Both Republicans and Democrats have unveiled their visions for health care ahead of the 2026 midterm elections, with a combined 3 pages of text. The White House released The Great Healthcare Plan for Republicans, while Senate Minority Leader Chuck Schumer (D-NY) took the lead for the Democrats with the Democratic Vision for Health Care. While there were some common mentions, namely improving health care affordability, lowering costs, and holding health insurers accountable, what might be the most revealing is what has been left out of the conversation.
This blog walks through 3 major health policy areas missing from both plans and where we can look beyond these messaging documents for answers to where the parties stand on these health care issues.
The Medicaid Silence
The lack of discussion on Medicaid in either plan is staggering. For a program that covers more than 75 million Americans and is the single largest payer for long-term care, behavioral health, and births in the US, a mention might be warranted. But the Republican plan does not mention Medicaid at all. The Democratic plan fares only slightly better, with vague references to “15 million losing care,” and “750 plus hospitals at risk.” These are claims that Democrats often attribute to changes to Medicaid under the OBBBA due to the implementation of community engagement requirements, changes to state directed payment rates, and limiting provider taxes. However, even though the claims are made, the plan does not reference what actions Democrats would take to strengthen the Medicaid program if they were to flip Congress in November.
For providers that often care for a large share of Medicaid patients, such as safety-net hospitals, managed care plans, and long-term care providers, neither party’s proposal explains what to expect should they be in power. In an industry where information is critical, the silence is deafening.
Workforce: A Value, But No Plan
The health care workforce shortage is arguably one of the most time-sensitive issues facing the health care industry. The Association of American Medical Colleges projects a shortage of 86,000 physicians in the next decade, and the American Association of Colleges of Nursing has shared data which predicts a shortage of 63,720 registered nurses in 2030. Even a fraction of these projections would lead to access challenges due to hospital closures and increasing long wait times for care.
And yet, neither the Republican plan nor the Democratic plan offers input on the many policies suggested to address health care workforce challenges, such as graduate medical education funding, top of license practicing, or improvement of visa programs to allow for more foreign-born nationals to fill the gaps. While the Democratic plan does list “a strong workforce” as a value, a bullet without a mechanism for action does not hold a lot of promise.
The AI Elephant Not in the Room
Artificial intelligence (AI) is the fastest moving area in health care policy, as providers, regulators, and policymakers grapple with how the technology fits into the health care landscape. And yet, neither plan makes any suggestions or offers insight into how each party will approach AI regulation or use in health care settings.
However, now is not the time to be passive. AI is already being used across the federal government, such as for reviewing prior authorizations in Medicare through the Wasteful and Inappropriate Service Reduction (WISeR) Model at the Centers for Medicare and Medicaid Services (CMS) or aiding in approving drug applications at the Food and Drug Administration (FDA). Without a clear path forward for federal action, individual state regulations could create a haphazard regulatory environment for providers, health systems, and pharmaceutical companies to navigate.
Reading Between the Lines
In Washington, you often have to look deeper than the messaging documents that make the headlines. To understand where the parties actually stand on these issues, and not just what they will be campaigning on, looking past the press releases to see what the White House and leaders of health care committees in Congress are working on can fill in the gaps and provide context.
- Medicaid: Republicans have been laser-focused on fraud, which can be seen by recent actions taken by CMS to pause hospice and home health agency enrollment in Medicare and the House Ways and Means hearing on preventing Medicare fraud. In contrast, Democrats have highlighted the impacts of OBBBA Medicaid funding changes in reports and have advocated for their reversal at numerous hearings.
- Health Care Workforce: There are numerous bipartisan bills that have been introduced to address the health care workforce crisis; however, each party has preferred proposals. Republicans often support bills to improve domestic supply of physicians, improving rural training programs, and reducing administrative burden. On the other hand, Democrats have emphasized expanding funding for health care training facilities and expanding immigration pathways as a stopgap.
- AI: The Trump administration has been pro-adoption of AI in health care, including releasing an RFI on Use of AI as Part of Clinical Care, issuing a proposed rule with provisions intended to make it easier for AI to be used as it relates to electronic health information, and implementing the WISeR model. Republicans have generally supported these moves, while Democrats have been much more skeptical. For example, congressional democrats have introduced bicameral legislation to prevent the WISeR Model from going into effect.
What This Means for Health Care Leaders
With the plans released and the midterms fast approaching, here are a few takeaways on how best to engage with the health policy landscape and shape your federal engagement strategy.
- Don’t focus only on the plans: while helpful guides, these plans are only campaign tools. Policy decisions are still being made in committee rooms and in agency offices. Tracking and understanding these updates can provide important context.
- Engage with decision makers now: movement is happening in health policy, regardless of campaign promises. Providing input to agencies through comment letters and meetings with lawmakers is more important than ever if you want your perspective represented.
- Watch the year-end vehicles and other legislative packages: These are the most likely avenues for policy to move. Tracking and advocating on legislation can continue to advance your interests.
The Bottom Line
Both health care plans reflect each party’s desire to address health affordability concerns but leave out other key health policy conversations. These messaging exercises help to highlight what they want voters to focus on in the lead up to the November midterms, but if you want to understand what is truly happening in Washington, looking at the actions of the administration and leaders of health care committees in Congress can help to shape federal engagement strategies and give a better sense of what is – or isn’t – coming.