Health Care Costs and Access Will Feature Prominently in 2026 Congressional Midterms

While former Democratic congressman Tom Periello’s 2010 vote in favor of establishing the Affordable Care Act contributed to him being voted out of office in Virginia’s Republican-heavy 5th Congressional District, his continued support of the policy may be part of his ticket back in this year.

“It’s easy to think that the country is polarized, but there is a lot that is uniting people,” Periello said in a recent call. “The hunger for more affordable health care crosses all district lines.”

Republicans have long loathed the health care policy that was a pillar of former President Barack Obama’s tenure, while Democrats, including Virginia’s congressional representatives, have been strong supporters of the ACA.

Public sentiments about the policy have shifted in the past 16 years and came to a head last summer, when a Republican-controlled Congress passed a reconciliation bill that set the stage for millions nationwide to lose their health care coverage or pay more than they can afford to keep it.

In a KFF Health poll released in late January, two-thirds of respondents said Congress did the “wrong thing” by not extending the ACA tax credits.

“Two-thirds of the public (66%) say they worry about being able to afford health care for themselves and their family, ranking higher than utilities, food and groceries, housing, and gas,” the poll also found.

In total, 61% of respondents said the expiration of the ACA credits would have a minor or major impact on how they vote in the midterms. Other expert sources agree.

“Health care policy is going to be a top issue in all of these competitive House races this cycle,” said Cook Political Report analyst Erin Covey.

An uncanny midterm election cycle

The ACA is critical to states’ abilities to help keep people insured.

First created in 2010, it has filled coverage gaps for people who earned too much for Medicaid but not enough to purchase private insurance. It also allowed states to opt into expanding their Medicaid eligibility to help more people get care. When Virginia became the 33rd state to expand Medicaid in 2018, it did it with bipartisan support, a year after congressional Republicans had sought to undo the ACA.

Analysts say the health care concerns at the top of voters’ minds might give Democrats an advantage when polls open this fall.

Last summer’s measure, which President Donald Trump calls the “big, beautiful bill,” will trigger changes to Medicaid and hospital funding mechanisms. Virginia incumbents U.S. Reps. Rob Wittman, R-Westmoreland, and Jen Kiggans, R-Virginia Beach, had initially opposed portions of the bill before ultimately voting for it. U.S. Rep. John McGuire, R-Goochland, an outspoken Trump loyalist, backed it.

A data analysis from centrist think tank Third Way estimates that various hospitals in Kiggans’, Wittman’s, and McGuire’s districts will lose about $216 million due to the bill Trump signed into law last July. Some clinics have already closed or reduced services, citing the Big Beautiful Bill as part of the reason.

When advocating against versions of the bill last summer, hospital associations in several states, including Virginia, warned that uninsured patients would be more likely to put off care until dire situations arise, then flood emergency departments — ultimately costing hospitals and taxpayers more.

Hospitals always brace for patients who can’t pay, but they also negotiate with private insurers who can raise rates for everyone else to compensate. Meanwhile, safety nets like free clinics argued that their resources would be further strained, too.

Adding to the hiccups, Congress also failed to renew expiring ACA subsidies that had further helped people purchase health insurance. Richmond’s chamber of commerce, local hospital chains, and small business owners spent the summer imploring Congress to renew the subsidies, and the government shut down for over a month last fall when lawmakers came to an impasse over the bill.

By the start of this year, Wittman became one of 17 Republicans nationwide to vote in favor of a three-year extension. Kiggans opposed it after previously championing an extension because she preferred a single year instead of three.

“I have supported a one-year extension, a two-year extension with significant reforms in place,” she told The Virginian Pilot at the time. “I have never supported a three-year extension of COVID-era tax credits with no health care reform in place.”

Wittman, on the other hand, framed his vote as a “strictly temporary” solution.

“This vote was about responsible governance — protecting families from sudden cost increases today while fighting for better, conservative solutions tomorrow,” Wittman said at the time.

The Mercury asked him then and since to elaborate on what health care policies he would like to pursue next, beyond the ACA, but did not receive a further response.

Covey said Kiggans’ experience as a nurse practitioner and her partial support of renewing the ACA subsidies could score her points with voters. But her vote against their extension and support of the reconciliation bill is “going to be an issue that she’s going to be vulnerable on.”

As campaigns ramp up, both parties will highlight affordability

Democrats will focus on affordability in attacks against Republicans this year, Covey predicted.

“I think Democrats want to make this into an election about the cost of health care,” Covey said. “This is going to be a salient issue for voters everywhere.”

For Periello, who would need to clinch the Democratic nomination contest before vying against incumbent McGuire, the first order of business if he gets elected is “rolling back the health care changes.”

He framed it not just as a measure of compassion for constituents but as an economic driver so that people can afford to live, work, and seek medical care in Virginia.

McGuire’s office did not follow through on a request for comment on health care policy preferences.

Covey emphasized that the federal-level hits to health care might hurt Republican candidates’ chances.

“Republicans have aspects of the One Big Beautiful Bill that they can try to frame as a benefit to working-class and middle-class families, like the tax cuts,” she said. “But the health care cuts are one of the most politically devastating parts of the bill for them.”

Rather than turn away from talking about the subject, Trump is pressing Republicans to lean into it.

First, the One Big Beautiful Bill Act was rebranded last fall as the “Working Families Tax Cut Act.”

By January of this year, Trump — who’d previously campaigned on “concepts of a plan” when it came to health care — announced his “Great Health Care Plan.” Congress has yet to take action on it.

The more spelled-out proposals in the president’s plan entail sending funds directly to people to help them purchase their insurance, though it’s unclear how much money would be disbursed.

Trump claimed the nonpartisan Congressional Budget Office estimated his proposal can save people 10% on their premiums, though it isn’t on their website. The office did, however, analyze a previous health care bill by U.S. Rep. Marionette Miller-Meeks, R-Iowa.

That legislation, which has not yet become law, could lower health care premiums by allowing small businesses and self-employed people to band together to buy health insurance as groups. CBO estimated an 11% reduction in costs. It would need to pass the Senate before it could get to Trump’s desk.

The president also recently launched a new website called TrumpRx, which he pitched as a cost-saving solution for people to access prescriptions. But 16 companies his administration had negotiated with to lower drug prices ended up raising them.

Covey said she’s curious to see how the administration attempts to clamp down on health care costs ahead of the election, after it helped spur loss of coverage.

“The GOP members of Congress, with the votes they took last year, it’s still pretty bad for them. It’s going to come up in attack ads,” she said.

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