2026-11-04T16:53:00-0500
民主党在周二选举中一举拿下美国参众两院的压倒性胜利，将重塑联邦医疗政策的走向——为监督调查、推动立法推翻对《平价医疗法案》（Affordable Care Act，简称ACA）和医疗补助计划（Medicaid）的削减奠定基础，并聚焦于降低保险费、药品价格等成本。
这场决定性的胜利让民主党得以主张，选民（在选举前调查中称医疗负担能力是首要关切）已赋予他们明确的授权，推翻特朗普总统与共和党人对公共医疗项目实施的历史性削减。
此次选举的大胜范围广泛，包括密歇根州当选参议员阿卜杜勒-赛义德（Abdul El-Sayed）及其他进步人士的胜选，可能会鼓舞部分民主党人推进雄心勃勃的政策提案，例如扩大联邦老年人医疗保险（Medicare）的覆盖范围，让所有美国人都能参保。他们的计划是在2028年总统选举中以“优先降低医疗成本的政党”自居。
不过，民主党领导人要推进任何医疗议程，都需要获得特朗普的支持。尽管特朗普拥有否决权，但他可能有兴趣通过促成立法协议来巩固自己的政治遗产，并转移对其政府在对伊战争、大规模驱逐、合同丑闻及其他争议问题上处理方式的调查带来的负面舆论影响。
据美联社数据，截至周三下午，民主党已预计将拿下众议院435个席位中的至少237个，以及参议院至少54个席位。包括阿拉斯加和密西西比州参议院竞选在内的几个关键选区的结果仍未公布。
随着选举结果在周三凌晨持续公布，特朗普在接受《政客》（Politico）电话采访时表示，他已与民主党领导人通话，选民传递出的信息是，他必须与民主党合作，“确保国家局势向好发展”。
“我不想在未来两年里只是坐着否决所有提案，”特朗普说，“民众也希望看到切实的行动。”
但特朗普新的和解姿态能否改变共和党主导的政策，例如扩大医疗补助计划（为低收入和残障人士设立的州联邦联合项目）的成年人工作要求，仍有待观察。共和党在中期竞选期间大力鼓吹其对医疗补助计划的全面改革，以及《大而美法案》（One Big Beautiful Bill Act）对其他医疗项目的调整，称这些是标志性政绩。
不过，民主党在调整政策时，必须权衡自己的另一项诉求——调查围绕美国顶级卫生官员小罗伯特·F·肯尼迪（Robert F. Kennedy Jr.）的一系列问题，他曾取消美国的疫苗推荐政策、精简联邦卫生机构人员编制、削减公共卫生资金。
“民主党将提出全面的医疗议程，包括推翻对医疗补助计划和《平价医疗法案》的削减，但在特朗普仍在白宫的情况下，要实现这一切是不可能的，”KFF的执行副总裁拉里·莱维特（Larry Levitt）表示，KFF是一家医疗信息非营利机构，包含KFF卫生新闻网（KFF Health News）。
新的一年、新的国会、新的多数席位
民主党在2027年的首要任务之一，可能是推动立法恢复增强型补贴，这项补贴曾降低数百万人的《平价医疗法案》医保计划缴费。这项数额更大的补贴是新冠疫情期间作为经济救助计划的一部分设立的，但去年随着特朗普与共和党控制的国会拒绝延长补贴，补贴已到期。
现任民主党众议院领袖、预计将成为众议院议长的纽约众议员哈基姆·杰弗里斯（Hakeem Jeffries）周三告诉CNN，民主党应恢复补贴以帮助陷入困境的家庭。
“我预计，这项补贴将被纳入更广泛的预算谈判或一揽子方案，其中可能涉及也可能不涉及其他医疗优先事项，比如恢复医疗补助削减或民主党的其他核心诉求，”乔治城大学健康保险改革中心联合主任萨布丽娜·科莱特（Sabrina Corlette）表示。
民主同盟倡导组织“保护我们的医疗”（Protect Our Care）主席莱斯利·达赫（Leslie Dach）称，如果行动果断，民主党既可以恢复《平价医疗法案》到期的补贴，也可以延长2027年医保的参保期，大部分州的参保期将于1月15日结束，而新国会定于不久后宣誓就职。
达赫表示，他们需要在掌控国会后几天内采取行动。
“国会将在开放参保期间宣誓就职，鉴于共和党推动保费进一步上涨，届时民众将不得不艰难抉择自己的医疗保障，”他说。
根据KFF研究人员的数据，2027年《平价医疗法案》基准计划的平均保费将上涨13%。
前共和党国会医疗顾问罗德尼·惠特洛克（Rodney Whitlock）表示，由于国会可能在12月通过另一项短期政府拨款法案，即将上任的议员们将在春季就医疗补助削减展开又一场争斗。
民主党人大多将医疗负担能力作为竞选核心议题，如今他们已处于将这个问题与特朗普总统就联邦支出展开谈判的有利位置。
“如果你们有机会在3月就财年资金展开博弈——而民主党正选择将这届统一控制国会与总统后的首次博弈聚焦于此，天哪，这难道不是在直指医疗问题吗？”惠特洛克说，“这难道不是在直指废除或推迟所有医疗补助削减吗？”
