Democrats swept both chambers of Congress in the Nov. 3 midterm elections, leaving the health insurance industry with a new set of looming political headwinds on affordability and oversight alongside the possibility of restored ACA subsidies and a reversal of Medicaid cuts.
“Whatever your political affiliation, you should look at this and say we’re operating on a very short leash right now as an industry,” Paul Markovich, president and CEO of Blue Shield of California parent company Ascendiun, told Becker’s on Nov. 4. “If we do not figure out how to make healthcare sustainably affordable, it’s going to get figured out for us, and it will not be pretty.”
Five notes:
1. Democrats will gain control of Congress
Democrats won historic majorities in both the House and Senate, the first time the opposition party has controlled both chambers during a Republican presidency since the 2006 election.
As of the morning of Nov. 4, Democrats held a 54-44 edge in the Senate and a 228-139 edge in the House. Several races remain uncalled, including the Senate races in Mississippi and Alaska.
2. Democrats’ healthcare agenda starts with ACA subsidies and Medicaid
House Democrats spent the weeks before the election laying out a first-100-days agenda, with healthcare affordability near the top. Their plans include restoring the enhanced ACA premium subsidies that expired at the end of 2025 and reversing nearly $1 trillion in Medicaid cuts from HR 1, including work requirements for the expansion population and more frequent eligibility checks. Major changes will, however, remain difficult to enact while President Donald Trump keeps veto power.
In early trading on Nov. 4, Centene shares grew more than 8% to $73, Elevance more than 3% to $4, and Molina around 6% to nearly $221.
“We would like to see the enhanced subsidies return. We would like to see, as much as possible, the continued payments for Medicaid and support there,” Mr. Markovich said. “I would also say, you can’t subsidize your way out of this affordability problem.”
“What we need to take away is there’s an enormous amount of angst and just a complete rejection of the status quo from voters,” he added, arguing that the industry needs to make structural reforms through health records digitization, payment model changes and efficiency gains.
Affordability weighed heavily on voters, with 89% calling it a crucial or major factor in their vote, according to NBC News exit polling. Midterm voters also trusted Democrats over Republicans on healthcare by 19 percentage points (49% to 30%), according to a KFF poll released Nov. 4.
3. Expect more oversight of drug pricing deals
A House majority gives Democrats subpoena power through committees such as Energy and Commerce. Democratic health leaders have already pressed for details of the administration’s undisclosed pricing agreements with drugmakers within the last year.
In March, Reps. Frank Pallone, D-N.J., and Diana DeGette, D-Colo., asked Republican committee leaders to join their push for the administration to hand over the written agreements to Congress. At the time, 16 drugmakers had reached deals whose terms had not been made public.
4. Payer CEO hearings set the stage for deeper scrutiny
In January, the CEOs of UnitedHealth Group, CVS Health, Elevance Health, the Cigna Group and Ascendiun sat for more than nine hours of back-to-back hearings before the House Energy and Commerce Health Subcommittee and the House Ways and Means Committee. Lawmakers from both parties grilled the executives on premium hikes, prior authorization practices, executive pay and industry consolidation.
Billed as the first in a series of hearings examining the “root causes” of healthcare costs when launched by Republican lawmakers, Democrats will now have the ability to compel testimony, request internal documents and launch formal investigations into insurer business practices.
Sen. Ron Wyden, D-Ore., who is expected to chair the Senate Finance Committee in January, said Nov. 4 he would use his new authority to demand accountability from insurers “delaying and denying healthcare to churn a profit,” Bloomberg reported.
Vertical integration has also been under bipartisan legislative fire this year. In February, Sens. Elizabeth Warren, D-Mass., and Josh Hawley, R-Mo., introduced the Break Up Big Medicine Act, which would ban companies from simultaneously owning health insurers or PBMs alongside medical providers or management services organizations.
Democrats even reportedly discussed a policy agenda earlier this year that could include breaking up large healthcare organizations. Texas Sen.-elect James Talarico released a plan during his campaign to break up what he called “Big Medicine monopolies.”
5. Medicare for All has its highest support in a decade
Support for a single-payer national health plan reached 66% among U.S. adults in September, the highest since KFF began polling on the question in 2016. Support dropped to 52% when respondents were asked about a plan that would eliminate private insurance.
Medicare for All was also a central campaign issue for several winning Democratic candidates, most notably Abdul El-Sayed, who won his Michigan Senate race.
Sen. Ed Markey, D-Mass., a member of the Senate HELP Committee and the top Democrat on its Primary Health and Retirement Security Subcommittee, posted on X on election night: “WHO WANTS MEDICARE FOR ALL?” Markey is in line to chair the subcommittee when Democrats formally take the majority in January.
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