INSIGHTS
November 2, 2026

What’s on the ballot for healthcare

Midterm elections are tomorrow and healthcare costs are a top concern for voters. The election comes at an especially consequential moment for federal health policy, with several changes already underway that could affect how much Americans pay for coverage and care. Enhanced ACA subsidies expired at the end of 2025 and insurers are seeking a median 15% premium increase for 2027. Medicaid work requirements take effect next year, with states racing to build out the infrastructure to accommodate these shifts. Democrats are campaigning on restoring ACA credits and reversing Medicaid cuts, while Republicans are pitching HSAs in place of subsidies and codifying Most-Favored-Nation drug pricing. Key races will determine party control of Congress and in turn, influence which federal proposals are likely to move forward.

States may drive more direct changes, where several health-focused measures go to voters. South Dakota could repeal Medicaid expansion, Missouri and Colorado will weigh in on gender-affirming care for minors, and Idaho, Nevada, Virginia, and Missouri will consider abortion access. With 36 governorships also on the ballot, election results are likely to shape how federal Medicaid changes reach patients. We’ll be following the results as they roll in this week and considering the implications for healthcare coverage and care delivery.

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