US Healthcare Priorities for a Newly Elected Congress

Healthcare affordability remains one of the most important issues facing American families. Rising insurance premiums, expensive prescription drugs, hospital closures, workforce shortages, and uneven access to care continue to challenge patients, providers, employers, and government programs.

As a newly elected Congress prepares to take office in January 2027, healthcare policy will once again become a central part of the national conversation. The November 2026 midterm elections have reshaped the political landscape, with Democrats gaining control of both chambers of Congress. Their early healthcare priorities are expected to include restoring Affordable Care Act (ACA) subsidies, addressing Medicaid funding changes, lowering prescription drug costs, and expanding access to affordable coverage.

However, translating campaign commitments into legislation will require navigating competing budget priorities, political differences, and the continuing role of the White House.

Beyond the political debate, the underlying challenge remains the same: How can the United States build a healthcare system that delivers better outcomes, improves access, and makes care more affordable?

Here are seven major US healthcare priorities for the newly elected Congress that could shape healthcare policy, delivery, and financing over the next several years.

1. Make Healthcare More Affordable and Protect Insurance Coverage

Healthcare affordability should be at the top of the congressional agenda. Americans experience rising healthcare costs through monthly insurance premiums, deductibles, copayments, prescription drug expenses, and unexpected medical bills.

For many families, having health insurance does not necessarily mean being able to afford care. A plan with a low monthly premium may carry a high deductible, leaving patients responsible for thousands of dollars before insurance coverage meaningfully begins.

Congress will face important decisions about the future of Affordable Care Act marketplace subsidies, Medicaid eligibility, and access to employer-sponsored coverage.

One immediate priority for the incoming congressional majority is expected to be restoring enhanced ACA premium tax credits that expired after 2025. These subsidies helped millions of Americans afford individual marketplace coverage. Their expiration has increased pressure on household healthcare budgets.

Lawmakers should also consider policies that reduce unnecessary coverage interruptions, simplify enrollment, and improve transitions between Medicaid, marketplace plans, and employer-sponsored insurance.

The goal should extend beyond increasing insurance enrollment. Policymakers must ensure that coverage provides meaningful access to primary care, specialists, mental health services, maternity care, and prescription medications.

For consumers, the real measure of affordability is whether they can obtain the care they need without taking on significant financial hardship.

Related reading: Are Affordable Health Plans Really Affordable?

2. Lower Prescription Drug Costs and Improve Pharmacy Benefit Transparency

Prescription drug affordability remains a major concern for patients, employers, health plans, and government healthcare programs.

Federal policy has already introduced significant changes through Medicare drug price negotiation. The first negotiated prices for selected Medicare Part D medications took effect in January 2026, marking an important development in federal efforts to reduce prescription drug spending.

The next challenge is ensuring that negotiated savings translate into meaningful financial relief for patients while maintaining access to effective treatments and encouraging pharmaceutical innovation.

The incoming Congress is likely to examine several areas:

• Medicare drug price negotiation: Whether the negotiation program should expand to additional medications and how it should evolve.
• Pharmacy benefit managers (PBMs): Whether additional transparency, reporting, and accountability requirements can improve prescription drug affordability.
• Rebates and pricing practices: How manufacturer rebates, formulary arrangements, and other pricing mechanisms affect patients and overall healthcare spending.
• Generic and biosimilar competition: How to accelerate access to lower-cost alternatives without compromising safety or quality.
• Patient out-of-pocket costs: How to ensure that savings reach consumers at the pharmacy counter rather than remaining within the broader supply chain.

PBMs play an important role in negotiating drug prices, managing formularies, administering pharmacy benefits, and helping employers and health plans manage prescription drug spending. However, greater transparency and accountability will remain important to maintaining confidence in the pharmacy benefit system.

Congress should focus on reforms that produce measurable savings for patients and plan sponsors while preserving competition, access, and incentives for medical innovation.

The broader objective should be a prescription drug system in which patients understand what their medications cost and have access to clinically appropriate, affordable treatment.

Related reading: How New Pharmacy Benefit Models Could Lower Prescription Drug Costs

3. Strengthen Medicare and Medicaid While Protecting Access to Care

Medicare and Medicaid are fundamental to the US healthcare system. Together, these programs support millions of older adults, people with disabilities, low-income families, children, and other vulnerable populations.

