Health in the 2026 Midterm Elections


Mapping ACA Marketplace and Medicaid Enrollment by Congressional District 

With an estimated 14 million people expected to become uninsured by 2034 due to major changes to Medicaid and the Affordable Care Act (ACA) Marketplaces in the 2025 reconciliation law plus the expiration of the ACA’s enhanced premium tax credits, KFF’s new interactive maps provide a way to view ACA Marketplace and Medicaid enrollment by congressional district across the U.S.

Share of Congressional District Enrolled in ACA Marketplace, 2026

ACA Marketplace Enrollment by Congressional District

This ACA Marketplace enrollment map shows that more than half of Marketplace enrollees (55%) live in Republican districts. The highest shares of state enrollment are in Florida (16%), Georgia (11%), Texas (10%), and Utah (10%)—states that were all won by President Trump in 2024.

Share of Congressional District Enrolled in Medicaid, 2025

Medicaid Enrollment by Congressional District

This new interactive map illustrates Medicaid enrollment by congressional district and eligibility group. In half of Republican congressional districts, at least 20% of residents are enrolled in Medicaid, and in half of Democratic districts, at least 25% are enrolled.

Event

KFF Midterms Data Presentation: What Do Voters Think About Health Care Now?

Event Date:

During this virtual event, KFF public opinion and survey experts provided analysis and insights on the latest findings from recent public opinion surveys about health care issues in advance of the midterms, including current public sentiment about Medicare-for-All and how it compares historically.

Two-Thirds of U.S. Adults Now Favor Medicare-for-All, the Largest Share Since KFF Began Polling on the Plan

Public Opinion on Medicare-for-All

This chart pack summarizes KFF polling data on public opinion on Medicare-for-all and other national health plan proposals. The latest update finds that two-thirds of the public supports Medicare-for-all, while support changes drastically as respondents hear arguments from proponents and critics.

Public Opinion

Democrats Hold a Nearly 2-to-1 Advantage Over Republicans on Handling the Cost of Health Care

Poll: Health Care and Gas Costs Top Voters’ Midterm Concerns 

As the 2026 midterms approach, health care costs remain tied with gas as voters’ top midterm concerns and the Democrats hold a clear edge over the Republicans Party on who voters trust to handle many top electoral issues, including the cost of health care and the cost of living.

Midterm Election Updates

These fact sheets offer background on election-related health care issues.

ACA Marketplaces

More people than ever got coverage through the Affordable Care Act Marketplaces in 2025, but the expiration of enhanced premium tax credits has driven up what people pay and contributed to declining enrollment in 2026.

Medicaid

Major federal changes to Medicaid eligibility and financing from the 2025 reconciliation law are coming, including new work requirements that will affect millions of Medicaid enrollees.

Vaccine Policy

Federal vaccine policy has shifted toward fewer recommended routine childhood vaccinations, more emphasis on individual decision-making, and greater skepticism about the safety and efficacy of some vaccines.

women's health policy

Women’s Health Care Affordability Challenges

As health care costs dominate the national political conversation, our 2026 KFF Women’s Health Survey shows the toll those costs are taking on women. Our new nationally representative survey of women and men ages 18–64 finds costs remain a major barrier for women, specifically — causing everything from delayed care to rationed medications to cuts in spending on basic needs.

featured videos

How Unaffordable is Health Care? 

Health care affordability is a top issue for many people. Why and how did care get so expensive? In this three-part video series, KFF experts look at the rising cost of health care in the U.S. from the macro level to the issues facing everyday Americans. Drawing on KFF policy analysis and polling, the videos examine the underlying drivers of health care spending, the true cost of employer sponsored health insurance and whether the Affordable Care Act has delivered on its promise. View the videos

Are Health Insurers to Blame for Our Health System Problems? 

Political leaders on both sides point fingers at health insurers for high costs and patient frustrations. How much blame do insurers, in fact, deserve for our health system’s problems? This three-part video series from KFF considers this question and the complicated answer, exploring what’s driving rising insurance premiums, whether insurers provide value, and who we trust to decide what gets covered and at what price. Watch and share →

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  • State Fiscal Conditions: Context on Medicaid Budgets for FY 2027

    Issue Brief

    This brief describes current fiscal conditions using the latest state revenue and spending data from the National Association of State Budget Officers (NASBO) and analyzes how these conditions may impact states’ Medicaid budget decisions going forward.

  • Are Health Insurers to Blame for Our Health System Problems? 

    Video

    Political leaders on both sides point fingers at health insurers for high costs and patient frustrations. How much blame do insurers, in fact, deserve for our health system’s problems? In this three-part video series, KFF’s Larry Levitt considers this question and the complicated answer, exploring what’s driving rising insurance premiums, whether insurers provide value, and who we trust to decide what gets covered and at what price.

  • What’s Driving Rising Health Premiums?

    Video

    Costly health insurance premiums are straining employers and consumers alike. But, it’s underlying health care spending, especially for hospital care, that’s driving costs. KFF’s Larry Levitt looks at how hospital consolidation and employer demands for broad networks affect insurers’ ability, and willingness, to control prices in this first video of a three-part series on health insurers and rising health care costs.

  • What Do We Get for the Cut Health Insurers Take?

    Video

    Insurers take a cut of every premium dollar for overhead and profit. The question isn't just whether they profit, but also whether we’re getting value in return. KFF’s Larry Levitt breaks down how much goes to administrative costs and profit and how that varies across private insurance markets and Medicare, and considers what a Medicare-for-all system, which would be operated by the government, would address and what might be left unresolved in this second video…

  • KFF Health Tracking Poll: Mifepristone and the Midterms

    Poll Finding

    Amid an ongoing FDA re-review of mifepristone, awareness of the safety and prevalence of the abortion pill remains limited. This KFF poll also finds that the voters who say abortion policy is an important issue for 2026 midterm candidates to discuss are disproportionately Democrats.

  • Are Health Care Costs THE Top Issue for Voters?

    From Drew Altman

    In a new column, Dr. Drew Altman, Founding President and CEO, analyzes the polling on health costs as a voting issue and concludes that there is no one top voting issue. He writes: “I have come to the conclusion that the search for a single top issue through polling questions—whether it’s health costs, or gas prices, or the cost of food—is artificial. People worry about and experience these costs together. There is no top issue,…

  • How Has ACA Marketplace Enrollment Changed Across States in 2026?

    Issue Brief

    Following several years of rapid enrollment growth in the Affordable Care Act (ACA) Marketplaces that corresponded with temporary enhanced premium tax credits, enrollment fell for the first time in seven years in 2026, when those tax credits expired. Every state except for New Mexico saw a drop in ACA Marketplace enrollment from 2025 to 2026. State-based Marketplaces that run their own enrollment platforms, including those that partially offset the expiring federal enhanced tax credits, generally…