Just over one week after Democrats swept both chambers of Congress, the party’s impending healthcare agenda has come into focus around reversing pieces of HR 1 and ramping up oversight of the health insurance industry.
Rep. Richard Neal, the incoming chairman of the House Ways and Means Committee, told Bloomberg on Nov. 12 that Democrats plan to move quickly on reviving the expired enhanced ACA subsidies and reversing cuts to Medicaid. Democratic leaders in the Senate are also coordinating on that strategy and they see potential to attract Republican votes on some issues, per the report. Still, President Trump will hold veto power, so Democrats’ strongest immediate tools will include committee oversight and negotiations over must-pass spending bills.
Here’s what’s taking shape across the major health policy fronts:
ACA subsidies and Medicaid
Restoring enhanced ACA premium subsidies that expired at the end of 2025 and reversing Medicaid cuts from HR 1 are the top-line items in House Democrats’ first-100-days agenda. Starting Jan. 1, HR 1 will impose work requirements on the Medicaid expansion population and more frequent eligibility checks, with further changes to state-directed supplemental payments set for 2028.
States have been building the administrative systems needed to implement the requirements, creating confusion about whether the Democrats will be able to repeal or delay the changes. Sixteen Senate Democrats asked leadership on Nov. 9 to impose a two-year delay on implementation.
Sen. Andy Kim’s “MediKids” bill, introduced in July, would guarantee coverage until age 26 by broadening Medicaid eligibility and requiring automatic newborn enrollment. House Democrats’ agenda listed the bill as a first-year consideration.
Some House Democrats from Texas are also pushing for federal intervention on the state’s Medicaid application backlog, citing HR 1 as having worsened the issue. The backlog has grown from 1,671 pending applications at the start of this year to 237,505 as of September.
Medicare expansion
In the House Democrats’ healthcare agenda, obtained by Politico ahead of the election, lawmakers stopped short of backing a Medicare for All approach, acknowledging diverse opinions within the party on how to create widespread health coverage. But the broader Medicare for All conversation has real momentum behind it, with 66% of adults saying they supported a single-payer plan in a September KFF poll. Michigan Sen.-elect Abdul El-Sayed made the policy a centerpiece of his campaign, while Sen. Bernie Sanders, I-Vt., a longtime backer of expanding Medicare eligibility to all ages, is expected to return as chair of the Senate HELP Committee.
Sen. Tammy Baldwin, D-Wis., introduced the Medicare at 50 Act on Nov. 10, which would let people ages 50 to 64 buy into Medicare with access to the same benefits, including Medicare Advantage. In October, House Democrats introduced a similar bill to lower the eligibility age through different mechanisms.
Vertical integration and insurer oversight
Sen. Ron Wyden, D-Ore., who is expected to chair the Senate Finance Committee come 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.
Democrats reportedly discussed a policy agenda earlier this year that could include breaking up large healthcare organizations, and Texas Sen.-elect James Talarico released a plan during his campaign to break up what he called “Big Medicine monopolies.”
Separately, CVS Health said Nov. 4 it plans to split into two distinct companies, unwinding some of the integrated model the company built with its 2018 acquisition of Aetna, along with other earlier purchases across the healthcare landscape. One company, called CVS Health in the interim, will include Aetna, pharmacy benefit manager CVS Caremark, CVS Specialty, primary care centers Oak Street Health and health evaluations business Signify Health. The other company, CVS Pharmacy, will include the 9,000 retail pharmacies, mail pharmacy, MinuteClinic and technology services business Health100. CVS expects to complete the split in the first half of 2028.
Pharmacy, drug pricing and PBMs
Incoming Democratic committee control in January opens several new potential fronts on pharmacy policy, including oversight of the Trump administration’s drug pricing agreements with manufacturers, whose full terms have not been disclosed. Top Democrats on four committees have been pressing drugmakers for details since late 2025, with the inquiry expanding to 27 companies in November.
PBM reform remains bipartisan, and Democrats have signaled interest in going further than what is already in the pipeline. The Consolidated Appropriations Act of 2026’s new standards for reasonable and relevant pharmacy contract terms in Part D networks don’t kick in until 2029. The Labor Department finalized a rule Oct. 29 requiring PBMs and affiliated brokers and consultants to disclose compensation to large, self-insured employer health plans, with requirements applying to plan years beginning on or after July 1, 2027.
CMS also finalized a Medicare hospital outpatient payment cut for 340B drugs to average sales price minus 28% on Nov. 4, effective in 2027. Hospital litigation over drugmakers’ 340B restrictions continues in the courts, and incoming Democratic committee control adds another pressure point.
State-level moves
In Georgia, Gov.-elect Keisha Lance Bottoms made full Medicaid expansion a central campaign promise and has called it a “day one priority,” WABE reported Nov. 12. Georgia is one of at least four nonexpansion states, alongside Kansas, Texas and Wisconsin, where the midterm results could tilt the political calculus toward expansion, Stateline reported Nov. 6.
On healthcare AI, states are emerging as the likelier near-term venue for regulation as federal AI legislation remains unlikely, according to reporting from Time and CNBC. 47 states introduced more than 250 bills regulating AI in healthcare in 2025, and 33 were signed into law across 21 states, according to a Manatt Health analysis. Voters in 10 states also weighed in directly on data center restrictions during the midterms, siding against additional building in 40 of 41 ballot measures, according to Ballotpedia data.
