Health Policy · Healthcare Costs

On a Wednesday in November 2007, a new senator from Illinois spoke to a crowd in Bettendorf, Iowa. Bettendorf is a town by the Mississippi River. The Iowa caucuses were two months away. He was trailing in the national polls. He made a promise that would follow him for years.

“That's how I'll pass a universal health care bill that cuts a typical family's premiums by up to $2500,” Barack Obama said in prepared remarks. “And mark my words — I will sign this bill by the end of my first term as President.” [1]

He did sign a bill. The Affordable Care Act became law in March 2010. But the part of the promise that would affect a family's budget never transpired.

Now jump ahead to this week. In Tuesday's midterm elections, Democrats had flipped seven Senate seats and 21 House seats by midday Wednesday. Health care was a centerpiece of the campaign. In battleground Senate races alone, Democrats spent $65 million on ads focused mainly on health care. Those ads promised lower costs, more coverage, and tougher oversight, starting January 1, 2027. [12]

Before anyone circles that date on the calendar, it's worth looking back. Here's what happened the last several times politicians from both parties promised to "fix" healthcare. And it raises a bigger question: is it time to stop waiting on Washington and reinvent healthcare from the ground up?

Promise #1: “Up to $2,500” Off Your Premium

When Obama made his Bettendorf pledge, the average employer family plan cost $12,106 a year, according to the Kaiser Family Foundation annual survey. [2] By 2016, his last full year in office, that number had climbed to $18,142. [3]

In 2012, the fact-checkers at PolitiFact rated the statement as “Promise Broken.” They found no evidence that premiums would fall for the typical family. They also noted that the economist behind the $2,500 figure stated that he meant it to cover total health spending, not premiums alone. Obama, however, had repeatedly tied it to premiums. [4]

Promise #2: “Insurance for Everybody”

In January 2017, days before taking office, President-elect Donald Trump told The Washington Post that his plan to replace the Affordable Care Act was nearly finished.

“We're going to have insurance for everybody,” Trump said. “There was a philosophy in some circles that if you can't pay for it, you don't get it. That's not going to happen with us.” He said the plan would be “much less expensive and much better.” [5]

The House eventually passed a version of the bill. The Senate did not. No replacement plan became law, and the “much lower deductibles” never came.

Promise #3: Let Medicare Bargain for Lower Drug Prices

This one comes with a twist, because it eventually came true. Just not when anyone said it would.

House Democrats gained their majority in 2006 by promising to quickly address a few key issues. One of these issues was allowing Medicare to negotiate drug prices. They moved quickly. On January 12, 2007, the House voted on H.R. 4, the Medicare Prescription Drug Price Negotiation Act. The vote was 255 in favor and 170 against. [7]

The day before the vote, the White House said President George W. Bush would veto it. Sen. Chuck Grassley (R-Iowa) put it bluntly: “I look forward to a presidential veto.” [8] It never got that far. In the Senate, a weaker version that would only have lifted the ban on negotiation fell short on a procedural vote, 55 to 42. It needed 60. [9]

Medicare finally got the power to negotiate through the Inflation Reduction Act of 2022. Negotiators set the first prices for 10 high-cost drugs to begin in 2026. [10] That's nearly two decades after the House vote.

Promise #4: The Senator Who Ran on Health Care

In 1991, Pennsylvania held a special election to fill the seat of the late Sen. John Heinz. Harris Wofford, a little-known appointee, faced Richard Thornburgh, a former governor and U.S. attorney general. Wofford won, in part by making health care his main issue. [11]

Washington took notice, and health reform became a national fight in the years that followed. But the sweeping reform push of the early 1990s collapsed in 1994. That November, Wofford lost his seat to Rick Santorum in the Republican wave. [11] The candidate who proved health care could win an election never saw his promise become law.