Both programs face increasing financial and operational pressures.

Medicare: Balancing affordability, access, and sustainability

As the American population ages, Medicare spending will continue to be an important federal budget consideration. Congress must balance the program’s long-term financial sustainability with beneficiaries’ ability to access affordable healthcare.

Key priorities include:

• Protecting access to primary care, specialists, and hospital services.
• Addressing the affordability of Medicare premiums and out-of-pocket expenses.
• Improving access to prescription medications and specialty treatments.
• Supporting home-based care and services that help older adults remain independent.
• Strengthening Medicare Advantage oversight while preserving appropriate plan choices.
• Encouraging preventive care and chronic disease management.

Medicare policy should also recognize the growing importance of coordinated medical and pharmacy benefits, particularly for beneficiaries managing multiple chronic conditions.

Medicaid: Protecting vulnerable populations

Medicaid is a major source of healthcare coverage for low-income Americans and an essential financial foundation for many hospitals, nursing facilities, and community health providers.

The incoming Congress is expected to revisit federal Medicaid funding and eligibility changes enacted in 2025. Debate will likely focus on coverage requirements, federal-state financing, administrative burdens, and the potential effects on beneficiaries and healthcare providers.

Particular attention should be given to rural communities, maternal health, behavioral healthcare, children with complex medical needs, and long-term services and supports.

Rather than viewing Medicare and Medicaid exclusively through the lens of federal spending, policymakers should evaluate how changes affect access, health outcomes, and the financial stability of the organizations delivering care.

4. Address Healthcare Workforce Shortages and Strengthen Primary Care

Access to healthcare depends on having enough qualified professionals to deliver it.

Across the country, patients experience workforce shortages through delayed appointments, limited access to specialists, closed primary care panels, and difficulty finding behavioral health providers.

Rural communities and underserved urban populations often face the greatest challenges.

Congress has several policy tools available to address these shortages, including:

• Expanding graduate medical education and physician residency opportunities.
• Supporting nursing education and workforce development.
• Strengthening loan repayment and incentives for clinicians serving underserved communities.
• Expanding training opportunities for behavioral health professionals.
• Supporting community health workers and other members of the care team.
• Encouraging appropriate telehealth and interstate licensing flexibility.

However, increasing the number of healthcare professionals is only part of the solution.

Clinician burnout, administrative requirements, inconsistent insurance processes, and inadequate reimbursement can make it difficult to retain experienced professionals.

Congress should encourage payment models that reward care coordination, prevention, chronic disease management, and improved patient outcomes rather than relying primarily on the volume of services delivered.

Reducing unnecessary administrative burdens, including duplicative prior authorization requirements, could also allow clinicians to spend more time with patients.

A stronger healthcare workforce is essential to improving access, reducing avoidable hospitalizations, and building a more sustainable healthcare delivery system.

5. Make Mental Health, Maternal Health, and Preventive Care National Priorities

Mental health and preventive care should be integral parts of the national healthcare strategy rather than separate policy discussions.

Demand for mental health and substance use treatment continues to highlight gaps in access, affordability, and provider availability.

Insurance coverage alone does not guarantee that patients can find an available, in-network behavioral health professional.

Congress should strengthen enforcement of mental health parity requirements, expand the behavioral health workforce, and improve coordination between primary care providers, hospitals, schools, and community organizations.

Maternal and infant health also deserve greater attention. Access to prenatal care, postpartum services, and maternity providers remains uneven, particularly in rural communities.

Federal programs can help improve maternal health outcomes through better access to preventive services, early identification of high-risk pregnancies, and stronger coordination across providers.

Preventive healthcare should receive similar attention.

Programs focused on diabetes prevention, obesity, cardiovascular health, cancer screening, vaccination, and tobacco cessation can help identify health risks earlier and reduce avoidable complications.

The financial benefits of prevention may take years to become fully visible, but the potential benefits for patients and the healthcare system are substantial.

Congress should support evidence-based public health programs while giving states and local communities flexibility to address their specific needs.

6. Establish Responsible Policies for Artificial Intelligence and Digital Healthcare

Healthcare technology is evolving rapidly. Artificial intelligence (AI), remote patient monitoring, digital therapeutics, predictive analytics, and connected health applications are changing how healthcare is delivered and managed.

