The Midterms and Medicaid: Oversight, Repair and What Doesn't Change

Democrats’ midterm victories on Nov. 3, which spanned the Senate, House of Representatives and governor’s offices, reflect a mandate to address health care affordability— but not necessarily a unified policy agenda. 

Repealing or modifying the 2025 reconciliation law will likely be an early priority, potentially through budget reconciliation, but any bill that passes is almost certain to be met with a presidential veto.

States can’t count on Congress for near-term relief. Medicaid work reporting requirements and more frequent eligibility redeterminations on Jan. 1, 2027, and the administration retains powerful regulatory tools to continue advancing its health policy agenda.

For the first time since 2010, most governors will be Democrats, potentially signaling greater action and innovation on health care policy at the state level. Those states with new Democratic trifectas may be able to soften the law’s impact, but even they will be limited by the constraints of federal laws that will not change in the near-term. Governors facing divided state legislatures may turn more heavily to executive and waiver authorities.

Listen to this week’s episode of , where host interviews her Manatt Health colleagues , and on the impacts of this year’s midterm elections.

And don’t forget to to The 80 Million Podcast.