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For the first time since 2008, Democrats are poised to control both chambers of Congress and the White House once Joe Biden is sworn into office. The last time Democrats had complete control of Washington they used their political capital to pass the Affordable Care Act (ACA).

So, should we expect more sweeping change now that Democrats can once again run the field? Probably not.

There are two big differences between 2008 and now: Democrats razor-thin majorities in Congress and the COVID-19 pandemic that will continue to dominate DC.

What can healthcare leaders expect from a Democratic-controlled Washington? Here are a few thoughts:

More and bigger COVID-19 relief. While the idea of $2,000 stimulus checks for most Americans has grabbed headlines, Biden and congressional Democrats are certain to push for a new round of federal COVID-19 relief. That means additional dollars to support cash-strapped healthcare providers and more money to boost the sluggish vaccine rollout. Knowing this, now is the time for healthcare leaders to be in contact with their federal elected representatives to discuss the impact COVID-19 has had on their organization, team and community.

Shoring up the ACA. The thin majorities in the House and the Senate limit Democrats’ ability for large-scale healthcare reform like a public option or Medicare for all. However, expect Biden and congressional Democrats to restore ACA funding that was cut by the Trump administration and push for new exchange subsidies that would lower the overall consumer cost to purchase plans through the exchange.

Additional scrutiny on (some) healthcare consolidation. For months, experts have predicted that the financial challenges created by the pandemic will accelerate health system consolidation. At the same time, president-elect Biden has suggested healthcare mergers, especially mega-mergers, will receive additional scrutiny. Acquisitions of rural hospitals and smaller health systems are unlikely to receive the same attention from federal regulators as the mega-mergers.

Friendlier environment for unions. President-elect Biden has promised to be “the strongest labor president” ever. Additionally, Biden has chosen Boston Mayor Marty Walsh, a former labor union leader, as his Labor secretary. With Biden in the White House and Democrats controlling Congress, look for movement on the PRO Act, a rewrite of the National Labor Relations Act, that would make union organizing easier and weaken right-to-work laws.

With changes expected on both the legislative and regulatory fronts, now is the time for healthcare executives to have a thoughtful conversation with their leadership team about how change in Washington will impact their organizations. And, it never hurts to establish or renew relationships with your elected representatives to ensure your organization’s point of view is known.

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