Democrats’ control of the House and Senate will reshape the balance of power in Washington and usher in a new era of divided government. When the 120th Congress convenes in January, Democrats will have control over the congressional agenda, including which legislation reaches the floor, who leads committees, and how Congress will exercise its oversight authority. This control will not, by itself, allow Democrats to rewrite federal health policy. President Trump will retain veto power, and durable policy change will depend on bipartisan agreement or negotiations with the White House.
For health systems, this distinction matters. Democrats are likely to move quickly on coverage, Medicaid and affordability priorities, but many early votes will be intended to define the party’s position rather than produce immediate changes in law. The policies most likely to be signed into law will be narrower measures that attract support in both parties or become part of legislation that Congress must pass.
The first test: The lame-duck session
The first indication of how the parties may govern together will come before the 120th Congress convenes. The current continuing resolution funding the government expires Dec. 11, forcing the outgoing Congress to come to an agreement in a compressed lame-duck session. Another short-term continuing resolution is the most likely outcome, although its duration remains uncertain. That negotiation will provide an early test of whether congressional leaders and the White House can separate immediate governing obligations from the larger partisan disputes that will carry into 2027.
The lame-duck session will also include debate on a set of health provisions, known as “extenders,” scheduled to expire Dec. 31. Congress is expected to come together around at least a limited extenders package, including an extension of the Medicare-dependent hospital program and the low-volume hospital payment adjustment. They also will offer an early preview of the governing pattern likely to define the next Congress: narrow bipartisan policies moving alongside broader funding legislation, while more contested health priorities are deferred or used as negotiating leverage.
What Democrats will prioritize
Democrats in the House have already released a memorandum outlining their plan for “Healthcare Action” over the first 100 hours, first 100 days, and first year of the 120th Congress. Democrats in the Senate Finance Committee have also already indicated an interest in pursuing a healthcare agenda focused on expanding access to affordable coverage and increasing oversight of the healthcare industry. The common themes across both chambers: affordability and access. For health systems, the Democratic agenda will include efforts to reverse or delay major OBBBA Medicaid changes, restore the enhanced Affordable Care Act premium tax credits that expired at the end of 2025, strengthen the healthcare workforce, protect the 340B Drug Pricing Program, and support rural providers. Democrats are also likely to pursue prescription drug reforms and greater scrutiny of healthcare consolidation and private-equity ownership.
But, again, setting the agenda is not the same as enacting it. Democrats can determine which bills receive votes and use their committees to conduct oversight, but President Trump will retain veto power. That means the more important question for health systems is not simply what Democrats propose, but which of those priorities could reasonably move and become law.
Opportunities for bipartisanship—how will this all move?
In a divided government, policies that cannot advance independently become more viable when attached to funding agreements, reauthorization packages, or other legislation that both parties have incentives to complete (often called “must-pass bills”). With that in mind, some of the most consequential healthcare negotiations of the 120th Congress will occur in conjunction with deadlines that require congressional action. Government funding bills will give Democrats leverage to seek changes to the implementation of existing policies, while the September 2027 expiration of the FDA user-fee programs stands out as one of the most likely upcoming major bipartisan healthcare vehicles.
For health systems, that creates both opportunity and risk. Bipartisan negotiations could advance policies addressing Medicare Advantage, telehealth, the healthcare workforce, and rural health, but some of the policies with bipartisan support also represent significant concerns for hospitals, particularly site-neutral payment, price transparency, and scrutiny of consolidation.
The biggest Democratic priorities will be harder to move. A full repeal of the OBBBA, providing universal coverage via Medicare for All, or a permanent restoration of the enhanced ACA premium tax credits would likely face Republican opposition, presidential resistance, and significant budgetary costs. And efforts to pay for broader coverage policies could increase pressure for hospital payment reductions, including site-neutral payment reforms. In other words, the bipartisan negotiating table may create opportunities for health systems, but hospitals should also expect to be part of the discussion over how new policies are paid for.
What health systems should expect
The election changes the balance of power, but it does not reset the operating environment for providers. Health systems should continue implementing current law while preparing for targeted changes that may emerge from bipartisan negotiations. They should also distinguish between high-profile votes that signal congressional priorities and provisions attached to legislation with a genuine path to enactment.
The key will be distinguishing between proposals that generate headlines and those with a genuine path to enactment. Health systems should pay particular attention to bipartisan negotiations and must-pass legislation, where opportunities to advance health policy will intersect with continued pressure on hospital payments.
In divided government, Democrats’ broader priorities will define the debate, but the narrower compromises will determine what actually changes for health systems.
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