Congress is engaged in vigorous debates about health reform, the federal budget, and other sweeping policy changes that could have a potent impact on health. The future of Obamacare and the possibility that Medicaid may be significantly restructured or cut back dramatically are very much in play. The level of funding for the biomedical research and public health activities of the NIH, CDC and FDA are uncertain. Foreign-aid decisions are certain to influence major HIV initiatives and pandemic surveillance worldwide. Senator Chris Coons (D-DE) offers an insider’s look at the policy and political implications of possible congressional actions.