Democrats emerged from the November 3 midterm elections seizing control of both chambers of Congress, while voters in several states delivered consequential decisions on health policies.
The results could reshape the national health policy agenda in 2027, although existing federal funding cuts and coverage restrictions remain in place.
Abortion rights prevail in three states
Voters considered abortion-related ballot measures in four states, with reproductive rights protections prevailing in three.
In Virginia, voters approved Question 1, establishing constitutional protections for reproductive freedom, including abortion, contraception and fertility care. Nevada voters approved Question 6 for a second time, adding constitutional protections for abortion.
Missouri voters rejected Amendment 3, preserving reproductive freedom protections approved in 2024 rather than reinstating abortion restrictions. Idaho voters rejected Proposition 1, which would have established statutory reproductive freedom protections. The state’s restrictive abortion law remains in place.
The outcomes underscore continuing differences in reproductive health access following the Supreme Court’s 2022 decision overturning Roe v. Wade.
Medicaid protections survive in South Dakota
South Dakota voters rejected Amendment I, which keeps a safeguard against automatically ending Medicaid expansion if the federal government’s contribution falls below 90 percent.
Elsewhere, Democratic gubernatorial victories could also influence Medicaid policy.
In Georgia, Governor-elect Keisha Lance Bottoms supports full Medicaid expansion, which could extend eligibility to approximately 347,000 uninsured adults, according to the Center on Budget and Policy Priorities.
Ohio Governor-elect Amy Acton campaigned on protecting Medicaid access and addressing medical debt. Both states would need additional policy action to implement changes.
However, those proposals require additional state action.
Other health policy decisions
Additional ballot measures could affect health services and funding:
- California: Voters rejected a requirement that certain nonprofit community clinics devote at least 90 percent of revenue to patient services. Opponents warned the mandate could financially strain clinics serving low-income patients.
- Colorado: Proposition 135, which would prohibit certain gender-affirming surgeries for minors and bar insurance coverage for those procedures, was leading with nearly 52 percent of the vote Wednesday afternoon but remained uncalled.
- New Mexico: Voters approved funding to improve senior centers and facilities serving older adults.
- Rhode Island: Voters approved $275 million in borrowing for higher-education facilities, including potential investments supporting healthcare workforce training.
What happens next in Washington?
Democratic control of Congress creates opportunities to challenge President Donald Trump’s 2025 tax and spending law, including Medicaid reductions and new eligibility requirements scheduled for 2027.
Lawmakers could also pursue restoration of enhanced Affordable Care Act premium subsidies, investigate federal vaccine policies and address maternal health funding.
However, reversing existing laws would require Congressional support and presidential approval or a veto override.
As URL Media previously reported, the Congressional Budget Office estimates the federal law’s Medicaid provisions will reduce spending by approximately $911 billion over a decade, from 2025 to 2034.
The election results offer new opportunities for policy changes, but don’t guarantee relief.
For families facing rising insurance premiums, disappearing maternity services and uncertainty about coverage, the next test will be whether electoral victories translate into affordable, accessible, quality care.
