The midterm election is right around the corner, and healthcare costs are a top issue on the ballot, tied with gas prices, according to a KFF poll published Oct. 6.
With major races taking place across the country this fall, many candidates are finding different ways of integrating healthcare affordability efforts into their platforms.
The ACA subsidy cliff
ACA enhanced subsidies expired at the end of 2025 after Congress did not extend them. Insurers anticipated that healthier enrollees would move away from ACA plans and, thus, raised rates.
Ahead of the expiration, Sen. Jon Husted, R-Ohio, who is participating in the state’s race, suggested a temporary extension of the credits while installing a minimum monthly premium to disincentivize fraudulent enrollment. That bill stalled. Sen. Susan Collins, R-Maine, signed onto a similar plan, which also did not progress.
North Carolina Republican candidate Michael Whatley has faced heat on the matter, according to WRAL, and his spokesperson blamed Democrats for the government shutdown that ensued. Republicans have been questioning the viability of the ACA marketplace overall. Meanwhile, Democrats have called to reinvigorate subsidies.
Despite the fizzled subsidy talks from earlier this year, steeper premiums are still on the horizon for 2027 as ACA insurers proposed a median average 15% premium bump, according to a Peterson-KFF Health System Tracker analysis from the summer.
Medicaid cuts
While Republican candidates generally support HR 1’s Medicaid changes, which include work requirements, more frequent eligibility checks and tightened state-financing mechanisms, Democratic candidates have opposed these provisions.
Sen. Dan Sullivan, R-Alaska, who is seeking reelection, supported HR 1, saying Alaska had not been using provider taxes or state-directed payments prior to the budget law anyway. He instead advocated for more money to go toward the Rural Health Transformation Program.
Texas Attorney General Ken Paxton, the state’s Republican Senate nominee, called HR 1 “HISTORIC legislation” on X following its passage, whereas his opponent, Democratic Senate candidate James Talarico, described the law to CBS Texas as having “gutted our health care.”
Amid changes to the ACA marketplace and Medicaid, politicians have been weighing solutions to address those who may lose coverage.
Medicare for All — with some twists
Healthcare coverage pitches have surged as employer healthcare costs are slated to jump 9.5% in 2027, according to Aon. People have been dropping off the ACA marketplace as they face higher premiums, and disruption could continue with Medicaid eligibility changes in 2027. Cue: Medicare for All.
Medicare for All has been a buzzword across states — but it isn’t quite a one-size-fits-all term. Recent polling from Tavern Research on behalf of the Searchlight Institute found shifting support for a government-run health plan for everyone depending on the scope and framing. The data is not alone in showing this: Politicians have been unveiling their own versions, as well.
Medicare for All traction is notable. That October KFF poll found 66% of adults favor the plan, the highest share since the organization started polling on the idea in 2016. The proposal got the support of 43% of Americans in a recent Axios/Ipsos American Health Index survey.
Medicare for All is among the hottest topics in Michigan’s Senate race, featuring Abdul El-Sayed, MD, as the Democratic nominee. Dr. El-Sayed previously co-authored “Medicare for All: A Citizen’s Guide” and is advocating for “cradle-to-grave” coverage. His proposal includes no premiums, copays or deductibles.
While Dr. El-Sayed’s campaign website said he would not ban private insurance through employers or unions, those options would be “redundant and unnecessary.” In a “Meet the Press” interview, Dr. El-Sayed said people could pay “a little bit more in taxes” for more stable Medicare for All coverage, rather than coverage dependent on employment or marital status.
Sen. Bernie Sanders, I-Vt., renewed his Medicare for All legislative efforts in 2025. Maine’s Democratic nominee, Troy Jackson, has been a supporter of Medicare for All. When Mr. Jackson was asked about whether he supports Mr. Sanders’ idea of moving to an entirely public insurance system, he emphasized how “everyone has to get into the plan.”
“The healthcare industry, big pharma, has made people feel like they’re not going to get as good of coverage. You’ll be getting something less than. But I actually see a scenario where this is going to be great coverage,” he said during an Oct. 18 CNN interview.
A spokesperson for his opponent, Ms. Collins, previously called Mr. Jackson’s healthcare plan “a slogan,” according to the Portland Press Herald.
In Texas, Mr. Talarico is proposing a different route that he does not neatly characterize as Medicare for All. Under his proposal, every American — regardless of their age — could join Medicare. They could sign up for an affordable, nonprofit healthcare option, aiming to drive down private insurance costs in the process.
Pushing back against vertical integration
Major companies, such as UnitedHealth Group, CVS Health, Elevance Health and Cigna, have businesses spanning the healthcare ecosystem. Vertical integration was one subject of congressional hearings in early 2026, and some candidates have vocalized their opposition.
Mr. Talarico recently joined forces with Cost Plus Drugs co-founder Mark Cuban. During an Aug. 29 discussion, Mr. Talarico said he would stand with the Break Up Big Medicine Act, a bill introduced by Sens. Elizabeth Warren, D-Mass., and Josh Hawley, R-Mo., that Mr. Cuban has backed. The legislation would keep companies from simultaneously owning a health insurer or pharmacy benefit manager and a provider or management services organization.
“This is not a free market. This is coverage by cartel,” Mr. Talarico said. “The only way that we’re going to drive down these prices, the only way we’re going to put our lives ahead of their bottom line, is to break up these big healthcare monopolies.”
Mr. Cuban said the legislation could lower costs “overnight.”
AI-driven denials
Sen. Jon Ossoff, D-Ga., is up for reelection, and he has homed in on the use of AI in healthcare coverage denials as one issue to address. He co-sponsored a Senate resolution that called to repeal the Wasteful and Inappropriate Service Reduction model, a pilot that includes AI-enabled prior authorization decisions to certain services under traditional Medicare in select states.
Meanwhile, in Michigan, Dr. El-Sayed’s campaign directly challenged AI use in healthcare decision-making.
“I categorically oppose the use of AI to allow health insurance of any kind to second-guess decisions made by your doctor,” his website said.
AI use among health insurers has been heavily scrutinized, with senators from both sides of the aisle questioning insurers’ approaches. UnitedHealth, for one, has faced litigation over alleged wrongful denials while using an AI algorithm. The candidates’ strong opposition to these use cases comes as insurers continue to bet big on AI.
Hospital pricing and affordability
Hospital pricing is not just a concern for insurers and drugmakers: It’s weighing on the minds of voters, too.
A Century Foundation survey of voters from earlier this year found that 67% think preventing hospitals from charging excessive prices should be a top federal priority when it comes to cutting costs. This push was bipartisan, garnering support from 66% of Republicans and 71% of Democrats.
That report said hospital prices climbed twice as fast as prescription and insurance prices from 2006 to 2023, while hospital lobbying spending has also been increasing. The West Health-Gallup Healthcare Affordability Index found fewer than half of Americans can consistently afford needed care and medications, a five-year low.
Dr. El-Sayed’s Republican opponent, Mike Rogers, has called for more transparency from both hospitals and insurance companies.
“If hospitals and insurance companies don’t publicly post real prices so patients know what they’re paying before they receive care — the executives should be held accountable,” his website said. “Fines should be imposed.”
In October, CMS finalized a price transparency rule for payers that includes executive attestation, and the Federal Trade Commission sent warnings about price disclosures to health systems.
Editor’s note: This article was initially published Aug. 31 and updated Oct. 19.
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