By Megan R. Wilson

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In today’s issue:

• Why Democrats believe this is their moment to begin overhauling the health care system
• A federal watchdog alleges many nursing homes are creating faux diagnoses to hide their use of risky antipsychotic drugs
• Exclusive: As an agency deadline to finalize Medicare Advantage payments looms, advocates are leveraging voter sentiment

Hello, and welcome to Health Brief. While Republicans in the House are sussing out which policies they want to grab from the series of hearings on increasing health care costs, let’s take a step back and look at how Democrats are trying to snatch the moment for themselves.

Do you have any health policy tips or industry intel for me? Are you White House deputy chief of staff James Blair? Reach out. I’m at megan.wilson@washpost.com. If you prefer to message me securely, I’m also on Signal at megan.434.

This newsletter is published by WP Intelligence, The Washington Post’s subscription service for professionals that provides business, policy and thought leaders with actionable insights. WP Intelligence operates independently from The Washington Post newsroom. Learn more about WP Intelligence.

Health policy looms large in Washington this midterm election year. (Elizabeth Frantz/Reuters)

	The Lead Brief

Democrats, the minority party on Capitol Hill, are plotting their political comeback. And they increasingly view distinguishing themselves from Republicans on health policy as the path to victory.

For House Democrats, the battle is more immediate. They’re looking to set themselves apart from Republicans, tackling rising health costs as a way to win seats in November’s midterm elections. Some Democrats in the Senate, meanwhile, have set their sights on a longer-term vision, and are hoping for a unified government in 2028.

Why it matters: The balance of power on Capitol Hill is shaky. Republicans have a razor-thin majority in the House. There are more Republicans than Democrats in competitive races in 2026 — potentially giving Democrats the ability to take back the majority.

Although the Senate is unlikely to flip this election cycle, Dems in the upper chamber hope it could swing in their favor during the 2028 presidential election.

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THE HOUSE

The ramp-up in messaging from Democrats was on full display Wednesday during the final hearing in a three-part series on health care affordability held by a key House committee — a GOP-led effort meant to seize on the issue many voters say is among their top concerns.

The series of hearings examined how insurers, pharmaceutical supply chain players and providers — including doctors and hospitals — contribute to rising health care costs.

While Democrats had previously taken swipes at the GOP approach to health policy — including refusing to extend enhanced subsidies that lowered premiums for people on Obamacare plans — the theme was more predominant during Wednesday’s hearing focused on providers.

Every Democrat on the panel hammered on messaging around the nearly $1 trillion in Medicaid cuts that are expected to stem from Republicans’ tax-and-domestic-policy law, known as the One Big Beautiful Bill, enacted last year.

→ Several Democrats, including Rep. Raul Ruiz (California), pressed the projected downstream impacts on hospitals from the cuts. They cited, with agreement from executives, the potential closure of low-margin hospital departments, including labor-and-delivery units.

It doesn’t matter “if you have Medicare, Medicaid or private health insurance, if the hospitals don’t provide those services, you’re sh*t out of luck … because you’re not getting the care,” said Ruiz, an emergency department physician.

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• The sharper tone represented a shift from the two prior health affordability hearings, during which lawmakers in both parties found common ground haranguing other industries over their business practices and calling for reform.

“This series of hearings was nothing more than a smoke screen from Republicans to distract from the fact they lit a flame to our health care system,” Rep. Frank Pallone Jr. (New Jersey), the top Democrat on the House Energy and Commerce Committee, told me in an emailed statement. “We all agree that health care affordability is an issue, but you can’t trust the arsonists to fix it.”

→ A spokesperson for Rep. Brett Guthrie (R-Kentucky), who leads the Energy and Commerce Committee, highlighted the panel’s other high-profile victories.

• The panel has worked to enact comprehensive reforms for pharmacy benefit managers (PBMs) that had previously languished. It had also championed bills that reauthorized a program meant to incentivize drugmakers to develop treatments for rare pediatric diseases, and paved the way for Medicare coverage of multi-cancer early detection screening tests.

While not all those policies are tied to affordability, the committee “has proven and will continue to prove that we are serious legislators who are actively taking steps to enact meaningful reform for families feeling worried about explosive health care costs and the threat of emerging harmful substances,” Katie West, the Guthrie spokesperson, said in an email.

THE SENATE

Meanwhile, in the upper chamber, Sen. Ron Wyden (D-Oregon) is leading a handful of other Democrats in an effort to lay the groundwork for a set of comprehensive health care reforms to lower costs.

Wyden, the top Democrat on the Senate Finance Committee, on Thursday sent out a “Dear Colleague” letter, along with 11 other senators outlining ambitious policy goals targeting private health insurance and plans to tackle rising monthly premiums and difficulties obtaining coverage.

Although the lawmakers take aim at policies that have been championed by Republicans, Democratic staffers for the committee say that lawmakers want to provide solutions to prove to voters that they can solve the health care problems experienced by Americans.

Last month, Wyden announced the initiative to address prescription drug prices. The next framework will involve policies aiming to make long-term care, including nursing homes and at-home aides, more affordable.

The lawmakers “want to advance transformational change,” said one Democratic committee aide. “They very much believe that our health care system is at an inflection point.”

