On Tuesday night Democrats flipped seven Senate seats (Kansas, Iowa, Texas, Ohio, Maine, North Carolina and South Carolina) and will hold at least 54 Senate seats plus a solid House majority when the new Congress is sworn in on January 3. It is the first time since 2006 that the opposition party will control both chambers under a Republican president.
Healthcare was on the ballot, and voters knew it. In KFF’s polling, midterm voters trusted Democrats over Republicans on healthcare 49% to 30%. The reasons aren’t abstract. The enhanced ACA subsidies expired at the end of 2025. HR 1 cut nearly $1 trillion from Medicaid, and the CBO projects it could leave 11.8 million more people uninsured by 2034. Benchmark marketplace premiums are set to rise another 13% for 2027. On Tuesday, patients said so.
The doctors are coming
The next Congress will have at least 18 physicians, and possibly 21 once the last races are called. That’s a record. So far the count is 10 Democrats and 8 Republicans.
Two of them flipped the Senate. Dr. Annie Andrews, a Charleston pediatrician who has researched childhood asthma and gun injuries, beat Darline Graham to become South Carolina’s first Democratic senator since 1998. Dr. Abdul El-Sayed, a physician-epidemiologist and former Detroit health director, won Michigan as an outspoken Medicare for All advocate.
In the House, surgeon and Army trauma veteran Dr. Adam Hamawy takes New Jersey’s 12th. Pediatrician Dr. Richard Pan unseated Kevin Kiley in California. Emergency physician Dr. Amish Shah was leading in Arizona at last count. Returning Democrats include Ami Bera, Kim Schrier, Maxine Dexter and Herb Conaway, the only member with both an MD and a law degree.
Physicians lost seats too. Republican Sen. Roger Marshall, an OB-GYN, fell in Kansas, and Rep. Mariannette Miller-Meeks lost in Iowa. Still, Republican doctors like Rich McCormick, Andy Harris, John Joyce and newcomer John Cowan return.
That matters. Doctors know what prior authorization does to a cancer patient’s timeline, and what a $400 inhaler does to a child’s asthma control. But an MD isn’t a policy. The eight Republican physicians may be where durable, bipartisan reform finds its votes.
The honest math
Let’s not mistake a mandate for a supermajority. Fifty-four senators is not 60, and it is nowhere near veto-proof. President Trump holds the pen until January 2029. Any law touching Medicaid, Medicare or ACA subsidies still needs his signature. Budget reconciliation can get around the filibuster, but not the veto. And Medicaid work requirements take effect January 1, before the new majority is even sworn in.
So here is what’s realistic for 2027. Democrats will push to restore the enhanced ACA subsidies, and KFF’s Larry Levitt notes that a deal with the White House could be backdated. They’ll use spending bills to fight the Medicaid cuts. And they’ll use oversight to put HHS under a microscope.
That’s triage, not reform. Structural reform is a 2029 project at the earliest. Which means the blueprint has to be written now.
What I would build
1. Resurrect the ACA, in full. Restore the enhanced subsidies permanently, not on another cliff-edge sunset. Reverse the Medicaid cuts. Close the coverage gap in the ten states that still haven’t fully expanded Medicaid.
2. Decouple insurance from employment. Job-based coverage is an accident of World War II wage controls, not a design. Tying insurance to a job means a layoff becomes a health crisis. It locks people into jobs they’d leave and hides the true cost of care inside stagnant wages. Coverage should be portable, bought through the exchanges, with the employer tax break gradually converted into subsidies that follow the person.
3. Require every insurer to run a nonprofit basic plan. Any company selling on the exchanges or in Medicare Advantage should have to offer a nonprofit, standardized plan. It would cover primary care, prevention, generic drugs, maternity and emergency care, with capped overhead and no prior authorization for routine services. Let insurers compete on service, not on denials.
4. Set prices across the supply chain, as Japan does. Japan’s health ministry, advised by a council of payers and providers, sets one national fee schedule for nearly every visit, procedure, drug and device. It revises that schedule every two years, and drug prices are routinely cut. Japan spends a fraction of what we do per person and still has some of the best health outcomes in the world.
Here’s the part reformers often skip: Japan’s insurance is still largely tied to employment. Its secret isn’t who holds the card. It’s that everyone pays the same price. That’s why I’d argue price-setting is the piece that makes the other three affordable.
The objections deserve answers
Drugmakers argue that price controls slow innovation, and Japan has struggled with “drug lag,” where new medicines arrive later than elsewhere. Rural hospitals run on razor-thin margins and could close under blunt caps unless they get targeted support. Many workers like their employer plans, and moving more than half the country off them would be enormously disruptive. Insurers will fight a nonprofit mandate with everything they have. And all of this costs money the Treasury has to find.
These aren’t reasons to stop. They’re design constraints. Phase changes in, protect rural providers, and build in incentives for real innovation rather than me-too drugs.
Stop the bleeding, then operate
Voters handed Democrats a mandate on affordability, and they sent a record number of physicians to carry it. The next two years are about stopping the bleeding: subsidies, Medicaid and oversight. The two years after that are when we operate.
Any surgeon will tell you the case goes better when the plan is written before you scrub in. Let’s start writing.
Sources: STAT · CBS News · NBC News · [Becker’s](https://www.beckershospitalreview.com/legal-regulatory-issues/democrats-gain-control-of-congress-