曼亚特律师事务所（Manatt）合伙人艾莉森·奥里斯（Allison Orris）在选举日前建议客户，即便民主党掌控国会，也不要指望会有什么改变。
“白宫最终必须签署任何立法，而《众议院法案1》（HR 1）是标志性政绩。要推翻甚至推迟2025年出台的政策，都将耗费资金，”她指的是《大而美法案》。
还可能发生什么？
特朗普总统可能会继续大量使用行政令来制定白宫层面的医疗政策。与此同时，民主党将利用对国会的控制权，监督特朗普政府及美国卫生与公众服务部（Department of Health and Human Services，简称HHS）的工作。
众议院民主党领袖杰弗里斯承诺，民主党将通过对特朗普政府展开积极监督来“追究骗子的责任”。众议院监督与政府改革委员会的民主党人在6月发布了一份报告，预告了可能发起的调查。
具体而言，民主党希望重点调查特朗普政府与制药公司达成的秘密药品定价协议——作为回报，制药公司将获得某些关税减免。这些协议的任何合同或文件都尚未公开。他们还声称，当制药公司在2025年共和党税收与支出法案下获得医疗保险药品定价豁免时，公司股价上涨使特朗普从中受益。
通过掌控国会委员会，民主党将获得传票权，这是重要的调查工具。但由于特朗普领导的司法部主要负责执行传票，他们能否成功从政府或企业获取文件尚不确定。不过，针对特朗普对处方药实施和威胁实施的关税，民主党可能仍会发出调查传票。
民主党国会领袖还将可以就特朗普政府的行为提起诉讼，对白宫的行动提出质疑。
民主党还透露了计划，调查围绕有争议问题的科学决策，比如允许更多风味电子烟销售、白宫推广草甘膦除草剂，以及这些行动是否与相关公司的政治捐款存在关联。
民主党对其他行业的监督可能还包括关注保险公司的事先授权拒赔、对商业保险公司运营的传统医疗保险替代项目——医疗保险优势计划（Medicare Advantage）的审查，以及人工智能在医疗决策中的应用。
更广泛的全民医保讨论也在酝酿中，包括一些阶段性步骤，比如扩大传统医疗保险的福利，覆盖牙科和听力护理，并将医疗保险参保年龄降至60岁或更低。
即便特朗普愿意支持，扩大医保覆盖所有美国人的计划也面临巨大挑战。该国医疗行业的大部分——包括医生、医院和保险公司——肯定会反对任何相关立法努力，而民主党人从未认真考虑过这样的提案对联邦预算、税收、医疗服务和更广泛社会的巨大影响。
其他可能的举措包括实施联邦层面的解决方案，解决10个州选择不全面扩大医疗补助覆盖低收入成年人的问题，以及允许儿童在26岁后继续留在父母的医保计划中。
由于新国会要到1月才宣誓就职，共和党仍占多数的国会将在今年年底召开 lame-duck 会期，焦点将是为联邦政府拨款，以及处理一些即将到期的医疗项目。
国会近期将采取的一项重要行动：确认海蒂·奥弗顿（Heidi Overton）领导美国食品药品监督管理局（Food and Drug Administration，简称FDA），FDA自5月以来一直没有最高领导人。不过奥弗顿的确认并非板上钉钉，民主党一致反对提名。
少数共和党人质疑她是否会充分限制药物流产的可及性，一些立场更温和的共和党人也表示担忧，包括路易斯安那州参议员比尔·卡西迪（Bill Cassidy），他质疑奥弗顿是否支持政府对疫苗推荐政策的调整。
卡西迪在特朗普支持共和党初选挑战者、众议员朱莉娅·莱特洛（Julia Letlow）后失去了自己的席位，后者在周二以微弱优势赢得参议院席位。
其他议题则获得两党支持，比如防止原定于1月1日启动的对医生的医疗保险支付削减，以及修改《无意外法案》（No Surprises Act）——2022年生效的联邦法律，旨在保护私人保险消费者免受意想不到的网络外收费。但这些议题几乎不可能取得进展。
“大家对 lame-duck 会期总是热情高涨，而结果总是令人失望，”保守派倾向的美国行动论坛（American Action Forum）总裁、经济学家道格·霍尔茨-埃金（Doug Holtz-Eakin）表示。
但明年1月，华盛顿将需要找到合作方式，以降低医疗成本——否则将面临选民的不满，近年来选民一直将医疗问题列为核心关切，民主党民调机构“影响研究”（Impact Research）合伙人马特·霍根（Matt Hogan）指出。
霍根指出，医疗和药品价格加在一起，是50岁以上选民最关心的成本问题。
管控药品价格可能是一项获得两党支持的领域——包括特朗普，他在中期选举前声称，降低一些药品价格是其政府的最大成就之一。两党都提出了对药房福利管理公司（Pharmacy Benefit Managers）的限制，这类公司为保险公司和雇主协商药品价格；还提出了对某些药品的专利限制；以及将美国药品价格与其他国家支付的价格挂钩。
