Democrats who won new statehouse power in Tuesday's midterm elections are lining up to expand Medicaid under the Affordable Care Act in at least four holdout states: Georgia, Kansas, Texas and Wisconsin. Lawmakers have not yet released details.
Ten states, mostly under Republican control, have refused the expansion, which lets states cover adults earning up to 138% of the federal poverty line, about $22,000 a year for a single person. Washington pays 90% of the cost for newly eligible enrollees, and the 40 states that accepted have added nearly 20 million low-income people.
Larry Levitt, executive vice president for health policy at the nonprofit KFF, said that before the election he would not have expected much movement in the remaining holdouts.
Governors as the deciding factor
In Georgia, Gov.-elect Keisha Lance Bottoms built her campaign around full expansion and has called it a day-one priority. Democrats won every statewide office on the ballot and appear poised to take the state House, but Republicans keep the state Senate, so any bill will need bipartisan votes.
State Rep. Michelle Au, a Democrat and physician, said a 2024 expansion bill drew support from both parties, including Republicans from rural districts dealing with hospital closures and high uninsured rates. It died in committee, she said, largely because Republican Gov. Brian Kemp did not back it.
What became apparent in that process was that there was nothing more important to the passage of this issue than having a strong governor who supports it
Michelle Au, Democratic Georgia state representative
Texas voters also handed Democrats every statewide office on the ballot, electing Gina Hinojosa governor and flipping the state House while Republicans held the Senate. Hinojosa has said she will press the Legislature to expand Medicaid.
In Kansas, outgoing Democratic Gov. Laura Kelly had called the Legislature's refusal the most foolish move in the state's history and blamed the Republican House speaker. Democrats flipped as many as 20 House seats this week, ending the GOP supermajority there, though Republicans appear set to keep a House majority and a Senate supermajority.
With votes still being counted, Democrat Cindy Holscher holds a narrow lead in the Kansas governor's race. She campaigned on expansion, arguing it would help keep hospitals open and improve mental health access, and said more than 75% of residents support it.
Federal cuts cloud the math
Wisconsin Democrats will control the governor's office and both legislative chambers, but Gov.-elect David Crowley has deferred to legislators on expansion. State Rep. Greta Neubauer, in line to become speaker, stopped short of a promise and said lawmakers will weigh several health care options. Wisconsin and Georgia already run limited expansion programs.
Neubauer said the Trump administration's new work requirements and other program changes complicate expansion. President Donald Trump signed a tax and spending law in July 2025 that the Congressional Budget Office projects will cut federal Medicaid spending by about $886.8 billion over a decade, largely because work rules will push people off the rolls.
Those rules take effect in January and apply to people who qualified through expansion. Levitt said the new Democratic-controlled Congress is expected to consider delaying or reversing them, which could make expansion more appealing in states such as Texas and Georgia.
