With the expiration of enhanced Affordable Care Act tax credits driving up premiums by more than 20 percent and enrollment falling for the first time in years, Democrats are scrambling to craft a new healthcare agenda that can recapture voter trust ahead of the midterms. Polling from Emerson College in June placed healthcare among the top five issues for voters, trailing only the economy, threats to democracy, and immigration.
Congressional Democrats suffered a major setback earlier this year when the enhanced ACA subsidies lapsed, despite a 39-day government shutdown—the longest in U.S. history—that they initiated to force a vote on extending them. The House passed a three-year extension, but the Senate has not acted, leaving a policy vacuum that progressive and centrist groups are now racing to fill.
In March, the Center for Health and Democracy (CHD) unveiled “Medicare by Choice,” a proposal drafted by former Democratic aides and ex-CMS staffers. The plan would allow all Americans—regardless of age—to opt into Medicare, and would let employers select it as a workplace benefit. CHD is positioning the idea as the party’s 2028 healthcare platform.
Last month, the Searchlight Institute released its own blueprint: making primary care free for everyone and establishing a nonprofit public option for coverage. The group invoked former President Obama’s description of the ACA as a “starter home,” arguing that “now is the time to upgrade that starter home by making health care work better for all Americans.”
Natasha Murphy, director of health policy at the Center for American Progress (CAP), told The Hill that Democrats across the ideological spectrum are “champing at the bit” for ideas that address both premium affordability and out-of-pocket costs. “It’s been my experience that Democrats are certainly open to new and fresh ideas on the latest healthcare challenges,” she said.
The left flank of the party is pushing even further. Ten years ago, Sen. Bernie Sanders (I-Vt.) was a lonely voice for Medicare for All; now, multiple non-incumbent Democratic candidates have embraced it. Senate hopefuls including Maine’s Graham Platner, Illinois Lt. Gov. Juliana Stratton, and Michigan’s Abdul El-Sayed have all endorsed a single-payer system. Stratton has pointed to rural hospital closures as a reason for the policy. In House races, Pennsylvania’s Bob Brooks and New Jersey’s Adam Hamawy—a physician—have also backed Medicare for All.
Pollsters see healthcare as a defining issue for Democrats. Marissa Padilla, a partner at Global Strategy Group and a former Obama health staffer, said, “Voters trust Democrats more than Republicans to address health care issues. There is a meaningful share of the electorate, especially Independents, that doesn’t trust either party. And there is an opening for candidates to appeal to these voters.”
Not all strategists are on board with sweeping proposals. David Kendall, a senior fellow at the centrist Third Way, cautioned that “the public is looking for guarantees, not choices. People want something that’s achievable, that people can understand and that will give them immediate relief from costs.” Third Way released its own “Health Care Bill of Rights” earlier this year, calling for caps on costs, an end to medical debt, a ban on junk insurance, and a prohibition on surprise billing.
As Democrats vie for control of the House and Senate, the debate over how far to go—and how fast—remains unresolved. The collapse in ObamaCare enrollment has underscored the urgency, but the party must also navigate internal divisions and a skeptical electorate. Meanwhile, the Senate panel probing AI’s role in cutting costs suggests that technology could also play a part in future reforms.