“这是连续第三次将核心议题聚焦于负担能力的选举，”霍根说，“如果国会议员还没意识到这一点，我觉得他们现在肯定明白了。”
KFF卫生新闻网是一家全国性新闻编辑室，专注于报道医疗领域的深度新闻，是KFF的核心运营项目之一——KFF是一家独立的医疗政策研究、民意调查和新闻来源机构。
Democrats’ election rout is poised to dramatically reorder federal health policy
2026-11-04T16:53:00-0500
Democrats’ decisive sweep of the U.S. House and Senate in Tuesday’s elections will reshape the direction of federal health policy — setting the stage for oversight investigations, a legislative push to reverse cuts to the Affordable Care Act and Medicaid, and a focus on lowering costs such as insurance premiums and drug prices.
The conclusive string of victories sets up Democrats to argue that voters — who said in preelection surveys that healthcare affordability was a top concern — have given them a clear mandate to overturn historic cuts President Trump and Republicans made to public healthcare programs.
The breadth of success, including wins by Sen.-elect Abdul El-Sayed of Michigan and other progressives, is likely to embolden some Democrats to forge ahead with ambitious policy proposals such as expanding Medicare, the federal insurance program for people age 65 and older, to cover all Americans. Their plan is to be positioned as the party that prioritizes lowering healthcare costs for the 2028 presidential election.
Party leaders, though, will need buy-in from Mr. Trump to advance any healthcare agenda. While he has veto power, he may be interested in brokering legislative deals as he seeks to cement his legacy and deflect fallout from investigations into his administration’s handling of the war against Iran, mass deportations, contracting scandals, and other controversies.
Democrats were projected to win at least 237 of 435 seats in the House and at least 54 Senate seats as of Wednesday afternoon, according to The Associated Press. Several key races remained unresolved, including Senate contests in Alaska and Mississippi.
