Democrats will be able to take plenty of messaging votes on health care after their blowout wins yesterday — but they'll face too many limits and internal disagreements to force all of the big policy changes they want.

Why it matters: They'll have a tough time repealing Medicaid cuts or restoring enhanced Affordable Care Act subsidies while President Trump is still in office, and their own divisions will hold them back on other issues.

• And Medicare for All? Last night gave the idea a big boost, but don't hold your breath.

Friction point: With control of both the Senate and House, Democrats will have powerful new leverage — but that leverage will also expose fault lines.

• Until now, progressives backing Medicare for All and centrists favoring more incremental changes were united in opposing Trump administration policies and blaming the president and the Republican Congress for the health affordability crisis.
• They'll try to use their power in the next Congress to promote sweeping changes with an eye toward the 2028 elections while also advancing more piecemeal policies, hoping to force some deals with Republicans.
• But they'll still face divisions over how to expand the federal government's role in the health system, or how to bend the steep health cost curve.

Driving the news: House Democrats have already signaled their opening moves with a 100-hour/100-day agenda that prominently features health policies like reinstating the enhanced ACA tax credits that expired at the end of 2025.

• There will also be votes to roll back the steep cuts to federal Medicaid spending that Republicans included in their "One Big Beautiful Bill," per an 84-page memo from a health care working group to Democratic Leader Hakeem Jeffries (D-N.Y.).
• Other near-term agenda items include expanding Medicare drug price negotiations to private insurance, restoring withheld National Institutes of Health research funding and ending the use of AI in authorizing certain services in traditional Medicare.

Within the first year, the blueprint also envisions votes on Medicare for All, a government-run public insurance option and plans to let many Americans under 65 buy into Medicare.

• There will also be a heavy dose of oversight, with multiple committees intent on using their subpoena power to examine details of Trump's drug pricing deals and Health Secretary Robert F. Kennedy Jr.'s vaccine policies.

Reality check: Little of this would reverse the rising cost of care. And Democrats could spend a lot of energy next year playing whack-a-mole trying to target various expenses, like hospital spending, insurance premiums and the cost of insulin.

• Some policies, like site-neutral hospital payments, could generate billions in new savings to pay for coverage expansions, and even generate some bipartisan support at a time when more lawmakers are fed up with hospital consolidation and prices.
• There's also growing interest in how surprise billing disputes are driving up costs.

Between the lines: The biggest winner Tuesday may be the progressive wing of Sen. Bernie Sanders (I-Vt.) and Rep. Alexandria Ocasio-Cortez (D-N.Y.).

• Strengthened by the Senate victory of left-wing Democrat Abdul El-Sayed in the critical swing state of Michigan, the progressives can make a national case for Medicare for All — though the definition may be squishy.
• Expect many lawmakers to offer assurances that Americans can keep their health care if they want it, with a consensus likely forming around compromises like a Medicare buy-in.

Actual dealmaking will largely be driven by big legislative vehicles, like bills to keep the government funded and address the debt ceiling, that could be magnets for health policy changes.

• There also are certain must-do's, like a "doc fix" to shield physicians from scheduled Medicare reimbursement cuts and a reauthorization of FDA user fees to fund new product reviews.

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Public frustration with the health system helped drive the vote in key congressional races across the nation yesterday, laying the groundwork for Democrats to pursue a populist agenda next year.

Why it matters: If it wasn't exactly a mandate, it was a strong rejection of the status quo that could strengthen efforts to expand coverage and to confront insurers, drug companies, pharmacy benefit managers and other prominent players.

• Growing public acceptance of Medicare for All should also give progressives like Ocasio-Cortez a clear lane to enter the 2028 presidential fray and tilt the debate toward more sweeping policy changes.

Here are the results in key races where the winning (or leading) candidates' positions on health costs and coverage played a major role:

Senate

Michigan: El-Sayed defeated Republican Mike Rogers in a decisive victory for the left wing of the party. (All results cited here are from the AP.)

• El-Sayed ran on Medicare for All and proposals like canceling medical debt, cracking down on hospital mergers and broadening Medicare drug price negotiations. His victory could give a boost to progressives who want to push those ideas.

Ohio: Democratic former Sen. Sherrod Brown ousted incumbent Republican Jon Husted.

• Brown blasted insurers' denials of needed care as well as their pricing behavior. His return to the Senate will bring an experienced populist voice to Democrats' health care agenda.

Maine: Incumbent Republican Susan Collins conceded to Democrat Troy Jackson, another single-payer health care supporter.

• Collins has been a key moderate GOP voice on health care for years. She's also a frequent cog in bipartisan dealmaking, meaning the Senate will lose a key negotiator should the next Congress attempt bipartisan reforms.

Iowa: Democrat Josh Turek defeated Republican Ashley Hinson.

• This is one race where both candidates ran as populists slamming the health care industry. Hinson charged that "health care companies are ripping you off," and Turek — who was born with spina bifida — promised to "take on" Big Pharma and pharmacy benefit managers to lower prescription drug prices.

House

Iowa's 1st Congressional District: Democrat Christina Bohannan defeated Republican Rep. Mariannette Miller-Meeks.

• Bohannan proposed allowing Americans to buy into Medicare at any age, while Republicans campaigned for Miller-Meeks — a doctor — by highlighting her role in securing more funding for rural hospitals.

Wisconsin's 3rd Congressional District: Democrat Rebecca Cooke defeated Republican Rep. Derrick Van Orden.

• Cooke proposed expanding Medicare to cover vision, dental and hearing benefits. Van Orden embraced his vote for the GOP budget bill, playing up its funding for rural Wisconsin hospitals at the GOP's midterm convention in Dallas.

Arizona's 6th Congressional District: Though this one had yet to be called by the AP, Democrat JoAnna Mendoza was leading Republican Rep. Juan Ciscomani 53% to 45% as of 7am ET.

• Mendoza attacked Ciscomani's vote for the GOP budget bill with Medicaid cuts, while Ciscomani insisted the GOP is protecting the program against fraud and abuse.

Arizona's 1st Congressional District: This one also hadn't been called, but Democrat Amish Shah was running ahead of Republican Jay Feely 53% to 45%.

• Shah, an emergency room physician, took fire from Republicans for his past support for Medicare for All. He campaigned as more of a centrist, with his website committing to "expand coverage, protect Medicare, and lower prescription drug prices."

Elsewhere, abortion rights ballot measures passed in Virginia and Nevada, while Missouri's measure to restore an abortion ban failed. Idaho's measure legalizing abortion in the state up to fetal viability also failed.

The bottom line: While diesel prices, war with Iran and multiple economic concerns got enormous airplay, 2026 was still very much a health care election.

Don't be fooled: While Americans said health care wasn't the biggest factor that drove them to the polls this election cycle, medical costs are folded into broader concerns about affordability and the economy that did.

Why it matters: Voters have sent a clear signal: They feel like the cost of living is too high, and they want Washington to do something about it.

By the numbers: Only 8% of voters named health care as their top issue in CNN exit polling, compared with 39% who listed the economy.

• But 85% of respondents told NBC News they're concerned about the cost of health care, nearly the same share as those who said they're concerned about the cost of gas, food and utilities.

What they're saying: "Caution: post election polls that list 'health care' as a separate voting issue will miss the story. Health care costs is the issue moving voters now, and it's part of their cost of living and economic concerns," KFF CEO Drew Altman wrote on X.

What we're watching: Results are still rolling in, but it's looking like Democrats had a very good night amid these widespread cost of living concerns.

• Next up: Figuring out what to do about them. That won't be easy — health care costs have always gone up.