Associated Press projections cited by CBS News. Senate races in Alaska and Mississippi remained unresolved. Healthcare affordability had ranked as a top concern in preelection surveys, CBS reported.

Restoring enhanced tax credits that lowered premiums for millions of people buying ACA coverage is likely to be an early priority when the new Congress takes office in 2027. The pandemic-era subsidies expired at the end of last year. House Democratic leader Hakeem Jeffries has called for bringing them back.

NBC News reported that, after the credits expired, some people saw their monthly premiums double or triple and about 3 million dropped their coverage. Premiums for ACA benchmark plans are set to rise by an average of 13%, according to KFF researchers cited by CBS News. Leslie Dach of the Democratic-aligned group Protect Our Care told CBS that lawmakers would need to act within days of taking office if they wanted to restore subsidies and extend enrollment for 2027 coverage, which ends Jan. 15 in most states.

Democrats also want to reverse Medicaid cuts in the Republican tax and spending law, including new work requirements for many adult beneficiaries. NBC reported that some states have begun implementing the requirements ahead of a Jan. 1 national deadline. A federal judge in Boston blocked an administration policy that would have required some patients with disabilities or serious medical conditions to prove they could not meet the work rules, NBC reported. The judge gave states six more months to implement a less stringent version.

Trump’s position may determine how far Democrats can go. Before the election, he said he would call himself “Mr. Veto” if they won Congress, NBC reported. After the election, he told Politico he had spoken with Democratic leaders and heard voters’ message that he should work with them. “I don’t want to just be sitting there for two years vetoing everything,” he 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,” KFF executive Larry Levitt told CBS. NBC quoted Levitt as saying Trump was likely to veto bills rolling back Medicaid cuts.

Drug prices and insurance practices could offer areas for negotiation. NBC reported that health policy experts see possible common ground on prescription costs and limits on insurers’ use of prior authorization, which requires approval before some treatments. Democrats are also expected to examine Trump’s drug-pricing agreements with pharmaceutical companies; CBS reported that contracts for the agreements have not been made public.

Congressional control will give Democrats committee hearings and subpoena powers to scrutinize Health Secretary Robert F. Kennedy Jr., particularly his changes to vaccine recommendations and federal health agencies. NBC reported that the incoming majority includes three doctors who have criticized Kennedy: senators-elect Abdul El-Sayed of Michigan and Annie Andrews of South Carolina, and representative-elect Richard Pan of California.