As Democrats vie to take control of Congress in the midterms this fall, their main message on health care policy is fairly straightforward: Undo Republicans’ Medicaid cuts and restore the health care subsidies that lapsed at the end of last year.
But some analysts and lawmakers say momentum is growing for a bigger health care push in 2028.
Health care has historically been a winning issue for Democrats. Polling conducted by KFF earlier this year shows that the party has an advantage over Republicans when it comes to key health care issues such as Medicaid, Medicare and prescription drug pricing.
For the midterms, Democrats aim to make the case that the Republicans’ actions on health care this Congress — including the Medicaid cuts in the 2025 reconciliation law and the expiration of the Affordable Care Act enhanced premium tax credits — are raising health care costs for Americans. Democrats hope to harness the issue of affordability in their case against Republicans.
“There’s going to be a ton of health care discussion, but it’s all going to come through the lens of costs and pricing,” CJ Warnke, communications director at the left-leaning political action committee House Majority, said in an interview.
Larry Levitt, the executive vice president for health policy at KFF, said he expects Democrats’ message for the midterms to be mainly reactive to the Republican agenda, rather than proposing new policy ideas.That’s a common dynamic anytime the party that’s not in power seeks to gain back seats.
“The time is not quite right for an agenda of their own, because President Trump would still be in the White House,” he said.
But Levitt said he’s starting to sense momentum for a bigger push from Democrats. He said the environment right now feels similar to 2006, when Democrats were starting to lay out the building blocks for what became President Barack Obama’s signature health care achievement, the Affordable Care Act of 2010.
Some Democrats in Congress are already starting to map out their policy proposals for when the party potentially wins back power, but the ideas are in the early stages.
A group of Senate Finance Committee members led by ranking member Ron Wyden, D-Ore., last month outlined a slate of policy priorities, the first of which is: “Reverse Republican Cost Increases and Reimagine a Better Path.” They also want to ensure that insurance companies are using federal dollars to improve patient experience rather than drive profits, and simplify the process of enrolling in coverage.
“The devastating consequences of Trump’s and Republicans’ health care cuts are playing out in real time,” the senators wrote in a March 19 letter to colleagues. “Over the past year, Republicans have passed legislation and issued regulations that make insurance harder to buy and more expensive to keep.”
The lawmakers plan to release more details in the coming weeks and months, they wrote.
Drug pricing
Back in February, some Senate Democrats laid out their plans for drug pricing, which included expanding the Medicare drug price negotiation authority that was established by the 2022 reconciliation law.
Rep. Jake Auchincloss, D-Mass., who sits on the House Energy and Commerce Subcommittee on Health, said the main issue he hears from constituents is the rising cost of insurance premiums.
In his view, the conversation on health care has turned into a debate about who pays — the patient, the insurer, or the government — but, he said, there hasn’t been enough of a focus about actually lowering costs.
Auchincloss touted what’s known as Medicaid’s 1115 waivers, which states use to negotiate the terms of their Medicaid programs with the Health and Human Services Department. Auchincloss wants states to be more aggressive in how they use them to help negotiate for more control over their Medicaid programs.
“To me, these ambitious governors … should be using these 1115 waivers to say to Washington, ‘we want much more control over terms, conditions and funding for our Medicaid program, and we’re going to use Medicaid to drive down costs in our states,’” he said.
Beyond the midterms
The party that championed the passage of the 2010 health care law is starting to discuss their next comprehensive health care push, which could come during the 2028 presidential election.
Some Democratic lawmakers say they should start laying the groundwork for that now. While some members of the party are on record saying they would support switching to a single-payer health care system, the proposal would be a long shot for 2028.
Rep. Diana DeGette, D-Colo., ranking member of the Health Subcommittee, at a recent hearing drew attention to polling showing that 75 percent of uninsured Americans skipped or postponed care because of the cost, and said single-payer approach is the solution.
“Ultimately the best way to achieve affordable, accessible care for every American is to build a single-payer system like Medicare for All,” she said.
Graham Platner, who is running in the Democratic primary for Senate to unseat Sen. Susan Collins, R-Maine, included a proposal for “Medicare for All” at the end of his platform.
“It is time to join the rest of the developed world in providing universal health insurance to all citizens,” his health care platform reads. “No co-pays, no deductibles, no job-based coverage restrictions.”
Rep. Alexandria Ocasio-Cortez, D-N.Y., who also sits on the Health Subcommittee, said in an interview that Democrats should message on reversing GOP actions on health care, but also do more.
“We need to restore a lot of those previous safeguards,” she said. “But I think we also need to go further moving towards guaranteeing health care to every American.”
Rep. Sarah McBride, D-Del., said there have been conversations within the caucus about what that agenda would look like. She said the midterms are an opportunity for Democrats to lay groundwork should Democrats have control of both chambers of Congress and the White House in 2029.
“I do think that we need a North Star that we’re articulating that goes beyond a restoration of the previous status quo, and I think our caucus is eager to put forward that kind of vision,” McBride said.
‘Public option’
One idea that’s emerged in Democratic circles is a public health insurance option that would be available to the average American.
Proponents of the idea argue that it could be a middle ground, short of offering a full single-payer health care system, but still offering a cheaper alternative for the bulk of Americans who get their insurance through their employer.
About 154 million non-elderly people receive insurance through their employer, according to KFF’s 2025 employer health benefits survey.
“There’s wide agreement that a next critical step in Democratic health care policy is, at minimum, every American being able to buy in Medicare as a public option,” McBride said.
Levitt said such a proposal could allow Democrats to promise affordable health coverage to broad swaths of the population. But he said in practice there would be numerous political trade-offs to consider. The insurance industry would no doubt be up in arms about a federal policy program that excludes them altogether, he said.
“The only way a public option offers more affordable coverage is by lowering how much hospitals, drug companies and doctors get paid, and that will ignite opposition,” Levitt said.
Lloyd Pecora
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