https://mailchi.mp/e7ac0bb13b2c/how-democrats-big-win-could-reshape-health-care?e=ad91541e82

Some people are calling the 2026 midterms a “blue tsunami” or even a “Democratic wildfire.”

Whatever you call it, Democrats will have big majorities in the House and the Senate for the end of President Trump’s second term, which could have major implications for health policy over the next two years and beyond.

Democrats have their sights set high. They’ve pledged to repeal Republicans’ health care cuts in their first 100 hours in power — starting with restoring enhanced premium subsidies for people who buy insurance through Obamacare marketplaces and reversing nearly $1 trillion in Medicaid cuts and coverage restrictions set to take effect in January.

Achieving any of that will still require support from at least a few Republicans in Congress and President Trump. But even if they fail to roll back Republican cuts, Democrats will have far more power to influence the country’s health policy conversation, says Katie Keith, director of the Center for Health Policy and Law at Georgetown Law and a contributing editor at Health Affairs.

We spoke with Keith on Wednesday morning about Democrats’ health care affordability agenda in Washington and what the party’s strong showing at the state level could mean on issues such as abortion rights and Medicaid.

Here are some of the key takeaways from our conversation:

• Republicans and Democrats could become “strange bedfellows” on certain health care issues — like lowering prescription drug costs or even delaying some changes to Medicaid. The size of Democrats’ margins in Congress could allow them to add pieces of their health care agenda to must-pass legislation. The question, Keith says, is, “What is the trade that could bring President Donald Trump along to agree to that?”
  
• Democrats have a chance to take control of the health care agenda ahead of the 2028 presidential election — communicating to voters that “Congress hears the concerns of the American people and is doing something about it,” Keith says. She compared it to Republicans’ repeated attempts to repeal the Affordable Care Act after routing Democrats in 2010. Others have drawn comparisons to Democrats’ 2006 midterm victory, which put health care center stage in 2008 and led to the creation of Obamacare.
  
• Beyond legislation, Democrats in Congress are likely to go big on oversight and transparency, Keith says, to scrutinize the actions of the Trump administration and the private health sector. For example, Congress could subpoena drug manufacturers for copies of the deals they’ve made with the White House to, among other things, charge state Medicaid programs less than they charge in other countries around the world. The specifics of these deals, which have been cut with more than two dozen drugmakers, have been kept private.
  
• Democratic gains in state elections could have big implications for Medicaid. Democrats gained full control in at least five states and won a majority of races for governor and attorneys general. Keith says this red-to-blue shift could mean “a completely different approach to implementing Medicaid work requirements, eligibility and redeterminations.” New blue leadership in Wisconsin, Texas and Georgia could even, theoretically, open the door to Medicaid expansion. “The fact that you could even say maybe it’s something to look at was not something I was expecting to say the morning after [the election],” Keith says.

I hope you’ll listen to our entire episode or read the transcript.