Democrats ran on promises to roll back key Medicaid and ACA changes—and newly elected Democratic governors and legislators in several states could reignite ACA Medicaid expansion debates. Among the ten states that have not adopted the Medicaid expansion, Georgia, Kansas, Texas and Wisconsin are key states to watch for potential new debates about expansion given the outcome of the midterm elections.

The ACA Marketplace Open Enrollment season began November 1, bringing higher premiums, fewer insurer options in some states as more insurers exit the market, less access to health insurance subsidies, and less help finding coverage following federal actions to address broker fraud—among other changes to watch.