As election results continued coming out into early-morning Wednesday, Mr. Trump said in a phone interview with Politico that he had spoken with Democratic Party leaders and that voters had sent a message he must work with them “to make sure things go well for our country.”
“I don’t want to just be sitting there for two years vetoing everything,” Mr. Trump said. “They want to see things happen, too.”
But how Mr. Trump’s new conciliatory position plays out in undoing GOP-led changes, such as new work requirements for many adults enrolled in Medicaid, the state-federal program for low-income and disabled people, remains to be seen. Republicans touted their overhaul of Medicaid and other changes to health programs wrought by their One Big Beautiful Bill Act as signature achievements in midterm campaigns.
Democrats, however, will have to carefully balance their policy moves against their desire to investigate a host of concerns surrounding the nation’s top health official, Robert F. Kennedy Jr., who has dismantled U.S. vaccine recommendations, gutted the staff of federal health agencies, and cut public health funding.
“Democrats will put forward an expansive healthcare agenda, including reversal of cuts to Medicaid and the ACA, but achieving all of that will be impossible with President Trump still in the White House,” said Larry Levitt, an executive vice president at KFF, a health information nonprofit that includes KFF Health News.
New year, new Congress, new majority
An early order of business for Democrats in 2027 will likely be a legislative push to restore enhanced subsidies that reduced the price millions of people paid for Obamacare health plans. The larger subsidies were created during the covid-19 pandemic, as part of economic relief programs, but ended last year after Mr. Trump and the Republican-controlled Congress declined to extend them.
Rep. Hakeem Jeffries of New York, the current Democratic House leader widely expected to become speaker of the House, told CNN on Wednesday that the party should bring back the subsidies to help struggling families.
“My guess is it would be rolled into a broader budget negotiation or package that may or may not involve other healthcare priorities, like restoring Medicaid cuts or other things that are priorities for Democrats,” said Sabrina Corlette, a co-director of the Center on Health Insurance Reforms at Georgetown University.
If they act decisively, said Leslie Dach, who chairs the Democratic-aligned advocacy group Protect Our Care, Democrats could both renew the ACA’s expired subsidies and extend the enrollment period for 2027 coverage, which ends in most states on Jan. 15, shortly after the new Congress is scheduled to be sworn in.
They would need to act within days of assuming control, Dach said.
“Congress will be sworn in during open enrollment, at a time when people will be having to make difficult and horrific choices about their healthcare, given the further increases in premiums due to the Republicans,” he said.
Premiums for Affordable Care Act benchmark plans are set to increase by an average of 13% for 2027, according to KFF researchers.
With Congress likely to pass another short-term government funding bill in December, the stage will be set for incoming lawmakers to also fight a battle over Medicaid spending cuts in the spring, said Rodney Whitlock, a healthcare consultant who previously worked for Republicans in Congress.
Democrats — many of whom put healthcare affordability at the center of their election campaigns — are now well positioned to place that issue at the center of negotiations with President Trump over federal spending.
“If you’ve got the opportunity for a battle in March over fiscal year funding — and Democrats picking and choosing what they want to make this first battle about with a unified, controlled Congress with the president — damn, doesn’t it scream healthcare?” Whitlock said. “Doesn’t it scream repeal or delay all the Medicaid cuts?”
Allison Orris, a partner at Manatt, advised clients before Election Day not to count on anything changing — even with Democrats in control.
“The White House ultimately will have to sign any legislation, and HR 1 was a signature accomplishment. It will cost money to undo or even just delay changes that were enacted in 2025,” she said, referring to the One Big Beautiful Bill Act.
What else could happen?
President Trump is likely to continue leaning heavily into executive actions to shape health policy from the White House. Democrats, meanwhile, will use their control of Congress to exercise oversight of the Trump administration and the Department of Health and Human Services.
Jeffries, the House Democratic leader, has promised the party will “hold the crooks accountable” by pursuing aggressive oversight of the Trump administration. Democrats on the House Committee on Oversight and Government Reform put out a report in June previewing investigations they may launch.
