What the Blue Wave Could Mean for Health Insurance

The election changed who controls Congress. Now comes the harder question: will any of it make healthcare more affordable? That’s what I’m watching, and what employers should be asking.

Democratic leaders want to restore Affordable Care Act subsidies, reverse Medicaid cuts, and investigate healthcare companies. I expect more scrutiny of the industry and attempts to reach deals on coverage and costs. Broad changes such as universal healthcare will be harder to pass.

What Congress Can Change

Democrats take control in January, but President Trump remains in office. Most major bills will need 60 Senate votes to overcome a filibuster, and the president can veto legislation. Democrats can use hearings and investigations to press their case, but passing a bill through Congress does not guarantee it becomes law.

That leaves room for targeted agreements, especially during government funding talks. We see a much harder path for Medicare for All or a broad federal public option. Employers should plan around current law and adjust when a change is enacted.

Coverage Will Be an Early Priority

Democrats plan to seek the return of enhanced tax credits that helped individuals buy Affordable Care Act (ACA) Marketplace coverage. Those extra subsidies expired after 2025. Restoring them could lower monthly payments for eligible households. It could also encourage healthier people to enroll or keep their coverage. Their premiums help balance the costs of people who need more care. Earlier Congressional Budget Office research projected that losing the credits would drive some healthier members out and raise average premiums.

This matters for business owners, early retirees, and employees without affordable job-based coverage. If enhanced subsidies return, Marketplace coverage could become more attractive to some employees. Eligibility for financial help depends in part on whether their employer offers affordable coverage that meets minimum-value standards.

Medicaid is another immediate concern. Democrats want to reverse cuts, while existing law generally requires states to begin work or community-engagement requirements for certain adults by January 1, 2027, subject to exceptions. Employers with lower-wage workforces may field more questions about coverage. Losing Medicaid does not automatically mean someone qualifies for another subsidized plan.

Pharmacy Contracts Need Attention Now

Some changes that matter to employers were already underway before the election. The Department of Labor recently finalized a rule requiring detailed compensation disclosures from pharmacy benefit managers, or PBMs, and certain affiliated brokers and consultants serving large, self-insured employer plans.

The requirements apply to plan years beginning on or after July 1, 2027. For a calendar-year plan, that generally means January 1, 2028. Employers should use the time to review how their pharmacy partners are paid and what information their contracts provide.

The review should cover total drug costs, fees, rebate terms, and audit rights. A large rebate does not prove a plan is getting the lowest overall cost. If we can’t explain how a pharmacy contract works or why we recommended a funding arrangement, we haven’t done our job. Employers deserve more than another renewal spreadsheet.

More Oversight May Take Time to Affect Costs

Incoming Democratic leaders have signaled greater scrutiny of insurer delays and denials, drug prices, and corporate influence in healthcare. Hearings may expose problems and build support for legislation. Their effect on the next employer renewal is less certain.

Costs were rising before the election. KFF reports that average annual family premiums reached $28,303 in 2026, up 5%, with workers paying $7,471 on average. Those national averages do not predict any one employer’s renewal.

Hospital and physician prices also matter. Congressional Budget Office (CBO) research identifies negotiated provider prices as a major driver of commercial insurance spending. I support making coverage more affordable. But helping someone pay an insurance premium and lowering the cost of healthcare are two different jobs. We need to judge policy on both.

What Employers Should Do Next

Employers and their consultants should build budgets from claims experience and actual renewal terms. Waiting for Congress to lower costs could leave them with fewer choices when renewal arrives.

A useful benefits review should examine pharmacy spending, provider networks, and funding options. Fully insured, level-funded, and self-funded plans carry different risks. Any change should fit the employer’s finances and workforce, with a clear explanation of what employees gain and what they may give up.

Consultants should help employees understand coverage changes and enrollment deadlines. Their updates should explain what passed, when it applies, and what action is needed. My advice to employers: pay attention to Washington, but keep working on your plan. Ask better questions about pharmacy costs, provider prices, and where your money is going. Those decisions are still yours to make.