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

Authors: Nick Bath , Gayle Mauser and Allison Orris Editors: Patti Boozang and Amanda Eisenberg This episode of The 80 Million Podcast is hosted by Patti Boozang, Manatt Health Senior Managing Director and 80 Million editor. She is joined by her Manatt Health colleagues, partners Nick Bath and Allison Orris and director Gayle Mauser, to discuss what the midterm results mean for federal health policy and the future of the 2025 reconciliation law. tl;dr * 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 will still take effect 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. The 80 Million Impact The midterm elections shifted power in Washington, but they didn’t change the reality facing Medicaid. The 2025 reconciliation law remains in effect, the Trump administration still controls the executive branch and states are weeks away from implementing the law’s biggest coverage provisions. For Democrats, the results represent a significant political victory, but it’s a tactical win rather than a mandate to deliver a particular health care agenda. The challenge for Democrats now is turning voter frustration about growing barriers to accessing and affording health care into a health care platform — while balancing demands for oversight and the ability to govern. The next few months will begin with organizing the new Congress and reshaping key committees, including Energy and Commerce, Ways and Means, Education and Workforce, and Senate Finance. Hearings and legislative markups are expected to pick up around February, although House leadership may move sooner on messaging bills to repeal the 2025 reconciliation law’s health care cuts and extend the Affordable Care Act (ACA)’s enhanced premium tax credits . Repealing or reversing portions of the 2025 reconciliation law, particularly its Medicaid provisions, is likely to be a central priority for the incoming Congress. Budget reconciliation could offer a legislative vehicle to do this without needing bipartisan support