5 things you should know about the midterms and healthcare

The midterm elections that will determine control of the House and Senate are scheduled for next Tuesday, Nov. 3. Although the midterms are always a test for the parties and the popularity of their policies and positions, this year’s vote has grabbed more attention than ever, partly because of the large amount of money pouring into politics these days. Here are five takeaways about the midterms and their implications for U.S. healthcare.

1) Democrats are favored to take control of the House and Senate

Polls and pundits have been wrong, especially when it comes to President Donald Trump. Still, there are solid reasons to believe that Democrats will have a good night on Nov. 3.

The Republicans currently have a 53-45 majority in the Senate, although two independents caucus with the Democrats, effectively giving the Democrats 47 votes. In the House, Republicans have a 218-212 majority, with one independent with them, effectively giving the Republicans a narrow, 219-212 edge.

The Democrats need to gain a net of four seats to win a majority in the Senate, and The Cook Political Report now rates races in seven states as toss-ups: Alaska, Iowa, Kansas, Maine, Michigan, Ohio and Texas. Control of the House requires 218 votes, and the Cook Report currently rates races in 17 districts as toss-ups. Ballotpedia puts 46 districts in the battleground category.

As of yesterday, polling aggregator Nate Silver had Democrats as strong favorites for winning control of the House and described their odds of winning the Senate as holding steady, although he sounded a note of caution about slim margin-of-error differences in the polls in Alaska, Maine, Ohio and Texas.

Harvard and Caltech researchers have built an election forecasting tool called Electit that eschews polling data and instead depends entirely on data from past elections. The Electit model says there is a 94% chance that Democrats will take control of the House and a 71% chance that they will take control of the Senate.

Polls are not elections. Models are just models. Caveat emptor.

2) Healthcare is topic A in the affordability conversation

Healthcare, one way or another, is perhaps always an issue in the U.S. But with inflation, the Iran war and Justice Department prosecutions dominating the headlines, it didn’t seem like healthcare was going to gain much of a purchase in the midterms. But according to KFF’s latest tracking poll, which was conducted Sept. 16-21, healthcare and gasoline and transportation topped the list when respondents were asked. “How worried, if at all, are you about being able to afford each of the following for you and your family?”. The KFF results show that 25% are very worried and 35% somewhat worried about affording healthcare. In a Families USA poll of just over 1,000 registered voters that was conducted in July, 47% of the respondents indicated that healthcare costs should be a top priority for Congress and the president.

There are, however, notable differences that run along party lines on the relative importance of healthcare costs and affordability. In the KFF poll, 59% of Democrats indicated that they believe that healthcare costs are an extremely important issue for candidates in the midterm election to talk about compared with just 31% of Republicans, while 54% of Republicans said fraud in government programs was extremely important compared with 39% of Democrats.

3) Democratic majorities probably won’t translate into major legislative wins but will give them oversight powers

If Democrats win the House and Senate, they may move quickly to pass legislation to reverse Medicaid work requirements and more frequent redeterminations that were part of the 2025 One Big Beautiful Bill Act and go into effect in 2027. They will also likely move to restore the enhanced Affordable Care Act (ACA) credits that expired this year. A working group of House Democrats on healthcare and the cost of living that was co-chaired by Rep. Alexandria Ocasio-Cortz listed those reversals as a top priority in a memo issued at the beginning of September.

But as partners at Manatt pointed out in a Manatt webinar this week on the midterms and their implications for U.S. health, with the Republicans still controlling the White House and a series of Supreme Court decisions backing the unified executive theory, the Democrats may be relatively powerless when it comes to actually enacting law, so regardless of the results next Tuesday, with Medicaid and ACA marketplace plan enrollment likely to decline, state officials and healthcare providers may be bracing for the consequences of a growing number of patients who lack health insurance coverage, which include medical debt and conditions worsened by putting off healthcare.

What Democrats will have despite a Republican executive branch is oversight powers that could mean hearings and investigations into Trump administration healthcare policies. One major target of those investigations may be TrumpRx and the direct-to-consumer prices that the Trump administration has negotiated with pharmaceutical companies as part of its most-favored-nation drug policies. Democratic majorities may also mean hearings on, and investigations into, vertical integration, private equity investment and managed care practices such as prior authorization.

If the Democrats win control of the Senate, Sen. Bernie Sanders is in line to chair the Committee on Health, Education, Labor, and Pensions that has the most direct jurisdiction over healthcare. Politico has reported that Rep. Kathy Castor, a Florida Democrat who represents the Tampa area, is vying to chair the top House committee on healthcare.

4) Price transparency may be in that rare safe harbor of bipartisan agreement

Pharmacy benefit management (PBM) reform was signed into law earlier this year as part of the Consolidated Appropriations Act, 2026, following years of emerging bipartisan agreement that more transparency into and scrutiny of PBM practices were needed. Pricing transparency has bipartisan agreement. By wide margins, House and Senate committees marked-up several pieces of legislation this summer that would codify price transparency rules for health systems and health plans. The Manatt experts said that price transparency legislation might even be popular enough to pass during the lame duck session after the election.

5) User-fee reauthorization is one of several ’27 healthcare issues that are important but lurk below the partisan surface

Many healthcare issues and programs reside in a stratum below wide public debate and understanding, and they don’t necessarily follow the usual boundaries of partisan politics. For healthcare interests, though, they are often of greatest near-term importance. How much bearing the outcome of the midterms will have on them, if any, is hard to predict.

Programs and issues in this important-but-inside-baseball category include the 340B Drug Pricing Program and a pilot that would shift the program from discounts to rebates. A bipartisan bill that has been introduced in the House would require 340B price reductions to be paid through discounts through the end of 2028.

Physician groups, including the American Medical Association, are pushing for passage of the Patients First Act, which would transform how Medicare pays physicians by, among other things, tying annual reimbursement adjustment to measurement and abandoning the current system of quality measurement, called the Merit-based Incentive Payment System — MIPS, for short — to one called the Patient Outcome Improvement National Tabulation System, or POINTS.

Many healthcare insiders, especially those in the drug and medical device areas, have Sept. 30, 2027, circled on their calendars. That is when the FDA user-fee legislation will expire, and enacting a replacement is widely considered. How industry groups, the Trump administration, and possibly the newly empowered Democrats might leverage the user-fee legislation to advance their priorities is likely to be one of the main (and knottiest) healthcare policy and politics subplots of 2027.

Another insider issue is changing the dispute resolution process of the No Surprises Act, which has protected patients against out-of-network bills but, by some accounts, has led to outsize payments to out-of-network providers at the expense of payers.