Specifically, Democrats want to zero in on clandestine drug-pricing dealsMr. Trump has made with pharmaceutical companies in return for relief from certain tariffs. No contracts or paperwork on the agreements have been made public. They also claim he benefited from stock prices that rose when companies received exemptions from price negotiation in Medicare under the 2025 GOP tax and spending law.
By taking control of congressional committees, Democrats will gain subpoena power, an important investigatory tool. But it’s unclear whether they can successfully pry documents from the government or companies because the Department of Justice, under Mr. Trump, is largely in charge of enforcing subpoenas. Nevertheless, subpoenas are likely to be issued regarding investigations into tariffs Trump has imposed and threatened to impose on prescription drugs.
Democratic congressional leaders will also be able to file lawsuits against the Trump administration to challenge the White House’s actions.
Democrats also have telegraphed plans to probe scientific decision-making around such controversial issues as allowing more sales of flavored vapes and White House promotion of the herbicide glyphosate — and any connections these actions have had to political contributions from companies.
Other industry oversight by Democrats would likely focus on preauthorization denials by insurance companies; scrutiny of Medicare Advantage, an alternative program to traditional Medicare run by commercial insurers; and the use of artificial intelligence in medical decision-making.
Also looming is a wider discussion of universal health coverage, including partial steps such as expanding traditional Medicare benefits to include dental and hearing care and lowering the Medicare eligibility age to 60 or younger.
Expanding the program to cover all Americans faces formidable challenges, even if Mr. Trump were open to it. Much of the nation’s healthcare industry — including doctors, hospitals, and insurers — would surely fight any legislative effort, and Democrats have never seriously grappled with the enormous implications of such a proposal for the federal budget, taxes, medical care, and broader society.
Other possible initiatives include implementing a federal solution to address the 10 states that have opted not to fully expand Medicaid to cover lower-income adults, as well as allowing children to remain on their parents’ health insurance policies beyond age 26.
Because the new Congress is not set to be sworn in until January, a lame-duck session through year’s end, for which Republicans retain the majority, will focus on funding the federal government and addressing some health programs set to expire.
One major move Congress is expected to make soon: a confirmation vote for Heidi Overton to lead the Food and Drug Administration, which has been without a top leader since May. Her confirmation is not guaranteed, however, with Democrats uniformly in opposition.
A handful of Republicans have questioned whether she will sufficiently restrict access to medication abortion, while some more moderate Republicans have expressed concerns, too — including Sen. Bill Cassidy of Louisiana, who questioned whether Overton supports the administration’s changes to vaccine recommendations.
Cassidy lost his seat after Mr. Trump endorsed a Republican primary challenger, Rep. Julia Letlow, who narrowly won election to the Senate on Tuesday.
Other issues enjoy bipartisan support, such as preventing cuts to Medicare payments to doctors, scheduled to begin Jan. 1, and making fixes to the No Surprises Act, a federal law that took effect in 2022 to protect consumers with private insurance from unexpected, out-of-network charges. But movement would be a long shot.
“Everyone gets hyped up for lame ducks, and they’re always a disappointment,” said Doug Holtz-Eakin, an economist and the president of the conservative-leaning American Action Forum.
But come January, Washington will need to find a way to work together to make healthcare more affordable — or risk ire from voters who have consistently ranked it as one of their top issues in recent elections, noted Matt Hogan, a partner at Impact Research, a Democratic polling firm.
When put together, healthcare and prescription drug prices are the top cost concern for voters older than 50, he noted.
Reining in prescription drug prices could be an area with bipartisan support — including from Mr. Trump, who claimed ahead of the midterms that lowering some drug prices was one of his administration’s greatest achievements. Both parties have proposed limits on pharmacy benefit managers, which negotiate drug prices on behalf of insurers and employers; patent restrictions for certain drugs; and the benchmarking of U.S. drug prices against the prices other countries pay.
“This is the third-straight election that’s really been focused on affordability,” Hogan said. “If members of Congress haven’t got the message yet, I expect them to now.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.