As a new Congress and new governors prepare to take office, healthcare leaders share where they expect policy to shift, from ACA premiums and Medicaid work requirements to public health and AI oversight.
Healthcare was on the ballot. Now that the results are in, the question is what changes.
After Tuesday’s midterm elections, the Democratic Party took control of the House and the Senate, flipping seven Senate seats as of Wednesday morning. In the states, Democrats also flipped governorships in Iowa, Ohio, Georgia, Nevada, and Texas.
The frustration with the current health system was clear among voters. According to a KFF poll, 54% of midterm voters said that the Trump administration’s policies have made their own healthcare costs worse. In a pre-election poll, there was also bipartisan support for healthcare reform, with about 90% of Democrats and 75% of Republicans saying the system needs a complete overhaul or major changes.
Healthcare reform, particularly around affordability, was a key campaign issue for several candidates. What’s more, a number of health professionals won their bids for office.
“This was a healthcare election,” Shaughnessy Naughton, former Congressional candidate from Pennsylvania and founder of 314 Action, a nonprofit that backs scientists running for office, tells HLTH. “Americans are demanding Congress do something. Our candidates, scientists and doctors who ran on focusing on solutions to our healthcare crisis won because Americans trust scientists.”
A quick snapshot
In one of the larger upsets for Democrats, pediatrician Dr. Annie Andrews defeated Sen. Darline Graham, who had been serving as interim senator since her brother, Lindsey Graham, died earlier this year. Andrews said her work in the clinic propelled her to run, previously citing “broken policies” in healthcare and the affordability crisis.
Democrat Dr. Abdul El-Sayed, an epidemiologist, won a Senate seat in the swing state of Michigan. During his campaign, he supported Medicare for All, a highly debated proposal.
Meanwhile, Dr. Amy Acton, a physician and the former director of the Ohio Department of Health, defeated Vivek Ramaswamy in Ohio’s governor race to become Ohio’s first woman governor. She ran on protecting Medicare and Medicaid, lowering prescription drug prices, and reducing medical debt.
What it could mean for healthcare
Medicaid cuts, prior authorization, vaccine policy, data interoperability, and AI’s role in healthcare will be important to watch as the new wave of leaders enters Congress and state capitals. Still, in Congress, a Democratic majority will still have to get policy past President Trump’s veto power.
Affordability
Affordability is the biggest agenda item in healthcare. Democrats are expected to push to bring back the enhanced ACA subsidies that expired at the start of the year and reverse Medicaid cuts.
“The affordability issue in the very near term is going to fall very naturally around drug pricing and very specifically around ACA premiums,” said Aneesh Chopra, chief strategy officer at Arcadia, on a Second Opinion webinar hosted by Chrissy Farr Wednesday. “If I’m guessing, we’re going to get some action on that even before the new elected officials are in office.”
As for Medicaid, policy changes may be slower, starting with incremental adjustments like softening the work requirements set to take effect in 2027, according to several healthcare leaders. Medicaid covers roughly four in 10 U.S. births, so changes to work requirements are also a maternal health story.
“Then they have two years to workshop longer-term solutions to the healthcare crisis that can address the out-of-pocket costs, deductibles and skyrocketing premiums that they can run on in 2028 and be signed into law by the next president,” says Naughton.
Public health and prevention
As for public health priorities, Dr. Vin Gupta, public health physician and medical analyst for MS NOW, says protections around evidence-based guidance in public health, transparent advisory processes, and sustained disease surveillance “are achievable reforms that I believe will get significant attention.”
“Congress should examine how much scientific independence federal health agencies actually have, particularly when political leadership disagrees with career scientists,” he says, adding that public health protections alongside reforms on ACA subsidies and Medicaid “will tell us far more about the direction of American healthcare than the election results alone.”
For Karen Knudsen, CEO of the Parker Institute for Cancer Immunotherapy, investing in earlier, targeted care as a cost cutter will be top of mind for new leaders as well.
“Policymakers will face growing pressure to prioritize early detection, precision medicine, and getting patients to the right care the first time to improve outcomes and reduce costs,” she tells HLTH.
AI in healthcare
AI safety and innovation will likely be a bigger conversation in the next Congress. On Second Opinion’s webinar, Chopra expects more attention on safety, and said lawmakers “might tighten it up and formalize” the AI rules that already apply to healthcare.
Ahmed Qureshi, the CEO of Rainfall, said he’s most interested in watching how the new Congress approaches AI in healthcare. “Dems tend to spend a lot of time thinking about problems and putting together a thoughtful structure. But there’s something to be said about a fast-moving and pro-innovation approach that the GOP has taken on AI policy. We need a combination to create meaningful impact for patients and hospitals now,” he tells HLTH.
Dr. Jesse Ehrenfeld, the global chief medical officer of Aidoc and the former president of the American Medical Association, is watching how lawmakers approach paying for AI tools in healthcare. “Payment for these technologies is still being worked out one tool at a time, leaving many practices and health systems to cover the cost themselves,” he tells HLTH.
New governors will be essential to watch as they develop healthcare agendas in states as well.
The midterm results will drive many of the timely conversations happening at HLTH USA 2026, which starts on November 15th. You will hear from Senator Mark Kelly, Chris Klomp, the Chief Counselor of the U.S. Department of Health and Human Services, Dorothy Fink, the Deputy Director of the National Institute of Child Health and Human Development (NICHD), Dr. Zeke Emanuel, the Vice Provost for Global Initiatives at the University of Pennsylvania, Amy Gleason, Administrator of the U.S. DOGE Service, Steph Carlton, the Deputy Administrator and Chief Clinical AI Officer at the Centers for Medicare & Medicaid Services (CMS), Liz Powell, the Founder of Women’s Health Advocates, Rachana Desai, the Chief Program Officer with The Center for Reproductive Rights, and more.
