Healthcare Is on the Ballot—and Affordability Is the Test

October 20, 2026

By Allison Parker-Lagoo speaking with Mannar Hanna, Justine Handelman and Vusi Moyo

About nine in 10 voters told the Kaiser Family Foundation (KFF) that healthcare costs will influence how they vote in the U.S. midterm elections. APCO’s October 14 webinar, the fourth in its 2026 midterm series, set the horse race aside and focused on what comes next: the lame-duck session, the new Congress and how health organizations should prepare. The bottom line: Every part of the health sector will be asked to prove what it is doing on affordability.

Every Health Organization Needs Its Own Affordability Story

When it comes to the healthcare affordability crisis, one meme comes to mind: three Spider-Men (or is it Spider-Mans?) standing in a circle, each pointing at the others.

Stop pointing fingers, Spider-Man. Er, health organizations. The message isn’t landing with anyone.

Democrats, Republicans and, most importantly, the public are not interested in the blame game. They want real action. One part of the health sector saying the problem lives with another is not a communications or business strategy. Even within the Make America Healthy Again (MAHA) movement, which both parties are courting as a stakeholder in its own right, MAHA voters rank lowering healthcare costs as their top issue, ahead of food additives and vaccine safety. Every part of the health sector needs to show what it is doing itself, with true proof of investment and measurable patient savings.

For pharmaceutical companies, that means telling stories of domestic manufacturing or onshoring, local workforce benefits and lower costs. Hospitals need to make two arguments at once: why their communities depend on them, and what they are doing to make care more affordable, including real price transparency. Medical technology companies should show how their products lower the total cost of care, such as fewer readmissions, shorter stays or care moved to lower-cost settings, and how they are absorbing tariff and supply chain pressures rather than passing them on to patients. Insurers can explain their program integrity, prior authorizations framework and anti-fraud efforts, which officials may not realize are happening.

Trust in medicine, science and the institutions behind them is no longer enough on its own. The system is interdependent, and offering viable solutions beats simply saying, “What about the other guy?”

Midterms Mean Oversight, Not Overhaul for Healthcare

Democrats and Republicans are framing healthcare differently heading into the midterms, with affordability and access on one side and fraud, waste and abuse on the other. But both parties are scrutinizing the entire sector, and understanding that is essential to planning for the lame-duck session and the 120th Congress.

When the dust settles, a crowded health agenda will be waiting. Medicaid cuts, drug pricing, pharma and device tariffs, public health policy and artificial intelligence in healthcare are all moving at once, with executive actions and lawsuits adding to the churn. That churn will continue no matter who wins.

In the scenario we discussed most closely, Democrats win the House and Republicans keep the Senate. The House would likely advance messaging bills on affordability and drug pricing and hold hearings on coverage losses, drug shortages, agency decisions and executive actions. Senate Republicans would still control nominations and the floor. A “blue wave,” in which Democrats win both chambers, would bring even more oversight hearings, but sweeping healthcare reforms are unlikely in the next two years.

For instance, reopening last summer’s reconciliation law is unlikely, though adjustments to individual provisions are possible. Smaller bipartisan measures could move, including transparency requirements across the sector, pharmacy benefit manager (PBM) reform, the No Surprises Act, physician payment and Medicare Advantage coding. Restoring the enhanced Affordable Care Act (ACA) tax credits to their previous level also looks unlikely, though Democrats could force votes to frame the 2028 debate.

Scrutiny could also extend to the 26 pharmaceutical companies that signed most favored nation (MFN) pricing agreements. Companies should make their deals and narratives disclosure-ready and consider the ripple effects on global launches. The White House has asked Congress to codify MFN, but legislation has not moved and we see limited appetite for it. Medical technology and generics manufacturers face their own tariff and supply chain exposure, and the impact varies by company.

In the near term, the lame-duck session is the window. Government funding expires December 11, and year-end health extenders could carry other provisions. Organizations should share their priorities now, backed by strong data and, for proposals that cost money, ideas for offsets. Expected turnover on key health committees also means new chairs and members, so build relationships with both parties and with trusted messengers such as physicians, patients and state officials before a crisis hits.

Key Takeaways

Affordability is the common thread, and every part of the health system should expect scrutiny.
A divided Congress points to oversight and small bipartisan measures, not sweeping reform.
Use deadlines, including December 11, to prepare asks backed by data.
Build relationships on both sides of the aisle, including with new committee members, and monitor stakeholders like MAHA as they continue to determine priorities.
Make deals and narratives disclosure-ready, and plan for multiple election scenarios.
Put the pointed fingers down: Show proof of investment, patient savings and local benefits, not blame.

APCO’s health and government relations teams help organizations build affordability stories that hold up to scrutiny from both parties, prepare and execute against scenarios and build relationships that support business strategies. To discuss what the midterms mean for your organization, contact us. Our series continues October 28 with a look at state-level issues.