As we near the 2019 mid-term elections, pundits and prognosticators are focusing on what the make-up of Congress will look like in 2019 and what it means for President Trump’s agenda. Yet, for healthcare communicators, it is imperative that we expand our horizons and think more broadly about how the next six months will affect critical healthcare discussions for the next decade.

In this period, two dynamics will significantly influence public conversations around health and healthcare. The first is the anticipated “blue wave” that many politicos expect to sweep Democrats into control of the House of Republicans. With only control of the House, Democrats will immediately change the conversation from where it has been to one that is more aggressively anti-industry and pro-regulation (or pro-consumer and pro-reform depending on how you perceive the debate). In this position, House Democratic leadership will hold votes on a significant number of healthcare priorities that, although they may never have a chance to become law, will force Republicans to vote on bills that are purposely designed to place Republicans in the position of appearing to be anti-patient and anti-consumer. Whether or not the Senate changes control, Democrats will look to raise healthcare issues that will support the party’s efforts to win the White House in 2020.

The 2020 presidential election provides the second, and even more impactful, dynamic that will alter how we discuss healthcare for the foreseeable future. A quick Google search shows anywhere from ten to twenty Democrats doing the things candidates do when they run for the White House. Just like 2016 when Donald Trump beat 17 same party candidates to win his party’s primaries, Democrats seeking to capture the nomination will have to appeal to the most activist voters in the party. For many healthcare organizations, that will be concerning.

Among Democratic activists, issues of healthcare’s cost (including the cost of insurance, surprise medical bills, drug costs), coverage of pre-existing conditions, care quality, drug importation, access to generics and the future of reform—among many topics—will provide opportunities for anti-healthcare industry messaging and activities designed to motivate the Democrat’s base. What’s more, the growing Medicare For All movement will significantly mature and may become the dominant left-of-center healthcare position.

Healthcare companies, organizations, advocacy groups and other entities wishing to influence the public conversation on healthcare in the 2020 presidential cycle need to begin determining messaging, strategy, recruitment and activation now. Or risk spending the next decade playing catch up. Don’t get caught flat-footed, be prepared.