Exit poll after exit poll in states across the nation showed that healthcare overwhelmingly was Americans' top issue in casting their votes in the midterm elections, with many concerned about treatment costs and ensuring protections remain for people with pre-existing medical conditions.

Democrats consistently stayed on the healthcare message throughout their campaigns, while Republicans picked up on the issue in the latter months of their bids to win seats on Capitol Hill or in their state governorships.

"Healthcare was on the ballot and healthcare won," House Democratic Leader Nancy Pelosi of California told reporters during a Nov. 7 news briefing. "We knew how important healthcare was to families, not just for their well-being, but for their financial well-being."

"Healthcare, healthcare, healthcare in every household is an important issue," added Pelosi, who is expected to again take the gavel as speaker in January when the new Congress convenes.

With Republicans retaining the Senate and picking up a handful of seats but losing the House to the Democrats, the question remains on whether lawmakers will work together to make changes to the Affordable Care Act and lower Americans' costs, including for prescription drugs.

Pelosi signaled she was willing to collaborate with Republicans to take on the biopharmaceutical industry, saying she had discussed the matter the night before with President Donald Trump.

During his Nov. 7 briefing with reporters, Trump said he thinks he could work with Democrats specifically on lowering drug prices, saying that issue and infrastructure were the two areas with the best chances of achieving bipartisanship.

"I think we're going to have a lot of reason to do it," said Trump, who unveiled a package of proposals in May aimed at lowering drug prices.

Pelosi and other Democrats, however, have criticized Trump's blueprint, particularly for not including a measure to fulfill his 2016 campaign promise that he would seek authority for the government's Medicare insurance program for seniors and the disabled to negotiate directly with drugmakers on prices.

Rep. Frank Pallone, D-N.J., who is seeking to become the chairman of the House Energy and Commerce Committee, where he is ranking member, said in a Nov. 7 statement that lowering healthcare and prescription drug costs was one of his top priorities.

Senate Majority Leader Mitch McConnell, R-Ky., told reporters Nov. 7 that he "cannot imagine that [drug prices] will not be on the agenda" for the Senate's next congressional session.

Evercore ISI policy analyst Terry Haines said drug pricing may be the "market sleeper issue of 2019."

In a Nov. 7 research note, Haines said he anticipated that congressional Democrats would make drug prices a major priority starting in January, with Trump wanting to lead on it because it would be an issue of major concern to the public he could tout going into the 2020 presidential election cycle.

While Haines said he expected Senate Republicans to have some leverage on behalf of the industry, they are unlikely to want to stop any action entirely and may not be able to if a drug pricing measure is attached to some other legislation.

ACA fixes

McConnell said there were a number of things Republicans could work on with Democrats, including fixing what he called "serious problems" with the Affordable Care Act.

"We have to address it on a bipartisan basis," McConnell said during his morning news briefing.

McConnell said the Democrats' concerns that his party has tried to extinguish the protections in the ACA that prevent insurers from discriminating against Americans with pre-existing conditions were "phony," despite Republican efforts to repeal the 2010 law.

A cadre of 20 Republican state attorneys general also is pursuing a lawsuit challenging the constitutionality of the ACA.

Rather than defending the law, Trump's Justice Department joined the plaintiffs and is seeking specifically to invalidate the pre-existing conditions protections. A federal Texas judge is set to soon rule on the matter — a lawsuit that is expected to eventually make its way to the U.S. Supreme Court.

McConnell noted that some Democrats were unable to convince voters in their states that Republicans were not in favor of those protections.

Pharma foe defeated

Sen. Claire McCaskill of Missouri was one of those Democrats, losing her seat on Nov. 6 to her state's Republican attorney general, Josh Hawley, who is one of the plaintiffs in the suit.

McCaskill also had been among the Democrats on Capitol Hill who homed in on the drug prices issue and collaborated with Sen. Susan Collins, R-Maine, on investigations into companies that had significantly hiked the costs of their medicines, particularly older products that have lost patent protection.

When McCaskill was the ranking member of the Senate Aging Committee, she teamed with Collins in 2015 on a bipartisan investigation of what they called "egregious price spikes" for certain generic, off-patent drugs, like those from Turing Pharmaceuticals LLC and Valeant Pharmaceuticals International Inc., now Bausch Health Cos. Inc.

Most recently, McCaskill, now the ranking member on the Senate Homeland Security and Government Affairs Committee, and Collins probed the hike in the list price of a more than 60-year-old antibiotic made by Nostrum Pharmaceuticals LLC.

A new force

While Democrats are losing McCaskill in January, they are gaining a new force in healthcare who may have a particular interest in pursuing drug prices and fixing the market issues with the ACA — former Health and Human Services Secretary Donna Shalala, who was elected Nov. 6 to fill Florida's 27th district seat in the House.

Shalala, who bested Republican Maria Elvira Salazar to replace retiring Rep. Ileana Ros-Lehtinen, R-Fla., served eight years as HHS chief during the Clinton administration, holding the position longer than any other person.

She was also the president of the University of Miami until 2015, when she joined the Clinton Foundation.