Three Republicans were running in Michigan’s 8th Congressional District primary. Trump in June endorsed Amir Hassan, a Navy Veteran, former Guantánamo guard, and Department of Homeland Security official. Hassan was up against Thomas Smith, a retired engineer, and Al Lemmo, an anti-abortion activist. In July, Smith suspended his campaign and endorsed Lemmo, who had decried Hassan as a “possible Trojan Horse candidate and lifelong Democrat.”

On Tuesday, Smith, who was no longer running, won a pretty clean victory over his Trump-endorsed former opponent.

Though the AP called Abdul El-Sayed the winner of the Democratic nomination for Senate in Michigan as I went to publish this post, this race turned out to be much, much closer than people expected or what polls predicted. The margin ended up being just under 1% or about 15,000 votes. We become so entranced by polls that we often fall into thinking that a candidate like El-Sayed bobbled the race at the end or Stevens mounted a comeback. There may have been some late movement. But it’s important to remember that our narrative of the race was built around polls that were simply wrong. Very wrong. It was probably always much closer than people realized. Indeed, the margin is close enough that those polls might actually have shifted the outcome of the race by depressing Stevens’ turnout or juicing El-Sayed’s. It’s a good reminder that whether you’re a volunteer, a voter, an activist, or a campaign worker you play these things out till the very end. Polls are usually right. And they’re a good guide. Except when they’re not. And this was a big “except.”

On July 26 in Pennsylvania, House Democratic Leader Hakeem Jeffries introduced the party’s Fighting for an Affordable America agenda to mark 100 days until November’s midterm elections. The plan, according to the Associated Press, calls for “restoring healthcare cuts, bringing the cost of living down and ending the war in Iran to beat Republicans and hold President Donald Trump accountable.” 

Democrats always want to run on kitchen table issues, and this time they have an opening you could drive the Titanic through. Even among Trump’s most fervent followers, the war in Iran is unusually unpopular; it’s the first time I can ever remember Republicans not rallying around a war started by a GOP president. In fact, the party used to rally around so-called “Democrat wars” too, at least most of the time, even as they condemned them for being mistakes. Trump, though, seems to have broken that knee-jerk reaction, which, if it lasts, may end up being one of the only things he has done right, even if it was by accident. 

“Holding Donald Trump accountable” is obviously a necessary goal, and we can only hope that if they take back the House, and perhaps the Senate, Democrats will spend the next two years hammering Republicans on corruption, malfeasance, criminality and incompetence, pounding as many nails into the MAGA coffin as possible in anticipation of a hard-fought 2028 campaign. After Trump and the GOP’s anti-democracy turn, there are no Democrats — and vanishingly few independents — who are clamoring for a “return to normal,” if anyone can even remember what that looks like.

As we get further into Trump’s second term, the rise of the progressive left, generated at least in part by the desperate need for generational change, is bringing some longstanding issues to the surface. Younger Democrats aren’t talking about politics in technocratic terms, as the party’s politicians have been doing for the last 30 years, offering up 10-point economic plans and telling the public how they can work the system more efficiently. They see politics in largely moral terms, and they are ready to address some of the thorniest moral issues we face. 

Oligarchy is at the top of the list, an issue that has animated the left since at least the Occupy Wall Street movement began in 2011. Fifteen years later, a global backlash against billionaires who have outsize influence over politics — and who do not pay their fair share — is taking shape.

The left also rejects America’s global role as security guarantor, particularly in light of the tragedy taking place in Gaza, which has been aided and abetted by the U.S. government. The party’s mainstream has moved substantially in their direction, leading to an unprecedented split in the House caucus in July that saw over a hundred House members vote to cut off aid to Israel. Whether it was done out of genuine desire to end the blank check or simply to allow members a symbolic vote going into the midterms, it’s clear that the intense opposition to Israel’s actions have made a difference, despite the ongoing debate about the scope of the policy. 

