Voters in seven states will decide eight healthcare-related ballot measures, ranging from reproductive health policy to the future of Medicaid expansion and safety-net hospital funding.
The midterm elections carry federal consequences as well. Control of Congress will shape whether lawmakers revisit the Medicaid cuts in HR 1, the One Big Beautiful Bill Act; restore the enhanced ACA subsidies that expired at the end of 2025; and act on proposals tied to Medicare physician pay, practice ownership and AI-driven prior authorization.
Voters, for their part, trust physicians more than most players in the healthcare debate. In a May Morning Consult poll of 2,002 registered voters, 84% viewed physicians favorably and 70% said physicians should have the final say on coverage decisions. The poll was commissioned by the Coalition to Strengthen America’s Healthcare, a hospital industry advocacy group.
1. Liability protections for abortion providers in Idaho. Proposition 1 would create a right to abortion before fetal viability, and after viability in medical emergencies. It would also protect healthcare providers from professional discipline and from civil and criminal liability. Idaho law currently bans abortion except to prevent the death of the pregnant woman, and in the first trimester in cases of rape or incest reported to law enforcement.
2. Physician judgment in Virginia. Question 1 would add a fundamental right to reproductive freedom to the state’s Bill of Rights, covering prenatal care, childbirth, postpartum care, contraception, abortion, miscarriage management and fertility care. The state could regulate third-trimester abortion but could not prohibit it when a physician determines it is medically necessary to protect the patient’s life or health, or when the fetus is not viable. The amendment would also protect patients, and those who help them, from penalties.
3. A rollback in Missouri. Amendment 3 would repeal the reproductive rights amendment voters approved in 2024, which protected abortion through fetal viability. Abortion would be permitted in medical emergencies, for fetal anomalies, and in cases of rape or incest up to 12 weeks. The measure would also require parental or judicial consent for minors seeking abortion and ban gender-affirming care for minors, with exceptions for specific medical conditions.
4. Locking in Nevada’s 24-week standard. Question 6 would write Nevada’s current abortion law, which permits the procedure through 24 weeks of pregnancy, into the state constitution. Voters approved the measure in 2024 with 64.4% of the vote. Nevada requires constitutional amendments to pass in two consecutive general elections.
5. Gender-affirming surgery for minors in Colorado. Proposition 135 would bar healthcare professionals from performing gender-affirming surgery on patients younger than 18 and prohibit public funds, Medicaid and insurance from paying for those procedures. It includes an exception for people with a medically verifiable disorder of sex development and does not address hormone therapy. If approved, it would take effect Jan. 1, 2027.
6. A Medicaid expansion trigger in South Dakota. Amendment I would end expanded Medicaid coverage if the federal share of expansion funding falls below 90%, returning eligibility to the groups covered before the program’s 2022 expansion. About 30,000 South Dakotans are covered through expansion. Oklahoma Republicans floated a similar trigger earlier this year, as HR 1 tightens the rules states use to finance their share of Medicaid.
7. Safety-net clinic spending in California. Proposition 44 would require private nonprofit safety-net clinics to spend at least 90% of their revenue on healthcare services each year. Clinics currently average about 80%. Those that fall short would pay a penalty, refundable if they comply within five years. The state’s Legislative Analyst’s Office warned that some clinics “might close instead,” a risk that extends to the physicians those clinics employ.
8. New healthcare funding in California. Proposition 40 would impose a one-time 5% tax on the net worth of billionaires who lived in California on Jan. 1, 2026, with 90% of the revenue directed to healthcare. The state would likely collect tens of billions of dollars over several years. The measure was not part of a June deal between the California Hospital Association and the California Federation of Labor Unions that pulled two other measures from the November ballot, including a proposed $450,000 cap on hospital executive pay.
9. Medicaid, ACA subsidies and physician pay. Republican candidates have generally backed HR 1’s Medicaid changes, including work requirements that take effect in January 2027, more frequent eligibility checks and tighter state financing rules. Democrats oppose them. House Democrats have drafted an 84-page health policy agenda outlining what they would pursue with a majority, according to Politico. Reversing the Medicaid cuts is the top priority. The agenda also calls for restoring the enhanced ACA premium tax credits and includes bipartisan workforce and payment proposals such as Medicare physician pay and residency slots. Insurers, meanwhile, have proposed a median 15% premium increase for 2027.
10. Who controls clinical decisions. Two fights over corporate influence on care also hinge on the outcome. The Stop Corporate Takeovers of Physicians Act, introduced Sept. 16 by Senate and House Democrats, would limit ownership of physician practices to entities majority-owned and controlled by licensed physicians and ban most physician noncompetes. The bill has been referred to committee, and most leaders have told Becker’s that they doubted it would pass in the current political environment.
Separately, Texas Democratic Senate candidate James Talarico has backed the bipartisan Break Up Big Medicine Act from Sens. Elizabeth Warren (D-Mass.) and Josh Hawley (R-Mo.), which would bar companies from owning both an insurer or pharmacy benefit manager and a provider or management services organization.
“This is coverage by cartel,” Mr. Talarico said.
Prior authorization is part of the same debate. Sen. Jon Ossoff (D-Ga.), who is up for reelection, co-sponsored a Senate resolution calling for repeal of CMS’ WISeR pilot, which uses AI-enabled prior authorization in traditional Medicare in select states.
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