As of November 4th, Associated Press and network projections show Democrats winning the House and Senate, with at least 54 Senate seats, 228 House seats and 27 governorships. Some races remain uncalled. For employers, the key question is how this shift could shape benefits policy.
President Trump’s veto power and the Senate’s general 60-vote threshold mean major changes will still need bipartisan support. Government funding bills could become key vehicles for benefits legislation, but recent negotiations have produced mixed results.
With federal funding set to expire on December 11, the lame-duck session is the next checkpoint.
Another extension could push negotiations into 2027. The issues below are most likely to surface in funding talks or new hearings.
Pharmacy benefit manager (PBM) oversight remains a bipartisan priority. New laws require full rebate pass-through and detailed spending reports, with commercial requirements taking effect in 2028–2029. A recent Labor Department rule adds fee disclosures for large self-funded plans. Congress may strengthen enforcement or explore commercial drug price negotiations.
Lawmakers may partially restore expired ACA premium tax credits and protect preventive care coverage. Restored credits could shift some workers from employer plans to Marketplace coverage.
Moderate lawmakers may promote Custom Health Option and Individual Care Expense (CHOICE) arrangements, formerly ICHRAs, which let employers fund employees’ individual coverage, and seek tax changes to better align them with Marketplace plans. The group health tax exclusion, valued by congressional analysts at $6.6 trillion over the next decade, could also face scrutiny.
Other potential priorities include national paid and sick leave, worker classification and stronger mental health parity enforcement. Medicaid work requirements begin January 1, 2027, regardless of the election.
State election results could influence oversight of artificial intelligence (AI) in healthcare and insurance. While the Trump administration favors federal rules that override state requirements, election outcomes may bolster state regulators’ efforts to introduce new AI requirements for carriers and vendors.
Medical costs, drug spending, and subsidy changes will likely outweigh election results in shaping 2027 renewals, with premium increases forecast near double digits. Employers should review PBM rebate, reporting and audit terms; confirm mental health parity compliance; and monitor ACA subsidy, CHOICE arrangements, and paid leave proposals. Download the bulletin for more details.