These moral issues are animating a significant faction of the party, and they are having an impact. But I find myself wondering why another moral issue, much closer to home and shocking almost beyond comprehension, isn’t getting much play on the campaign trail. 

We are witnessing a fascist crusade taking place on the streets of America every single day that has seen federal immigration officers shoot and kill at least eight people since January. Over the weekend, a Salvadoran immigrant being held at the notorious Delaney Hall detention center in New Jersey died after experiencing a medical emergency, the second death the facility has seen since December.

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The treatment of immigrants of all statuses, and sometimes American citizens who happen to look “foreign,” is an abomination. But aside from perfunctory nods to abolish Immigration and Customs Enforcement, it seems to have become background noise.

Masked federal agents are killing people with impunity. They are splitting up families without compunction, throwing people in camps and deporting them to countries they have never even visited. Now, with the permission of the MAGA-compliant Supreme Court, the Trump administration is in the process of deporting Haitians who have been here legally for decades by forcing them to leave immediately or wear an ankle bracelet in anticipation of being sent to a country which our own State Department says is too dangerous to visit. These are people who own property and businesses, and many of them have American-born children. They also happen to be Black. 

This is not a popular policy. While most congressional Republicans still approve of Trump’s immigration agenda, many of them aren’t thrilled with the administration’s deportation policy. According to Strength in Numbers, most Americans are appalled and prefer a path to citizenship for non-criminals. Trump’s cruel priorities clearly work for many rank-and-file Republicans, and this seems to have some timorous Democrats spooked. But if there has ever been an issue that the left should be screaming about every single day, it’s this.

Many Americans are out in the streets protesting and putting themselves on the line. In fact, average voters may be more up in arms than Democratic politicians. If the progressive left wants to consolidate the party behind a more virtuous set of values, this is the issue that will rally the entire spectrum of ideologies. Jeffries and party leaders should move it to the very top of the agenda, and make Trump’s abuses a rallying cry across the country.

The Democratic Party should not play politics with this; the president’s abuses are happening right here on our own streets, in our own communities. It is the moral issue of our time.

The post Democrats’ missed opportunity on Trump’s immigration cruelty appeared first on Salon.com.

This story was originally reported by Mel Leonor Barclay of The 19th. Meet Mel and read more of their reporting on gender, politics and policy.

In the aftermath of Donald Trump’s second election, voting for legislation to boost immigration enforcement could have seemed like a safe choice to some Democrats, who tied Donald Trump’s second presidential victory to a rejection of their party’s handling of immigration. 

Forty-six Democrats broke with their party to support legislation named after the murdered Georgia college student Laken Riley. Now, for some, that vote is a potential liability, as primary opponents say the votes cosigned Trump’s mass deportation agenda. 

This article is part of Cafe, TPM’s home for opinion and news analysis.

On August 4, Kansas voters will decide whether to replace the state’s longstanding merit selection system for Supreme Court justices with direct elections. Republicans want voters to believe the proposed constitutional amendment is just about transparency and giving the public more power over who sits on the state’s highest court, but the debate in Kansas is also part of a broader Republican push to inject more partisanship into state judicial elections. But the differences in where they want partisan elections and where they do not give the game away.

It looks like we are going to get a big test of some cardinal (possibly outdated) assumptions about American politics. I’m thinking first about the Michigan Senate race (though we might have something similar in the Wisconsin governor’s race). Several recent polls show Abdul El-Sayed holding a consistent, substantial lead over Rep. Haley Stevens. The primary is on August 4. This has been presented as a prototypical Democratic establishment vs Bernie progressive/insurgent race. And in key respects it is.

El-Sayed has all the Bernie/progressive positions. He’s run a campaign that places a heavy emphasis on the Israel-Palestine issue. And he’s centered AIPAC in his campaign in a way that even for many longtime critics and haters of AIPAC (including myself here) has a distinct whiff of antisemitic conspiracy theories. To wit, yes, AIPAC sucks. They’re a blight. They are functionally a Republican operation these days. But they are not the secret hand guiding things in the background every time there’s a bad news story or reverse of fortune for some progressive candidate, which is basically the role they’re playing in El-Sayed’s campaign.