These technologies offer opportunities to improve access, support clinical decisions, reduce administrative work, and identify health risks earlier.

For example, AI-assisted clinical documentation can reduce administrative workloads, while predictive analytics can help health plans and providers identify patients who may benefit from earlier intervention.

Remote monitoring and digital health platforms can also support patients managing diabetes, cardiovascular disease, obesity, and other chronic conditions.

However, innovation introduces important questions about patient privacy, cybersecurity, algorithmic bias, data accuracy, and accountability.

Congress should establish policies that encourage responsible innovation without creating unnecessary barriers to useful healthcare technologies.

Important priorities include:

• Establishing appropriate transparency and accountability standards for healthcare AI.
• Protecting patient information across hospitals, health plans, technology companies, and consumer health applications.
• Strengthening cybersecurity requirements for healthcare organizations.
• Improving interoperability so patient information can move securely between authorized providers.
• Supporting evidence-based evaluation of digital health tools and clinical applications.
• Addressing disparities in access to broadband, connected devices, and digital health services.

Healthcare AI should be evaluated according to its intended use and potential clinical impact. A consumer wellness application does not present the same risks as an AI system that influences diagnosis or treatment decisions.

The objective should be to make healthcare technology safer, more accessible, and more useful for patients and clinicians.

Related reading: How Artificial Intelligence Is Changing Hospitals

7. Improve Healthcare Value Through Better Data, Coordination, and Accountability

One of the biggest opportunities for improving the US healthcare system is making better use of the information already generated across the healthcare ecosystem.

Medical claims, pharmacy data, laboratory results, clinical records, and patient-generated health information can provide valuable insights into population health, treatment effectiveness, medication adherence, and healthcare spending.

However, these sources are often fragmented across different organizations and systems.

Congress should encourage policies that improve secure data sharing, interoperability, and responsible use of healthcare information.

Better integration of medical and pharmacy data can help identify patients at risk of complications, improve medication management, and support more effective chronic disease programs.

For example, combining laboratory results with pharmacy claims may help identify patients with uncontrolled diabetes, gaps in medication adherence, or opportunities for earlier clinical intervention.

These capabilities can be particularly valuable for Medicare, Medicaid, and commercial health plans seeking to improve outcomes while managing costs.

Policymakers should also encourage value-based care arrangements that reward measurable improvements in health outcomes rather than simply increasing the volume of services delivered.

Healthcare organizations need the flexibility to develop innovative approaches, but those approaches should be evaluated against clear measures of quality, patient experience, access, and total cost of care.

The next generation of healthcare innovation will depend not only on new treatments and technologies, but also on how effectively the system uses information to coordinate care.

What Should Americans Watch as the New Congress Takes Office?

The 2026 midterm elections have created a new political environment for federal healthcare policy. Beginning in January 2027, Democrats will control both chambers of Congress, creating opportunities to advance a different legislative agenda.

Restoring enhanced ACA subsidies and revisiting Medicaid funding changes are expected to be among the early priorities.

Prescription drug affordability, Medicare policy, healthcare workforce shortages, and technology oversight will also remain important issues.

However, congressional control does not guarantee that proposed legislation will become law. The president retains veto authority, and major legislation may face procedural hurdles in the Senate. Bipartisan support will therefore remain important for many significant policy changes.

For Americans, the most important developments will ultimately be measured by four practical questions:

1. Can people afford health insurance and obtain meaningful coverage?
2. Can patients access the medications and treatments they need at a reasonable cost?
3. Can individuals find qualified healthcare professionals when they need care?
4. Can healthcare organizations use technology and patient information safely to improve outcomes?

These questions connect patients, providers, employers, insurers, pharmaceutical companies, and policymakers.

The United States does not need another debate focused exclusively on who pays for healthcare. It needs a sustained effort to improve how healthcare is financed, delivered, accessed, and measured.

A successful healthcare agenda for the newly elected Congress should focus on practical reforms that reduce avoidable costs, protect access, encourage innovation, and improve the health of Americans.

Ultimately, the measure of progress should not simply be how much the country spends on healthcare, but whether Americans receive better care and better health outcomes for the money invested.

About Good Morning Healthcare: Good Morning Healthcare explores the healthcare policies, technologies, innovations, and industry developments shaping the future of healthcare in the United States. Visit www.GoodMorningHealthcare.comfor more healthcare insights and analysis.