• The plan is punctuated by targets cracking down on practices employed by insurance companies to control their own costs, including prior authorization requirements, and increased oversight of the industry by limiting executive compensation, tightening medical loss ratio rules, and curbing the role of intermediaries.

“We’re in a blue sky moment. Our members feel incredibly emboldened,” said the staffer, who spoke on the condition of anonymity to talk about the internal matters. The plan is to provide a set of policies, unlikely to receive buy-in from Republicans, that could move “when Democrats next have a trifecta — control of Congress and the White House,” the staffer said.

• There’s also a bullet point in the letter that could set off a fierce interparty battle about how far the government should go when providing health care to Americans: the intent to “explore the benefits of giving all Americans access to Medicare-type choices.”

Universal health care coverage has divided Democrats in the past. Some lawmakers prefer a Medicare-for-all system, while others favor a public option that still allows for private insurers. Others haven’t weighed in or could be wary of a complete insurance overhaul.

Attention industry: The proposals are intentionally vague, said the aide, because Wyden wants members to “do the hard work of actually developing out what those proposals should be.” That will include a series of “office hours,” during which policymakers and outside advocates can provide input as the policies come together.

→ Republicans have argued that they’re going after fraud and abuse in the health care system, including people fraudulently enrolled in government-run health programs.

The Trump administration and GOP lawmakers have also floated alternative policies that would encourage health savings accounts to help pay for care and expand the availability of “catastrophic” health plans that come with lower monthly costs but higher deductibles. 

As part of his affordability agenda, President Donald Trump has urged Congress to codify the policies in agreements he’s made with drugmakers to lower their costs in line with peer nations, which has faced skepticism from Republicans on Capitol Hill.

“If Republicans wanted to work with us on some of these issues, we would certainly have those conversations,” the Democratic committee aide said. “We do not want to compromise on results.”

	From our notebook

A government watchdog report released Thursday found that many U.S. nursing homes are assigning false schizophrenia diagnoses to conceal their use of risky antipsychotic drugs to control patients with dementia.

Although the Office of Inspector General for the Department of Health and Human Services has previously flagged the issue, my WaPo colleague Christopher Rowland reports that it’s the watchdog’s sharpest findings of the alleged deceptive practices thus far.

Why it matters: Nursing homes can avoid reporting use of the drugs — and artificially improve quality-star ratings on a federal comparison website that allows people to compare facilities — if patients are diagnosed with schizophrenia. Doctors can prescribe the drugs “off-label” if a patient is violent and poses a threat to themselves or others.

The American Health Care Association, a nursing home industry group, told Christopher that nursing homes have been pioneering an effort to reduce the use of antipsychotics.

• In a companion report, the OIG said it found that nursing homes often used these powerful medications without first attempting nondrug approaches to manage dementia-related behaviors. The report claims staff told inspectors the drugs were sometimes used to ease workloads by keeping patients quiet.

→ For example: The government watchdog cited an instance where an unnamed facility in Pennsylvania gave a woman who was more than 100 years old an antipsychotic because she enjoyed caring for dolls.

Click HERE to read the full story.

And, ICYMI, check out Christopher’s earlier piece about how advocates are trying to convince regulators to relax restrictions on nursing homes’ use of antipsychotic drugs, “Should the practice of sedating the elderly in nursing homes be loosened?”

	Strategy File

The insurance industry is trying to rally public opinion as it pushes back against a Trump administration proposal that would keep Medicare Advantage payment rates relatively flat next year — emphasizing to policymakers that voters broadly oppose the plan.

A new poll, obtained first by Health Brief, was commissioned by the Better Medicare Alliance, an industry-backed group that advocates on Medicare Advantage policy.

The Centers for Medicare and Medicaid Services proposed a .09 percent payment increase, which insurers have argued is well below what companies need to stay afloat amid the rising cost of health care services and an increasing number of sicker beneficiaries.

• By roughly 2 to 1, voters favor increasing funding rather than finalizing the current proposal. A majority (58 percent) believes such funding could lead to higher premiums and cuts to benefits — mirroring the messages that have been touted by insurers.
• Most respondents (86 percent) enrolled in Medicare Advantage said that the rate will be important in how they vote.

Why it matters: It’s part of a broad lobbying effort to push back against a Trump administration proposal that would keep Medicare Advantage payment rates relatively flat next year, deploying a flood of advertising, direct advocacy efforts and getting lawmakers involved.

Some members of Congress, including Rep. Ryan Mackenzie (R-Pennsylvania), have written to regulators and expressed concern that the proposal could negatively impact benefits and access for 34 million Americans on Medicare Advantage plans.

Other groups, including philanthropy Arnold Ventures, are encouraging Medicare officials to finalize the proposed rate, arguing that private insurers are overpaid. Other advocates say that overall federal payments to insurers are higher once other factors are taken into account.

Mark your calendar: CMS will release finalized rates by April 6.

	What We’re Reading

“A $50 million push hopes to make child care a top issue in the midterm elections,” Moriah Balingit reports at the Associated Press.

“Oz Says California’s Not Fighting Health Care Fraud, but Data Shows It’s Part of a Larger Battle,” writes Don Thompson at KFF Health News.

“Provider consolidation slammed in latest House affordability hearing,” reports Healthcare Dive’s Rebecca Pifer Parduhn.