The 2026 midterm elections carry several implications for healthcare policy, from voters choosing a Democratic-led Congress to physicians headed to the Senate and new state abortion protections.
The new Congress is scheduled to be sworn in Jan. 3. Until then, Republicans retain control of both chambers.
Five things hospital and health system leaders should know:
1. Democrats will gain control of Congress.
Democrats won majorities in both the House and Senate. It is the first time the opposition party has controlled both chambers during a Republican presidency since the 2006 election, under President George W. Bush.
As of the morning after Election Day, Democrats held a 54-44 edge in the Senate and a 228-139 edge in the House, The Wall Street Journal reported Nov. 4.
Democrats needed to gain four Senate seats for a majority. They picked up seats in Texas, North Carolina, South Carolina, Kansas, Ohio, Iowa and Maine, and several races remained uncalled early Nov. 4. Democrats also flipped Republican-held House districts in Iowa, Pennsylvania and Texas, CBS News reported Nov. 4.
2. Democrats’ healthcare agenda starts with ACA subsidies and Medicaid.
House Democrats spent the weeks before the election laying out a first-100-days agenda, with healthcare affordability near the top. Their plans include restoring the enhanced ACA premium subsidies that expired at the end of 2025 and reversing nearly $1 trillion in Medicaid cuts from HR 1, ABC News reported Nov. 4.
“House Democrats will be united around the effort to reverse the Medicaid cuts and extend the Affordable Care Act tax credits,” Minority Leader Hakeem Jeffries, D-N.Y., told reporters in October, according to ABC.
Affordability weighed heavily on voters. Some 89% called it a crucial or major factor in their vote, according to NBC News exit polling. Midterm voters also trusted Democrats over Republicans on healthcare by 19 percentage points, 49% to 30%, according to a KFF poll released Nov. 4.
Major changes will be difficult to enact while President Donald Trump keeps veto power, particularly any that would undo parts of HR 1, which he signed into law in July 2025. A year later, Rep. Brendan Boyle, D-Pa., the top Democrat on the House Budget Committee, introduced legislation to fully reverse the Medicaid cuts. It was referred to two committees and has not advanced.
3. Expect more oversight of drug pricing deals.
A House majority gives Democrats subpoena power through committees such as Energy and Commerce. Democratic health leaders have already pressed for details of the administration’s undisclosed pricing agreements with drugmakers within the last year.
Since December 2025, top Democrats on House Energy and Commerce, House Ways and Means, House Education and Workforce and Senate Finance have sent letters to 15 drugmakers asking about the deals, including how they affect Medicare, according to an April update from committee Democrats. In March, Reps. Frank Pallone, D-N.J., and Diana DeGette, D-Colo., asked Republican committee leaders to join their push for the administration to hand over the written agreements to Congress. At the time, 16 drugmakers had reached deals whose terms had not been made public.
Senate Finance Committee Ranking Member Ron Wyden, D-Ore., said in a Nov. 4 statement that accountability will be a top priority for the committee, which oversees Medicare and Medicaid, in the next Congress. He named “insurance companies that are delaying and denying health care to churn a profit” and “the pharmaceutical company CEOs that price gouge while enjoying Trump’s hand-delivered windfalls,” adding that “when I am chair, they will be forced to answer to the Senate Finance Committee.”
4. Clinicians head to the Senate, House and governor’s office.
The current Congress includes 20 physicians, 16 in the House and four in the Senate, according to The Hill. Based on Tuesday’s results, the next Congress will include several new clinicians , though some physician incumbents lost.
More than 50 physicians, nurses and other clinicians were on the ballot for governor or a congressional office this year. While some results are still pending, clinicians won several major races.
Senate
- Annie Andrews, MD: The Charleston pediatrician defeated Republican Sen. Darline Graham for South Carolina’s Senate seat, 50.6% to 47.2%, according to an AP projection reported by WBTV. She will be the state’s first Democratic senator in more than 20 years, according to NBC4 Washington.
- Abdul El-Sayed, MD: He held Michigan’s open Senate seat for Democrats, according to CBS News. Dr. El-Sayed is a physician and epidemiologist who previously led Detroit’s health department. He defeated former Republican Rep. Mike Rogers.
House
- Mitchell Berman, RN: Mr. Berman, a nurse with the Veterans Health Administration, defeated Republican incumbent Rep. Bryan Steil in Wisconsin’s 1st Congressional District race. He will be the first Democrat to hold the seat in more than 30 years, according to Wisconsin Public Radio.
- Adam Hamawy, MD: The plastic surgeon and former Army combat surgeon won New Jersey’s 12th Congressional District, defeating Republican Gregg Mele, according to The New York Times. He will succeed retiring Rep. Bonnie Watson Coleman.
- John Cowan, MD: The Republican neurosurgeon won Georgia’s 11th Congressional District, according to the Times. He will succeed retiring Rep. Barry Loudermilk.
- Richard Pan, MD: The pediatrician and former California state senator unseated independent Rep. Kevin Kiley in California’s newly redrawn 6th Congressional District, according to CBS News.
Gubernatorial races
- Amy Acton, MD: The former director of the Ohio Department of Health was elected Ohio governor, CBS reported. She won over Republican Vivek Ramaswamy.
- Josh Green, MD: The incumbent governor of Hawaii defeated Gary Cordery by 54 percentage points, a gubernatorial record in Hawaii, according to West Hawaii Today.
Among the healthcare professionals who lost their races were several notable incumbents and candidates. Sen. Roger Marshall, MD, R-Kan., an obstetrician, lost his seat to Democrat Adam Hamilton, the first Democrat to win a Kansas Senate seat since 1932, according to CBS.
In Virginia, Rep. Jen Kiggans, RN, R-Va., lost a toss-up rematch to Elaine Luria. Rep. Mariannette Miller-Meeks, MD, R-Iowa, was unseated by Christina Bohannan, who won on her third attempt. Ralph Alvarado, MD, R-Ky., lost an open-seat race to Democrat Zach Dembo in a district President Trump carried by about 15 points in 2024.
5. Voters in three states protect abortion access; Idaho keeps its ban.
Voters in three states moved to protect abortion access. In Missouri, voters rejected Amendment 3, which would have reinstated a ban on most abortions with limited exceptions. “No” led with 55.6% of the vote when the AP called the race, NPR affiliate St. Louis Public Radio reported Nov. 3. The measure would also have written a ban on gender-affirming care for minors into the state constitution.
Virginia voters approved Ballot Question 1 by about 61% to 39%, according to VPM. The amendment adds a right to reproductive freedom to the state constitution, covering contraception, fertility care, miscarriage management and abortion. It permits abortion through the second trimester, eases limits on third-trimester procedures and protects providers from criminal prosecution.
Nevada voters approved Question 6, which adds abortion rights to the state constitution, KLAS reported Nov. 4. This was the second required approval after voters first passed the measure in 2024.
Idaho voters rejected Proposition 1, which would have restored abortion access up to fetal viability. The state’s ban, in effect since 2022, remains in place, NBC News reported Nov. 4.
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