What the US midterm elections mean for healthcare and pharma

The US midterm election outcome will shape healthcare coverage, drug pricing and pharmaceutical supply chains, but bipartisan pressure for domestic manufacturing will persist.

• On 3 November, all 435 House seats and 35 of 100 Senate seats are contested; a Fox News poll showed Trump’s approval at a record low and Democrats leading nationally by around 8 percentage points.
• Democrats favour expanded Medicaid, broader insurance coverage and permanent ACA subsidies, while Republicans prefer greater state responsibility; both parties want lower drug prices and more US manufacturing, but Democrats favour Medicare negotiation and Republicans favour MFN pricing and trade pressure.
• A Republican victory would preserve policy continuity, enable Medicaid restrictions and give Trump more scope to pursue MFN pricing, tariffs and company agreements, while coverage losses could hurt Medicaid-heavy hospitals and pharmaceutical volumes.
• A divided Congress would produce investigations and scrutiny of MFN deals, tariffs and Medicare negotiations, but major reform would likely stall because a Democratic House would face a Republican Senate and a presidential veto.
• A Democratic clean sweep could restore ACA subsidies, soften Medicaid cuts, expand Medicare negotiations and protect NIH and FDA funding; this would reduce consumer costs and support research, but increase pricing pressure on pharma.
• US imports more than half of its pharmaceuticals from China, while ING forecasts Chinese outlicensing above $250bn this year, nearly double the 2025 deal value; licensing restrictions are now considered more likely from Beijing than Washington.

Takeaway: Investors should distinguish between election-specific changes in coverage and drug pricing and the durable bipartisan push to localise pharmaceutical production, which leaves Europe exposed to lost manufacturing, intellectual property and partnerships.