Democrats gain Congress with focus on payer oversight and pharmacy benefit managers

Democrats have won control of Congress following the latest elections, Managed Healthcare Executive reported. The Associated Press called the Senate for Democrats late Tuesday and the House of Representatives early Wednesday. According to Managed Healthcare Executive, Democrats held 54 Senate seats to Republicans' 44 as of late Wednesday morning. [1]

Senate races in Alaska and Mississippi remained too close to call and could stay undecided for days or weeks, according to David Becker, director of the Center for Election Innovation & Research, who spoke with USA Today. Managed Healthcare Executive reported that because of a presidential veto from Donald Trump, the Democratic majority will likely focus on funding bills, committee hearings, and bipartisan deals rather than rolling back Medicaid cuts. [1]

Health care plans face immediate regulatory deadlines before the new congressional majority assumes office, Managed Healthcare Executive reported. Future legislative focus is expected to center on pharmacy benefit manager deals, funding battles, and expanded oversight of private health insurers. [1]

Medicaid operates as a state and federal partnership financing hospital care, physician visits, long term care, and preventive services. Total Medicaid spending reached 931.7 billion dollars in 2024, which represented a 6.6 percent increase from the previous year. Federal funds make up the majority of these expenditures, accounting for approximately 28.8 percent of average state budgets. [6]

As FTMQ Health reported earlier, multiple Democratic medical professionals entered the 2026 election cycle for congressional and state offices following federal health policy adjustments. Candidates included Abdul El-Sayed running for the Senate in Michigan, Amy Acton running for governor of Ohio, and pediatrician Annie Andrews contesting the Senate race in South Carolina. [7]