How to Think About the SAVE Act

The SAVE America Act is playing a few roles in our politics right now.

On the one hand, it is a sweeping voter suppression bill, and one prong of Trump’s multifaceted assault on elections. Should it become law, it would add new hurdles for a wide range of Americans to participate in democracy, including voter ID for casting a ballot and proof of citizenship to register to vote. Republican supporters of the bill seem to have the impression that these restrictions would overwhelmingly hurt Democrats, and they are likely right: Recent polling by G. Elliott Morris at Strength In Numbers shows a greater number of Democrats — and Black Americans in particular — are likely to have trouble producing the documents needed to prove their citizenship. The law would hit Republicans, too — more than its supporters seem to realize. Among other things, women who change their names when they get married, a group that certainly includes many white, American-born, Republican voters, may have to provide additional documents to prove their citizenship under their new name.

So thats’s the reality of the SAVE Act, if it passes. Quite significant.

At the same time, the more expansive versions of the SAVE Act, including versions with national mandates around voter ID and proof of citizenship, have never had a clear path through the Senate — even as Trump sporadically attempts to up the pressure on his fellow Republicans to make it happen.

That, despite the seriousness of the legislation at hand, has led to an almost comic dynamic where everything the Senate, and much that the House, tries to accomplish is derailed by new Trump demands related to the SAVE Act. It has blown up primaries, too; Ken Paxton was able to prevent a Trump endorsement of Sen. John Cornyn (R), and ultimately win it for himself, by painting Cornyn as an insufficiently dedicated supporter of the legislation.

So we cover all this keeping two things in our mind at once: Should Republicans find a way to maneuver the SAVE Act through Congress — including by finally agreeing to nuke the filibuster for it, as Trump has demanded — it would create a sweeping distortion of the franchise. In the meantime, however, it has been a force for chaos, with Trump’s monomaniacal fixation on it leading to a far less effective Republican trifecta than we might have predicted in the early days of his second term.

Trump Gets His New, Permanent DNI

Jay Clayton was confirmed last night, Khaya Himmelman reports for TPM, replacing Acting Director of National Intelligence Bill Pulte.

• His confirmation hearing was defined by his alarming refusal to state plainly that Trump lost the 2020 election.
• While that has become a kind of standard operating procedure for Trump nominees before the Senate, it is particularly troubling given what the DNI job has become under Trump: Former DNI Tulsi Gabbard participated in the FBI raid on Fulton County, Georgia’s election hub. Current, acting DNI Bill Pulte headed up a largely ineffectual, new effort to again undermine the 2020 election, culminating in Trump’s big primetime speech earlier this month.
• Fittingly, Politico reports this morning that Pulte is agitating to stay in his acting role a little longer, pushing Trump to delay Clayton’s swearing-in.

Tabs

• Former FBI Director James Comey’s lawyers are seeking grand jury transcripts related to his seashell-photo indictment, Lawfare’s Anna Bower notes — raising fresh questions about the Trump DOJ’s dealings with grand juries as it seeks to punish its enemies.
• Trump said on Truth Social earlier this month that he would ask the Supreme Court to reconsider its ruling on birthright citizenship. The deadline to do so has passed, NBC reports, and he has not.
• Large majorities of Americans support term limits for members of Congress, greater restrictions on money in politics, and scrapping the Electoral College, new polling by Pew Research Center finds.

Man of the Hour

Breaking News: Ross Douthat, The New York Times opinion columnist, is joining CBS News’s “60 Minutes” in one of the first major hires since Bari Weiss’s takeover.

— The New York Times (@nytimes.com) 2026-07-28T20:57:44.755968Z

It’s Ross Douthat, leaving his job as a top New York Times opinion writer to become the face of Bari Weiss’ 60 minutes. Good luck in the new job, Ross.

Are We at War?

Yes, with a wave of missiles fired by Iran overnight and Saudi Arabia joining the U.S. in striking Iranian militias.

