| “Health care is certainly going to be front and center for many states,” said Hemi Tewarson, National Academy for State Health Policy executive director. “Affordability is something we’re watching and working on with states. And when I say affordability, I mean it in two different ways: There’s affordability for consumers …. There’s also affordability to the states with respect to their Medicaid programs, their state employee health plan programs [and] overall changes in their own state budgets.” Other hot issues include: questions about health care tech and AI, rural health care, an aging population, food policy and affordability, maternal mortality, health care industry consolidation, the spread of infectious diseases, trust in public health, and more. Big local issues — such as rising cancer rates in Iowa — also are getting candidates’ attention. This year, health care costs are tied with gas prices as a top economic concern, according to KFF, the nonpartisan health care policy, polling and journalism organization. Overall, Democrats have the best chance to win a majority of governorships for the first time since Republicans had a good election night in 2010. That comes after several developments, including: - More generous Affordable Care Act tax credits expired in December after Congress did not renew them, making it harder for some consumers to afford insurance on HealthCare.gov and other marketplaces. This year, premiums rose by about 26 percent.
The average increase in 2027 premiums will be 13 percent, KFF reported Friday. Open enrollment starts Nov. 1. - States are implementing new Medicaid restrictions in the One Big Beautiful Bill Act tax-and-spending law. Some of the biggest changes commence in January.
On election night, Jessica Taylor of the Cook Political Report projects that Democrats may pick up between two and four gubernatorial seats. Currently, Republicans hold 26 seats and Democrats hold 24. Where the action is: Taylor projects that Democrats’ best chances to flip seats are in Iowa, Alaska and Ohio, all of which are rated “lean Democratic.” Toss-ups where Democrats are hopeful include Georgia in the race between Jackson and Democrat Keisha Lance Bottoms, a former Atlanta mayor. In Nevada, Gov. Joe Lombardo (R) hopes to hang on against a challenge from Democratic Attorney General Aaron Ford. Wisconsin’s open seat is a contest between Milwaukee County Executive David Crowley and Rep. Tom Tiffany. Florida is listed as “lean Republican” by the Cook report, but some analysts are keeping an eye on that open race. A state that’s “leaning” toward staying in Democratic hands is Arizona, where incumbent Gov. Katie Hobbs faces Rep. Andy Biggs. Republican opportunities to flip seats On the other side, Republicans hope to take over the governors mansions in Kansas, a race the Cook Political Report rates as a “toss-up,” and in Oregon, which the Cook Political Report considers to “lean Democratic” with the idea that incumbent Gov. Tina Kotek holds on. Zoom out: Health care has been on voters’ minds in many midterm elections since 1994, after then-first lady Hillary Clinton proposed a major system overhaul. That proposal never got a final floor vote in either chamber but it fueled voters’ motivation to get to the polls. Other midterms prominently featuring health care include 2010, months after former president Barack Obama signed the Affordable Care Act in March, and 2018, after Republicans unsuccessfully tried to repeal that Democratic law. Most recently, in 2022, abortion after the overturning of the Roe v. Wade Supreme Court decision helped Democrats buck history and avoid the typical losses that a president’s party usually takes in the midterms. Medicaid watch Medicaid, which covers about 66 million people who are low-income or have disabilities, is a marquee issue. It’s both one of the states’ biggest costs — often making up about a third of state budget expenses — and a major source of federal funds through matching grants that benefit states. Democrats’ Affordable Care Act allowed states to choose to expand Medicaid and cover more people. → Of the 10 holdout states that did not expand, nine have governors’ races this year. Democratic candidates tend to back expansion, while Republicans have taken a broader range of positions or de-emphasized the issue. Hospitals and other medical providers often support Medicaid expansion because it gives health care coverage to residents, who can then better afford to pay their medical bills. Under the law, the federal government pays 90 percent of the costs for consumers in the expansion group, and states pick up 10 percent of the costs. → Two states where the outcome in the governor’s race could make a difference in Medicaid expansion are Wisconsin and Georgia. Both states got