Douglas Huynh, JD, Director, Congressional Affairs, APhA
With the midterm elections now in the rearview mirror, there is a lot to digest, both now and in the future. While the results are still preliminary, with some races yet to be called, Democrats flipped at least seven Senate seats and gained close to 40 in the House to take an overwhelming majority in Congress. However, because the White House remains in Republican control and Democrats will still be shy of the 60-vote filibuster threshold, bipartisan collaboration will still be necessary to pass major health care policy. What that means for health care and pharmacists remains to be seen. However, the potential policy impact is enormous as Congress enters the lame-duck stage to close out 2026.
Once Democrats take control of Congress in 2027, current House Democratic leader Rep. Hakeem Jeffries (D-NY) is widely expected to become speaker of the House, with Rep. Katherine Clark (D-MA) taking the reins as majority leader and Rep. Pete Aguilar (D-CA) as majority whip. On the Republican side, Speaker Mike Johnson (R-LA) has indicated he will not seek any leadership positions within his party, leaving the minority leader and whip positions open to potential candidates such as Rep. Steve Scalise (R-LA), Rep. Jim Jordan (R-OH), Rep. Tom Emmer (R-MN), and others. On the Senate side, Sen. John Thune (R-SD) has indicated he will seek the minority leader nomination. However, it is unclear whether Senate Republicans will support the current majority leader after losing the majority.
At the committee level, the change in party control will reshuffle leadership, but pharmacy will continue to have important champions on both sides of the aisle. Three committees have primary jurisdiction over Medicare issues, including the Senate Finance Committee, the House Committee on Energy and Commerce, and the Ways and Means Committee.
Sens. Ron Wyden (D-OR) and Mike Crapo (R-ID) on the Senate Finance Committee are expected to switch places as chair and ranking member, respectively, but both have long-standing records of working on pharmacy priorities, including PBM reform. On the House side, Rep. Frank Pallone (D-NJ) is expected to become the new Energy and Commerce chair, with Rep. Brett Guthrie (R-KY) expected to take over as ranking member. Pallone publicly supported ECAPS during an Energy and Commerce Committee hearing on the bill, and Guthrie has long championed pharmacist recognition and reimbursement issues, previously leading a bill to pay for the full scope of pharmacist-provided patient care services. Lastly, on the House Ways and Means Committee, Rep. Richard Neal (D-MA) is now expected to resume the role of chairman. Rep. Jason Smith (R-MO) is expected to serve as ranking member. Smith strongly supports ECAPS and is currently leading the House effort to pass it into law.
Among the first actions the new majority is expected to take are renewing the Affordable Care Act insurance subsidies, which expired earlier this year, and restoring funding cuts implemented under President Donald Trump’s Big Beautiful Bill to the Medicaid program and the Supplemental Nutrition Assistance Program. Long term, many Democrats are expected to push for Medicare for All, but that is a tough ask with a Republican president.
Regarding pharmacist-related issues, we can expect Democrats to continue to focus on reducing the cost of prescription drugs, including, but not limited to, PBM reform.
On drug pricing, Democrats are expected to push to expand the Medicare drug price negotiation program established under the Inflation Reduction Act. In relation to this, Democrats may clash with the president over his Most Favored Nation pricing model to align US drug costs with international rates, instead favoring direct government price setting and negotiations.
On ECAPS, Smith, who is chair of the Ways and Means Committee, remains an ardent supporter of the legislation and continues to push the bill through. Similarly, Thune is doing what he can to advance the bill through on the Senate side. Because there are a limited number of legislative days left on the calendar, the bill will not be considered on its own and will have to be inserted into a larger package. With enough support from committee chairs and the four corners, ECAPS may be considered as part of a year-end health care package. However, limited funding available for health care priorities could require a more targeted or scaled-back approach.
In the short term, our attention now turns to how the next several weeks of the lame-duck session will unfold. Republican leaders are expected to huddle in the next few days to develop a strategy for the remaining Congress. This is where politics meets policy. Without any action, the federal government is expected to run out of funding on December 11, 2026. Republicans will be encouraged to push certain policy items through before the Democrats take over, to secure the “win” and credit for the policy. Democrats can allow the policy to pass with a short-term continuing resolution (CR) or push back and extend the CR with a long-term funding bill, which will let them set the agenda after they take over the majority on January 3, 2027.
The next several weeks could therefore be as consequential for pharmacy policy as the election itself. A year-end legislative package could provide one of the final opportunities of 2026 to advance bipartisan health care priorities, including ECAPS.
For pharmacists, the message is simple: The election may be over, but the policy fight is not. The lame-duck session and the opening months of the new Congress could significantly shape pharmacy practice, reimbursement, drug pricing, and patient access for years to come.