The November elections will decide more than which party controls Congress. They will also help determine who leads the committees that shape Medicare, Medicaid, drug pricing and health insurance rules. Seniority, competing leadership roles and individual preferences will shape the final lineup—and the healthcare agenda that follows.  

Why it matters: Committee chairs have considerable influence over which bills advance and which issues receive oversight. Their choices could affect hospital finances, access to discounted drugs and the burden of prior authorization. 

A new leader for HELP. The Senate Health, Education, Labor and Pensions Committee will have a new chair in 2027 because current Chair Bill Cassidy (R-LA) lost his reelection bid in the Republican primary.  

  • If Republicans retain the Senate, Lisa Murkowski (R-AK), Roger Marshall (R-KS), and Rand Paul (R-KY.) are among the senators to watch. Paul currently chairs another committee. 
  • The Maine race could have ripple effects. If Senate Appropriations Chair Susan Collins loses, Murkowski could pursue the top Republican position on that panel, potentially changing the field for HELP. Marshall must also win reelection in Kansas, which has turned into a highly competitive race attracting national attention. Marshall faces Rev. Adam Hamilton, a Democratic Methodist pastor in the Kansas City area. 
  • If Democrats gain control of the Senate, current ranking member Bernie Sanders (I-VT) would be a leading candidate for the HELP chairmanship. A chairmanship under Sanders could signify a myriad of things, including a push for Medicare for All and other health insurance reforms.  

The 340B watch: Cassidy released a discussion draft in the summer to make several changes to the 340B program, which lets eligible hospitals and other providers buy outpatient drugs at a discount. A successor could continue that effort or shift direction and prioritize other healthcare issues. With several 340B bills currently on Capitol Hill’s menu, who leads HELP would shape next year’s discussions.  

Finance is headed for turnover. The Senate Finance Committee, which has jurisdiction over Medicare and Medicaid, is set to lose Cassidy and fellow Republicans John Cornyn (R-TX), Steve Daines (R-MT) and Thom Tillis (R-NC). Tina Smith (D-MN) is also retiring. 

  • Potential new members could bring different priorities to debates over Medicare payments, Medicaid coverage and Affordable Care Act subsidies. 
  • Bernie Moreno (R-OH) and Dave McCormick (R-PA) are possible candidates for openings, though neither an interest in a seat nor an assignment is guaranteed. 
  • Mike Crapo (R-ID) could remain chair if Republicans keep the Senate. If Democrats take control, ranking member Ron Wyden (D-OR) could be in line to lead the committee. Wyden, similar to Sanders, is interested in advancing health insurance reforms that increase access to care. A document released earlier this year sought comments on several options, including Medicare for All, a Medicare buy-in option, or changes to strengthen coverage such as caps on deductibles and out-of-pocket costs.  

Prior authorization has a bipartisan path. This year, the House Energy and Commerce and Ways and Means committees advanced legislation to streamline prior authorization in Medicare Advantage. Their next chairs could influence whether Congress returns to the issue in 2027 and how lawmakers address insurers’ review practices. AHPA is advocating for Senator Marshall’s Improving Seniors’ Timely Access to Care Act and Medicare Advantage Improvement Act.  

The House equation: A Democratic majority could put Frank Pallone (D-NJ) in line to lead Energy and Commerce and Richard Neal (D-MA) in line to lead Ways and Means. Pallone has also expressed interest in pursuing coverage reforms and wants to look beyond Medicare for All. If Republicans retain control, current chairs Brett Guthrie (R-KY) and Jason Smith (R-MO) could continue leading those committees. Congresswoman Diane DeGette (D-CO, the top Democrat on the House Energy and Commerce Health Subcommittee, will leave Congress in January after losing in the primary elections. DeGette was very supportive of the 340B program and a strong healthcare advocate.  

What won’t change no matter who wins: Regardless of who wins or controls the gavel in these committees, access to care, healthcare affordability, drug pricing, rural healthcare and changes to the No Surprises Act Independent Dispute Resolution process, will be key issues of bipartisan interest that will shape next Congress’ healthcare agenda.

Topics: Congress, Federal News