Democrats have so much health care to talk about between now and the 2028 election that you almost wonder how the party could get it all done if they regain power.

Why it matters: Though some of the emerging agenda is driven by ideology and idealism, a lot of it is a response to forces well outside of Democrats' control that will be impossible to ignore.

The big picture: Multiple problems within the health care sector are due to come to a head, and some of the toughest issues they'd face don't make for the most compelling campaign fodder.

• "It's a conundrum for Democrats because only so much can be done at one time by one president, Congress and secretary, and there are real tradeoffs to be considered," KFF's Drew Altman wrote about Democrats' priorities last month.

What they're saying: "Barack Obama was able to enact the Affordable Care Act because he campaigned on it heavily and decided to prioritize it, rightly or wrongly, over climate change at the time," said the Center for American Progress's Topher Spiro.

• "There also wasn't this extent of devastation that we've witnessed with this administration, so there hasn't been as much to clean up before."

1. Cost and complexity

Affordability is top of mind for voters heading into this year's midterm elections, and there's not much reason to think they'll become more comfortable with health care costs by 2028.

• Some Democrats and their allies have already begun pitching a new agenda focused on reining in the business practices of the health care industry and delivering relief to patients.
• While lowering prescription drug costs has always been a priority, their focus has recently expanded to include hospital prices and insurance premiums.

Between the lines: Truly moving the needle on what Americans spend on health care — as opposed to just shifting more of it to the government — requires lowering payments to powerful health interests and risking unpleasant effects.

• It'd take up enormous political oxygen.
• That being said, it could also generate federal savings that Democrats could use to pay for their other priorities.

2. Coverage

The uninsured population is expected to tick back up as a result of Republicans' health care actions (or, in the case of the enhanced Affordable Care Act subsidies, inactions).

• Just when Democrats had finally been pivoting to the underlying cost of care, higher uninsured rates are likely to keep coverage top of mind.
• "Medicaid cuts and extending the ACA tax credits are very high priority," Spiro said.

Yes, but: That doesn't mean Democrats will simply vow to repeal what Republicans have passed, longtime Democratic health care consultant Chris Jennings told me.

• "The vision for the future won't be … repeal and restore; it will be rebuild and reimagine to address the frustrations of the public and the demand for change," Jennings said.
• Regardless, Republicans' Medicaid changes are expected to save the federal government roughly a trillion dollars over a decade, and extending the enhanced ACA subsidies would have cost hundreds of billions more.
• Reversing those policies and turning the spending back on would generate an enormous price tag.

The big picture: There will almost certainly be some other "big thing" that touches both cost and coverage, but what that thing is depends on who wins the Democratic presidential primary.

• The primary itself will likely feature a reprise of the fractious debate over Medicare for All, a public option and other major system changes.
• Enacting any of those is an enormous lift.

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Democrats will also face a host of other issues that have fallen into their laps.

3. The health care bureaucracy

Democrats have been accusing the Trump administration of assaulting the federal health workforce, neglecting public health and abandoning evidence-based policymaking.

• Fixing these perceived problems — in other words, remaking the FDA, NIH and CDC — would be no small undertaking.
• "It's going to take a long time to rebuild and reverse all the damage," Spiro said, describing the federal health care agencies as "decimated."

Between the lines: Restoring federal grants, recruiting new top talent into career health agency roles or convincing a larger share of the public that those agencies are trustworthy may not be the stuff of stump speeches but will make for painstaking work.

4. Abortion

With access to abortion pills once again in legal limbo, fortifying abortion rights seems poised to remain on Democrats' health care agenda.

• It's not splitting the ranks like some of the other topics on this list, but it's yet another topic to add onto a crowded agenda.
• And unity of purpose doesn't assure Democrats will prevail if their efforts are challenged in court.

5. Aging

Americans are rapidly aging, and that's putting a lot of pressure on both federal entitlement programs and families faced with a deeply inadequate caregiving system.

• Regardless of which party wins the 2028 election and what they'd like to be talking about, demographic change may force the issue.
• Extending the solvency of Medicare, Social Security and long-term care benefits could become a necessity during the next presidential term.

6. AI

AI is having an impact on every policy area, and health care is far from immune.

• Privacy protections and safety measures, however, are particularly important.
• Concerns range from the use of AI to deny prior authorization requests to the improper use of AI chatbots for mental health care.

The intrigue: Jennings pointed out that the technology's impact on productivity could end up generating a large pot of new federal revenue.

• That could be used to pay for some of Democrats' policy priorities.
• AI "has to" help fund some of this, Jennings told me. "The appetite not just in health care, but other areas, is just too great."