Congressional Democrats, who will have big majorities in the House and Senate in 2027, are making caregiving and, perhaps, long-term services and supports a top priority. Their heightened focus on long-term care would be a significant shift for federal lawmakers, who largely ignored these issues for years.

This new interest may not result in major policy changes over the next two years, as long as President Trump can wield his veto pen. However, any initiatives Democrats roll out next year could set the stage for more significant changes if the party wins the White House in 2028.

The Affordability Agenda

For now, they may become a key element of the party’s “affordability” agenda, a set of issues that helped Democrats take control of Congress. Along with health care, housing, energy, and others, caregiving has made the priority lists of both House and Senate Democrats.

In the House, a group of more than 100 moderates who call themselves the New Democratic Coalition created a working group on ways to support caregiving for children and older adults.

They are building on some ideas that have been on the table for years. Rep. Debbie Dingell (D-MI) proposed expanding Medicaid home and community-based care as well as creating a new Medicare program for long term services and supports.

Rep. Tom Suozzi (D-NY) developed the WISH Act, which would create a public, catastrophic, long-term care insurance program. His measure has modest Republican support as well as backing from several Democrats.

In the Senate, a group of 19 Democrats, led by incoming Senate Finance Committee chair Ron Wyden (D-OR), has asked for comments on 81 pages of questions aimed at expanding federal support for home and community-based long-term care. These changes likely would come through some combination of Medicaid and Medicare.

While that effort mostly focuses on benefits for care recipients and support for paid caregivers, it also could lead to additional assistance for family caregivers.

By including family caregiving and long-term care reform in their affordability agenda, Democrats would be taking a big step forward. For this long-neglected issue, it is something like getting invited to the cool kids’ party.

But receiving attention and becoming law are very different. Long-term care has four big problems to overcome before care and caregiving really change.

Competing Priorities

Long-term care must compete with a Democratic wish list that is miles long.

At the top are two health-related issues: Restoring the COVID-era subsidies for the Affordable Care Act and rolling back at least some of the $1 trillion in Medicaid cuts passed by the Republican Congress in 2025.

Last year, the GOP lawmakers and the Trump Administration allowed these extra premium tax credits to expire, resulting in 4.6 million people losing their health insurance. Many were people in their 50s and early 60s who were not yet eligible for Medicare.

Efforts to reverse the Medicaid changes will primarily be focused on working age people but some could benefit older adults as well.

Democrats certainly will pass bills to achieve both goals, probably early in 2027. But Trump is almost guaranteed to veto them. That may give Democrats a campaign issue for 2028 but won’t improve anyone’s life.

Then there is the rest of the Democrats’ affordability agenda: lowering costs for food, fuel, housing, and much else.  Long-term care reform is likely to take a backseat to those issues as well.

High Costs

Long-term care is expensive. And expanding or creating a public program will be very costly at a time when annual budget deficits are $2 trillion and the national public debt is $32 trillion and rising. For example, the gross cost of a substantial new Medicare program would be roughly $100 billion annually.  Public insurance could cost about the same.

Democrats could go for a more modest idea, such as creating a federal family leave program. It would be far less costly—about $20 billion-a-year, according to the Congressional Budget Office.

But how much would it really help? And even $20 billion would be on top of the very high costs of all those other Democratic priorities. While Democrats will try to raise taxes on high-income households and corporations, they can use that money only once. Will it be to finance expended ACA subsidies, restore pre-Trump Medicaid, or expand long-term care or support family caregivers?

Complexity

Fixing long-term care is complicated. Restoring ACA subsidies would be far less complex than, say, a major expansion of Medicaid home and community-based services. Creating a new Medicare benefit for long-term care would be even harder.

Democrats could try for ideas that not only are cheaper, but less complicated. They might include family-leave or a new tax credit to assist family caregivers. But that’s not so easy either. Say two adult siblings are sharing the care of their mother. Which of them gets the credit? Do they both? What activities are credit-eligible?

Divided Interests

The fourth problem is the deep division among long-term care interests. Advocates for people with disabilities and those for older adults rarely agree on policy priorities. They did work together to fight Trump’s Medicaid cuts but building consensus on a future agenda will be tougher.

One reason Suozzi’s WISH act is so controversial is the opposition of much of the disability community. While his plan would cover older adults, it requires people to contribute to the program for a period of time before becoming eligible for benefits. And that could leave out many people with disabilities.

Then, there are for-profit and not-for-profit senior service and senior living providers, whose interest often diverge. There are hospitals, health systems, and doctors who will have a stake in long-term care reform. There is the long-term care insurance industry and Medicare Advantage plans, and many smaller risk-based providers that all have different perspectives on long-term care reform.

Entire industries have built their businesses on the current, fragmented, incoherent model. It may be a mess, but for many it is a profitable mess that they will be reluctant to change.

Unsurprisingly, many politicians have been unwilling to wade into those swirling waters. And no reform is likely to move forward until these interests, or at least most of them, can find middle ground.

After all, they share one goal: To get more money into the system. And that’s what many Democratic reform plans would do.

Think of the next months, and perhaps years, as the first steps on a long road towards long-term care reform. But remember, it will only be a beginning.