The Scorecard

Why Healthcare Campaign Promises Keep Stalling

The pattern is not about one party. A few forces appear again and again:

• A campaign number is not a budget score. Candidates can promise a dollar figure. The CBO scores bills, and those scores often tell a different story.
• The math of Washington is unforgiving. A House majority is not enough. Most major bills need 60 Senate votes and a president's signature, or enough votes to override a veto.
• Premiums have many moving parts. What you pay reflects hospital prices, doctor fees, drug costs, and how much care people use. A single bill rarely moves all of them at once.

What the 2026 Midterms Promise, and What to Watch

The incoming House majority has already laid out a “First 100 Hours” health agenda. It includes reversing the Medicaid cuts in 2025's One Big Beautiful Bill Act, restoring the enhanced Affordable Care Act premium tax credits that expired at the start of 2026, and adding protections against medical debt. [12]

But there's a familiar obstacle. President Trump still holds the veto pen. He said on election night that he intends to work with Democrats on bills he believes will benefit the country. Even so, Washington analysts are cautious:

Analysts expect smaller, bipartisan bills to have the best shot at trimming medical costs. Areas mentioned include price transparency, prior approval reform, pharmacy benefit managers, physician pay, and surprise billing. [12] Those changes could matter. They're just a long way from “lower costs starting January 1.”

Is It Time to Reinvent Healthcare?

Foster Coulson
Founder & CEO, The Wellness Group

Look back at the scorecard and a pattern shows up. Every one of those promises tried to fix healthcare from the top down: a new law, a new subsidy, a new rule for insurers. Even the one that worked took 15 years. And none of them changed what happens when you sit across from a doctor during a rushed visit.

Foster Coulson, founder and CEO of The Wellness Group, the company behind The Wellness Company, believes the problem runs deeper than which party controls Congress. In his 2025 open letter, he describes care in our times of greatest need as “generalized, depersonalized, and heartless.” Most of us know the scene he paints: a doctor who repeats a generic “standard of care” and sends us on our way with a prescription. [15]

His alternative is what he calls a “closed loop” model. It starts with testing to understand a person's own biology. Those results shape specific recommendations, such as nutrition, targeted supplements, lifestyle changes, or prescriptions. Then new data flows back in, so the guidance gets sharper over time. [14] Instead of one plan built for millions of people, the plan adjusts to one person — the patient.

It's a different answer to the cost problem campaign promises haven't solved. Americans spend an average of more than $14,000 per person per year on healthcare, often bouncing between disconnected apps, specialists, and products with nothing tying them together. [14] Supporters of integrated, prevention-first care argue that catching problems earlier and coordinating care can lower long-term costs while improving outcomes. How far that goes at a national scale is still being tested. But unlike a premium cut, it doesn't need 60 votes in the Senate.

Coulson's larger point is about who's in charge of your health. He wants people to know “they no longer need to outsource their healthcare to the whims of a broken system, that they can take their health into their own hands.” [15]

Your Best Health Plan: Stay Healthy and Be Prepared

If history is any guide, the relief promised on the campaign trail may take years to arrive, if it arrives at all. The good news is that some of the biggest savings come from things no politician controls: staying healthy, understanding your own body, and having a plan before something goes wrong.

Think about the last time a minor illness turned into an unplanned trip to urgent care or the ER. Often it wasn't the illness alone that drove up the bill. It was not having what you needed at home, not knowing your options, and having to decide in a hurry at 10 p.m. on a Saturday. A little preparation changes that.

Nearly 20 years after a promise in Bettendorf, the average family premium has more than doubled. Washington may still deliver on some of this year's promises. But the most dependable healthcare reform may be the one that starts at home: learning what your body needs, preparing before a crisis, and treating health as something you build every day rather than something you buy when you're sick.

As Coulson puts it, “It's not about living forever, it's about living your best life while you're here.” [15]

Frequently Asked Questions

Disclaimer: This article is for general information only and is not medical, legal, or financial advice. It looks at public statements and results from officials of both major parties. It does not support any candidate or party. Foster Coulson is the founder and CEO of The Wellness Group, the company behind The Wellness Company. Talk with a licensed professional about decisions involving your health coverage or care.