The Trump administration went to the Supreme Court Monday asking for an emergency ruling to let it overhaul mail-in ballots and assemble citizenship lists for the 2026 midterms.

When you’re allegedly throwing phones at the desks of junior aides, there’s a problem that goes deeper than unmanaged anger. 

According to a damning story published in Sunday’s New York Times, embattled Democratic National Committee chair Ken Martin has descended into rage, fear, isolation and — according to his own supporters — ”a growing sense of paranoia” about his tenure atop the party. 

Elected by DNC membership in February 2025 after a fractious race, Martin nonetheless took office with high expectations, seen as someone in the mold of former chair Howard Dean who would rebuild the party and devise a strategy to, if not win back rural voters, then at least mitigate Democratic losses. Instead, Martin’s tenure has been an ongoing series of fumbles, including a high-profile feud with party activist David Hogg and the bungled handling of the DNC’s 2024 election autopsy.  

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Now, with the midterms now only 100 days away, the RNC has banked a war chest of $128.5 million, and the DNC is reportedly $2 million in debt. According to NOTUS, in 2025 the DNC used its headquarters in Southeast Washington as collateral for a $15 million line of credit used to bolster its investments in off-year elections. As the Times story and a recent report in the Wall Street Journal make clear, Martin is also hemorrhaging the party’s confidence and loyalty.

The implications for Democrats in the midterms are potentially serious. But part of Martin’s remit is to pave the way for a Democratic win in the 2028 presidential election, when the DNC’s role becomes even more powerful and critical. So far, he has shown few signs of being able to do so, leaving the party at a disadvantage in a political environment that should favor them. When everything else is stripped away, that alone typifies Martin’s failure of leadership.

The post DNC chair Ken Martin is under fire and melting down appeared first on Salon.com.

A federal appeals court has refused to let the Trump administration enforce key portions of President Donald Trump‘s executive order tightening mail-in voting rules, handing the White House another legal setback as states challenge the president’s authority to reshape election procedures ahead of November’s midterm elections.

In a 2-1 decision issued Saturday, the 1st U.S. Circuit Court of Appeals denied the Justice Department’s request to pause a lower court injunction blocking major parts of the March executive order while the administration appeals the case. The lawsuit was brought by 23 Democratic-led states, which argue Trump exceeded his constitutional authority by attempting to impose nationwide election rules through executive action.

The executive order seeks to require federal agencies to verify voter eligibility before mail ballots are delivered, directs the Justice Department to pursue jurisdictions that officials believe violate federal election law and conditions certain federal election funding on states complying with the administration’s directives.

The Trump administration argued the lawsuit was premature because federal agencies had not yet finalized many of the policies outlined in the order. But the appeals court found the states had shown they were already facing immediate consequences from the directive, including deadlines requiring them to alter election procedures and coordinate with federal agencies before the November elections.

The ruling leaves in place U.S. District Judge Denise Casper’s preliminary injunction while the broader legal challenge moves forward. The appeals court did not rule on the ultimate merits of the case but concluded the administration had not shown it was likely to succeed in overturning the injunction at this stage.

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The lawsuit centers less on the legality of mail voting itself than on who has the authority to regulate federal elections. The states argue the Constitution gives them primary responsibility for administering elections as they deem fit unless Congress says otherwise, while the administration maintains the president has authority to direct federal agencies in enforcing election laws.

The Justice Department could ask the U.S. Supreme Court to intervene while the appeal continues.

The post Court rebuffs Trump EO on mail voting rules appeared first on Salon.com.

Bernie Sanders doesn’t want to hear from Rahm Emanuel, and he’s pretty sure the average voter doesn’t want Emanuel’s opinion either. 

The former Obama administration insider and Chicago mayor published an opinion piece in the Wall Street Journal earlier this week, chiding progressive candidates for poisoning the well with supposedly unpopular policy positions ahead of the 2026 midterms. Speaking to CBS‘ “Face The Nation” on Sunday, the independent senator from Vermont pushed aside Emanuel’s concerns, saying that he’s just “nervous” because anti-establishment Democrats keep winning. 