waivers to partially expand their programs but did not broaden eligibility as much as the Affordable Care Act allows. “Wisconsin is probably the most interesting,” Jacob Rubashkin, the deputy editor of Inside Elections, which provides nonpartisan analysis of campaigns. “It’s the only one where it’s quite possible that Democrats could establish some foothold in the legislature, and that is obviously a key component of the Medicaid expansion process.” Most governors who expanded Medicaid did so by working with legislators to pass a law. “There is a real possibility that if David Crowley wins the governor’s race, and he can do so by a healthy enough margin, he could have the cleanest path of any of these incoming governors to get something done on Medicaid expansion,” Rubashkin said. Crowley has even talked about wanting to create a public, government-run option. “If Democrats are able to win back both chambers of the Wisconsin legislature, which is still a lift for them, and they win the governor’s race, I think we could see a tremendous amount of activity on health care and any number of other issues,” Rubashkin said. “Even if Keisha Lance Bottoms were to win the [Georgia] election, she has said she wants to expand Medicaid, but it’s hard to do that without the buy-in from the state legislature,” Rubashkin added. Either Georgia candidate will have to work with federal officials to update the state’s current partial Medicaid expansion program, which is up for renegotiations and, potentially, a higher matching rate from the Trump administration. → A more immediate challenge for most states is implementing the Republicans’ Medicaid spending growth cuts. The biggest cut comes from requiring people in states that expanded Medicaid to put in place work requirements. The federal rules require people to work or do other specific activities for 80 hours per month or attend school at least part-time — or lose their Medicaid coverage. Among the 44 states implementing Medicaid work requirements, 30 states have gubernatorial elections, and the District of Columbia has a mayoral election, according to KFF. Other parts of the GOP law will limit federal financing, leaving some states with budget holes to fill. States are in different situations, but, on average, revenue is tightening. Governors will face pressure to increase efficiency throughout government, including health care. Consumers’ coverage losses will also add concerns. “For some states, they’re [pondering] how … we address potentially larger numbers of uninsured populations,” said Tewarson. Some potential solutions include creating new programs to help hospitals and other providers with patients’ unpaid medical bills. Some states may consider tax increases. Some may subsidize costs for people who buy insurance on their own rather than through work. One thing governors might not mind is handing out federal rural health dollars. Although the Republicans’ tax-and-spending law cut rural health Medicaid funding by about $137 billion over a decade, the law also gave back $50 billion to be spent in the next four years for rural health care. States overall plans’ are already approved, and some funds were received. But governors will have some discretion in tweaking who gets future money that will be coming. “There’s more interest and need than there are dollars,” said Tewarson. “So this is going to be an area to watch for, with new administrations and current administrations, of where those investments are being made.” Shopping around is always a good idea during Medicare’s open enrollment season, which started this month and runs through Dec. 7. But this year, you could be losing a lot if you don’t: One well-known drug coverage plan’s monthly cost is rising by more than 62 percent. UnitedHealthcare’s AARP Medicare Rx Preferred, a national prescription drug plan, will have an average monthly premium of $204.50, up from $126 in 2026. That’s just one example of how premium prices are rising in standalone drug plans, as shown in a new analysis published Friday by KFF. More basic coverage can have far lower monthly costs. The lowest-premium national drug plan for 2027 is Centene’s Wellcare Value ScriptRx, with an average premium of $6.50, up 12 percent from 2026. That plan probably would not be a good option for people taking a lot of expensive drugs, however. → 50 percent increase: The average monthly premium for standalone Medicare drug plans will rise to $51 in 2027, up from $34 in 2026, unless enrollees switch into plans with lower premiums, KFF found. The analysis also said the projected average monthly premium of $51 for standalone plans is more than five times higher than the drug coverage premium in Medicare Advantage plans that cover drugs.
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