One week ago, voters handed Democrats control of both the House and the Senate, ending unified Republican control of Congress and setting up two years of divided government under President Trump. Last week we shared our first take on what that could mean. Now that the dust has settled a bit, we want to go a level deeper: what happens now, what a Democratic Congress can and cannot do, who to watch, and how organizations can position themselves for the next two years.
For organizations working in Medicaid, HCBS, and disability policy, this election creates a real chance to move from a mostly defensive posture to a more proactive one. The challenge will be finding where meaningful progress is possible without overestimating what a divided government can deliver.
The lame duck still matters
The new majorities do not take over until January 3, 2027. Until then, Republicans still control both chambers, even if the election has weakened their leverage. Congress returned to Washington this week with a lot of unfinished business, starting with the December 11 deadline to fund the government. Funding for community health centers, Medicare payment policies, and telehealth also needs attention before the end of the year.
We expect a fight between a short-term funding bill that runs into early 2027 and a full-year package that Republicans would prefer to finish while they still hold the gavels. Either way, funding legislation is a vehicle for smaller priorities, which could include technical fixes to H.R. 1 implementation or a further delay of the Administration's proposed changes to federal grant requirements. Major Medicaid or disability changes, like reversing work requirements or passing the SSI Savings Penalty Elimination Act, are unlikely this year. The lame duck is mostly about protecting funding and securing targeted extensions.
What a Democratic Congress can do
Starting in January, the agenda changes considerably. We expect Democratic leaders to focus on health care affordability, coverage protections, ACA subsidies, and the Administration's implementation of H.R. 1, with Medicaid at the center as states roll out changes to eligibility, enrollment, and financing. The new majority's influence will show up in three main ways:
Oversight. Hearings and investigations into how CMS is implementing H.R. 1, how many people are losing coverage, and whether states are ready.
Appropriations. More leverage over FY 2028 Labor-HHS funding and report language for CMS, the Administration for Community Living, SAMHSA, and other agencies.
Targeted bipartisan bills. Republicans looking to reconnect with voters and Democrats looking for wins are likely to find common ground on narrower reforms. Prior authorization, ACA subsidies, cybersecurity, and AI are likely health policy focus areas, and HCBS and the direct care workforce are strong candidates in the Medicaid space.
What it can't do
It is just as important not to overstate what the results mean. Democrats will control Congress, but not the federal government. President Trump keeps his veto, Democrats will not have the votes to override it in either chamber, and most major legislation in the Senate still needs 60 votes to overcome a filibuster.
H.R. 1 and its Medicaid cuts remain federal law. The new Congress can introduce bills to modify or repeal parts of H.R. 1, but those bills would still need President Trump's signature. That makes a comprehensive reversal highly unlikely, and H.R. 1's changes to Medicaid financing, eligibility, and enrollment will likely stay in effect for the foreseeable future.
Major new federal spending will be difficult. Between the Administration's opposition and Congress's fiscal constraints, expanding HCBS funding, creating new federal workforce investments, or adding Medicaid benefits will require a deliberate legislative and budget strategy.
Committee control does not equal control of the executive branch. Democrats can investigate HHS, CMS, and other agencies, demand information, and hold hearings. They cannot dictate administrative decisions or require the Administration to adopt their interpretation of the law. Oversight can expose problems and build a case for change, but it does not reverse statutory requirements on its own.
A Democratic majority does not guarantee consensus on health policy. The incoming caucus includes members with different views on federal spending, Medicaid financing, Medicare for All, private insurance, and the role of government. Building agreement within the majority will be the most important step in advancing any health proposal.
The Administration keeps significant regulatory authority. CMS and other agencies will continue to implement federal health laws, issue regulations, and make administrative decisions. Congressional oversight can influence those actions, but the Administration will still control much of executive branch policy.
The bottom line: further congressional Medicaid cuts are now highly unlikely, but that does not undo the policies already enacted or guarantee new investment in services. Knowing where the real openings are, and where they are not, is exactly where a strategic partner can make a difference.
New gavels, new champions
Committee control is one of the most consequential outcomes of this election. Democrats will now run the committees that write health legislation, oversee federal agencies, and set spending priorities. Sen. Ron Wyden (D-OR) is likely to chair Senate Finance, and Rep. Frank Pallone (D-NJ) is likely to chair House Energy & Commerce, the two committees with the most say over Medicaid. But the real work happens in the subcommittees, through the appropriations process, and with the oversight committees that will shape how H.R. 1 implementation is scrutinized.
The incoming class is just as important. We have already identified more than a dozen new and returning members whose backgrounds in medicine, public health, state Medicaid policy, and lived disability experience make them strong potential champions. Sen. Josh Turek (D-IA), a two-time Paralympic gold medalist who uses a wheelchair and was critical of H.R. 1's Medicaid cuts during his campaign, is one example. The opportunity is not just to find members who already share your priorities, but to reach them early enough to help shape how they understand Medicaid and disability services, before their agendas are set.
Don't forget the other side of the aisle
Republican leadership is changing too. Speaker Mike Johnson (R-LA) has announced he will not seek another term as Republican leader, and Reps. Steve Scalise (R-LA) and Jim Jordan (R-OH) are among the potential successors. That means relationships and priorities built under the previous leadership may not carry over.
It also means bipartisan relationships matter more, not less. Under divided government, anything that actually becomes law will need Republican support and President Trump's signature, so Republican partners remain essential.
Where we go from here, and how we can help
The 2026 midterms mark a major shift in the federal policy environment for Medicaid, disability services, and health care. For organizations serving people with disabilities and Medicaid enrollees, we see five priorities for the months ahead:
Use the lame duck strategically. Republicans control the agenda through January 3, and the December funding deadline and expiring health programs create immediate chances to protect funding and advance targeted fixes.
Engage the incoming Democratic leadership. Build relationships now with the new chairs of Energy & Commerce, Ways & Means, Finance, and HELP, along with their subcommittee leaders and staff.
Identify the next generation of champions. New members with personal experience with disability, health care backgrounds, or state Medicaid experience are worth reaching early, before their priorities are set.
Preserve bipartisan relationships. Republicans remain essential partners for anything that can become law under President Trump.
Protect existing Medicaid and disability services. Keep a close eye on H.R. 1 implementation and use oversight to surface and address unintended consequences.
This is a moment to move from a primarily defensive posture to one that pairs protecting existing programs with a proactive effort to shape the next generation of federal health and disability policy. That shift is easier with a partner who knows the committees, the staff, and the policy inside and out.
That is where we come in. We are already working with our clients on exactly this: a detailed map of the committees, subcommittees, and staff that matter most for their priorities, profiles of the new members worth knowing, and a plan for the lame duck and the first months of the new Congress. Windows like this one do not stay open long, and the organizations that move first will have a real advantage.
If your organization is figuring out how to engage this new Congress, we would love to partner with you. Get connected with us: pattersonandmeek.com/get-connected