“[Emanuel] no doubt has the support of millions of working class people,” Sanders joked. “There’s no debate. There is a strong division within the Democratic Party.”

Sanders went on to paint that schism as the divide between people like Emanuel, who are “dependent on billionaire campaign contributors” and upstarts like New York City mayor Zohran Mamdani.

“What is getting these guys nervous is we are winning all over this country,” he said. “People are sick and tired of the Rahm Emanuels and the Democratic establishment.”

Sanders pegged voter disaffection on the increasing difficulty and cost of living in the United States.

“People are asking simple questions,” he said. “Why in God’s name are we the only major country on Earth not to guarantee healthcare to all people? …Why do the economists tell us that in the richest country in the history of the world, our kids will likely have a lower standard of living than their parents?”

“People are tired and they want real change,” he said.

Bernie Sanders: "People are sick and tired of the Democratic establishment and the Republican establishment … the American people are tired of a rigged economy, a corrupt campaign finance system. They want real change. They don't want Rahm Emanuel and the establishment… pic.twitter.com/7fHrXxuYX4

— Aaron Rupar (@atrupar) July 26, 2026

Elsewhere in the interview, host Margaret Brennan asked Sanders about one candidate that he endorsed. Graham Platner dropped out of the Senate race in Maine following accusations of sexual assault. She wondered if Sanders felt he should have pushed Platner to leave the race sooner, given earlier scandals that dogged the Platner campaign.

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“I don’t think so,” Sanders said. “When we heard the serious allegations … I asked, along with virtually all of his other supporters that he should get out of the race, and he did.”

The post “People are sick of Rahm Emanuel”: Sanders says progressive wins make Dem establishment “nervous” appeared first on Salon.com.

‘Working Very Hard to Protect Them’

The Trump administration has been salivating for something — anything! — that could help feed President Trump’s belief in the myth that noncitizens are illegally voting en masse for Democrats. The unfortunate situation in New Jersey this week, involving a software error at the state’s Motor Vehicle Commission during Gov. Phil Murphy’s administration, sadly gives them at least one datapoint rooted in reality to point to to justify Trump’s singular fixation with the otherwise widespread conspiracy theory. And perhaps also offers a new rationale for his attempts to try to jam a voter suppression/documentary proof of citizenship bill through Congress to throw the midterms — and hope of Dems taking back power — into chaos.

His Justice Department was never not going to seize on the moment, especially as the DOJ faces loss after loss after loss in its crusade to try to force states to give their voter rolls to the federal government, supposedly for the purpose of purging noncitizens from the rolls, something that states already do themselves and an occurrence that is vanishingly rare, even in light of the news from New Jersey this week.

Gov. Mikie Sherrill (D) announced Tuesday that her administration had found that a software glitch at the MVC had allowed 6,600 noncitizens to be added to the New Jersey voter rolls. About 400 of them have voted in at least one election since 2023. Sherrill said the people had disclosed they were noncitizens while trying to get a license or ID and were mistakenly registered to vote. The people were removed from the voter rolls, likely had no impact on overall election results in the state, and the state is cutting ties with the software company behind the error. Sherrill placed blame for the issue on her predecessor and said her administration was “working very hard to protect” the people who were placed on the rolls through no fault of their own.

Nonetheless, and of course, Assistant Attorney General for the Civil Rights Division, and Trump’s former personal lawyer, Harmeet Dhillon sent a letter to Sherrill on Tuesday demanding that she hand over the identities of the 6,600 noncitizens who were placed on the voter rolls within five business days. She requested the names, nationalities and residential addresses for each of them, Politico reported.

Dhillon reportedly said that she was interested in the information as part of a DOJ investigation into whether New Jersey was following federal law, but she has since hinted publicly that the DOJ might want to make a big show of deporting or bringing criminal charges against the noncitizens on the rolls.

