Democrats who gained ground in Tuesday's midterms in Georgia, Kansas, Texas and Wisconsin are positioned to push Medicaid expansion under the Affordable Care Act in states that have long refused it, though lawmakers have not yet released details.
All four are among the 10 states that never adopted the law's broader expansion, which covers 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 those new enrollees, and the 40 states that signed on added nearly 20 million low-income people.
Georgia and Wisconsin run limited programs. In the holdouts, mostly under Republican control, GOP opponents have blocked expansion as too costly or out of ideological resistance to growing government. Larry Levitt, a health policy executive at the nonprofit KFF, said that before Tuesday he would not have expected much movement among them.
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 votes from both parties.
State Rep. Michelle Au, a Democrat and physician, said a 2024 expansion bill drew bipartisan backing, including from Republicans representing rural districts dealing with hospital closures and higher uninsured rates. It died in committee, she said, largely because Republican Gov. Brian Kemp did not support 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
In Texas, Democrats also swept 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.
Kansas Democrats flipped as many as 20 state House seats, breaking the Republican supermajority there, although Republicans appear set to retain a House majority and a Senate supermajority. With votes still being counted, Democrat Cindy Holscher holds a narrow lead in the governor's race.
Holscher campaigned on expansion, arguing it would help keep hospitals open and widen access to mental health care, and she said more than 75% of Kansans support it. Outgoing Democratic Gov. Laura Kelly had called the Legislature's refusal the dumbest thing Kansas has ever done, blaming opposition from the Republican House speaker.
Wisconsin's new Democratic trifecta could make passage far easier, yet party leaders are hedging. Gov.-elect David Crowley has deferred to legislators, and state Rep. Greta Neubauer, in line to become speaker, stopped short of a commitment, saying lawmakers will weigh several health care options.
Neubauer pointed to new federal work requirements and other program changes as complications. The tax and spending law President Donald Trump signed in July 2025 is projected to cut federal Medicaid spending by $886.8 billion over a decade, according to Congressional Budget Office estimates, largely by pushing people off the rolls through rules that take effect in January and apply to the expansion population.
The incoming Democratic-controlled Congress is expected to consider delaying or reversing those changes, a step Levitt said may make expansion even more attractive for states like Texas and Georgia.