“The consequences of voting when you’re not allowed to in a federal election can mean removal to your home country and worse — it’s a crime,” Dhillon said during a conversation with far-right influencer Benny Johnson Wednesday. “And you know people need to just stop cold in their tracks and not enable it. And shame on New Jersey for its sloppy and incompetent handling of this issue, or worse.”

Additionally, the DOJ is trying to use the incident to bolster its genuinely unbelievably disastrous campaign to seize voter records from states ahead of the midterms. The DOJ has lost every single case that has made its way through court thus far after suing 44 states and Washington, D.C. to try to obtain these records. In fact, in dismissing the lawsuits, every judge has shot down the DOJ’s legal theory, as TPM has reported. Per Politico:

Separately, the DOJ is also using the disclosure of noncitizen voters to bolster its case in court to obtain New Jersey’s unredacted voter registration files. The Trump administration is suing New Jersey, seeking access to the state’s full voter file which includes nonpublic information like the drivers license ID numbers and partial Social Security numbers of New Jersey voters.

Seems Like Thune’s the One Whose ‘Patience Is Running Out’

Senate Majority Leader John Thune (R-SD) got testy when presented with White House press secretary Karoline Leavitt’s recent remarks — that President Trump’s “patience is running out” with Senate Republicans, who both don’t have the votes to pass the SAVE Act or the interest in nuking the filibuster in order to jam through Trump’s voter suppression bill ahead of the midterms.

“Maybe she or somebody else ought to get on the phone and get the votes. Right? It’s 50 around here,” Thune said, when reporters asked him about Leavitt’s remarks.

“Instead of pointing the finger at Republicans, they might think about going after the people who are stopping it on the floor, which is the Democrats,” he continued. “And if there are Republicans they think are gettable, get on the phone.”

Obviously, Thune is one of the few roadblocks standing in the way of Trump having his delusions fulfilled by fall, but it’s not just Thune and Senate GOP leadership’s disinterest in changing filibuster rules for the sake of disenfranchisement. There are several other Senate Republicans who are not on board with the legislation, one of whom has been very vocal about the fact that it would be impossible to implement Trump’s documentary proof of citizenship and voter ID laws just months out from a major federal election.

Even Fox News Poll Finds Trump’s Approval Rating Won’t Stop Tanking

New stats from a new Fox News poll conducted between July 17-20:

Several findings in the latest Fox News Poll show voters are unhappy and want major change, which bodes well for Democrats in November: President Donald Trump’s job approval remains near a record low, more Democrats are motivated to vote, Republicans join Democrats and independents in rating the economy negatively, and 4 in 10 voters want “dramatic” or “revolutionary” change. Plus, more view the GOP as tied to elites than the Democratic Party.

More From TPM Today

Kate Riga covers the latest fallout from Callais: A panel of judges blocked Black Tennesseans’ attempt to challenge Republicans’ racial gerrymander in Tennessee where, after the Supreme Court ruling gutting the Voting Rights Act, state Republicans moved to carve up the state’s one Democratic district: Tennessee Gerrymandering Challenge Fails, Just as Supreme Court Intended

In this week’s edition of The Franchise, Khaya Himmelman digs in on election denier wins in Arizona’s Republican primaries this week and DHS Secretary Markwayne Mullin escalating the admin’s threats against state election officials: Election Deniers’ Grip on the Republican Party Strengthens in Arizona

“A new and ironic development in the first-of-its-kind legal challenge to President Trump’s U.S. attorney scheme gives me a chance to pull back the lens a bit to show the full scope of the corruption involved and why it matters,” David Kurtz writes in today’s Morning Memo: What’s Really Behind Trump’s Corrupt US Attorney Scheme

Yesterday’s Top Story

New Attack Launched Against Trump’s Corrupt US Attorney Scheme

What I’m Reading

Sex work or starve: Aid workers in Nepal left jobless by USAID cuts turn to sex work to survive

Government withdraws subpoenas of 3 reporters for The New York Times after admitting legal errors 

Trump Badly Screws Susan Collins as Maine ICE Death Takes Darker Turn 

American voters desperately want relief from rising prices — especially the increasingly unaffordable cost of healthcare. Democrats have a plan for that.

Massachusetts Sen. Elizabeth Warren recently introduced the Break Up Big Medicine Act with Sen. Josh Hawley, R-Mo., a bill that would split up the huge conglomerates that have made the current healthcare system so expensive and frustrating to navigate. Businessman Mark Cuban recently quipped that breaking up these near-monopolies could bring costs down by 40%.

If Democrats run on this healthcare affordability agenda, we stand a good chance of flipping not just the House, but the Senate too.

Insurers like UnitedHealth or Cigna don’t just sell coverage. They’ve consolidated power over virtually every part of our healthcare system, operating hospitals, clinics and pharmacy networks. And they use that control to generate billions in profits — by pushing patients toward care at the facilities they control.

UnitedHealth Group, for example, generates about 40% of its revenue — about $180 billion — from transactions between its thousands of subsidiaries. Its insurance branch steers patients to its roughly 90,000 affiliated doctors, and pressures those physicians to refer patients to its affiliated hospitals and clinics rather than lower-cost independent providers. And that’s not all. The company’s pharmacy benefit manager (PBM) arm pushes patients to affiliated pharmacies. Those pharmacies frequently upcharge patients for medicines, sometimes by 10 times the acquisition cost.

UnitedHealth Group is the largest of these conglomerates, but it’s hardly the only firm that operates this way. CVS Health owns Aetna, one of the nation’s largest insurers, in addition to the more than 9,000 CVS pharmacies it’s best known for. It also owns CVS Caremark, one of the nation’s largest PBM.

In theory, PBMs exist to save employers money by overseeing all the drug-related details of health insurance plans, and using their bulk-buying power to negotiate with pharmaceutical companies for big discounts and rebates. PBMs often tell employers that they pass along all the discounts and rebates they receive to the employer, minus a small fee for their services.

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What they typically don’t mention is that many PBMs are affiliated with foreign-based entities called “group purchasing organizations.” In 2025, the House Oversight Committee launched an investigation into whether PBMs are using these overseas entities to skirt government oversight. Lawmakers have raised concerns that these arrangements allow PBMs to retain rebate-related revenue and fees within opaque corporate structures, rather than transparently passing those savings on to employers and patients.

Meanwhile, insurers continually deny coverage for treatments and procedures that patients need. They often force doctors to get insurer approval — known as prior authorization — before prescribing, or they force patients onto less effective drugs. That places an immense administrative burden on physicians, who can spend an average of 12 hours per week completing prior authorizations, time that they’d certainly rather spend with patients.

Prior authorization can have dire consequences for patients. More than eight in 10 patients that face prior authorization simply give up on treatment. About a quarter of doctors say that prior authorization delays have led to a serious adverse event for a patient in their care — whether that’s hospitalization, permanent damage or death.

Breaking up the healthcare conglomerates that have enriched themselves by immiserating patients and cheating employers is good policy.

Polls show that voters overwhelmingly support bold healthcare reform. According to a recent poll, nearly seven in ten insured Americans identified either lowering out-of-pocket costs or nixing prior authorization as the single most important change they want from their health insurance. It would be a mistake for Democrats to content themselves with merely tweaking the Inflation Reduction Act, the party’s last major healthcare reform, which primarily focused on reducing the federal government’s pharmaceutical spending.

That kind of incrementalism won’t work — Democrats cannot win by being Republican-lite. We need to target the insurer and PBM practices that directly drive up Americans’ out-of-pocket costs and force too many people to choose between filling their prescriptions and filling their gas tanks.

If Democrats are looking for a 50-state strategy for the midterms — something I insisted on as chair of the Democratic National Committee during the 2006 blue wave — Sen. Warren’s bill offers a great place to start.

The post Democrats’ key to winning the midterms appeared first on Salon.com.