Democrats win Congress as voters in six states settle health care ballot measures

Democrats were projected to win control of the House and Senate in Tuesday's midterm elections, according to CBS News, NBC News and CNN.

The temporary 2.5% Medicare pay increase expires Dec. 31, and Medicaid work requirements under the One Big Beautiful Bill Act (OBBBA) start Jan. 1 in most states. The new Congress is not seated until later in January.

As of 3 a.m. Wednesday, Decision Desk HQ expected Democrats to win 258 House seats and 55 Senate seats, The Hill reported. Republicans held 53 Senate seats and 218 House seats going into Election Day.

Physicians on the ballot

Pediatrician Annie Andrews, M.D., M.S.C.R., won South Carolina's open Senate seat, becoming the first Democrat to win a Senate race in the state since 1998.

The seat was held for 23 years by the late Sen. Lindsey Graham. Andrews ran on treating health care as a "right" rather than a "privilege," maintaining vaccine access and keeping rural hospitals open, STAT reported.

In Michigan, Democrat Abdul El-Sayed, M.D., D.Phil., an epidemiologist and former Detroit health director, also won a Senate seat. He earned his medical degree at Columbia University and a doctorate in population health at the University of Oxford, where he was a Rhodes Scholar, but did not complete a residency.

El-Sayed and Andrews will be the first Democrats with medical degrees in the Senate since 1969, according to STAT.

Sen. Marshall ousted in Kansas

Sen. Roger Marshall, M.D. (R-Kansas), an OB-GYN and founder of the congressional MAHA Caucus, lost his reelection bid to Democrat Adam Hamilton, according to STAT.

In September, Kansas court records reviewed by The New York Times showed Marshall's obstetrics practice had sued more than 700 patients over unpaid bills. At least 81 of those patients were arrested after missing court dates, the Times reported.

Marshall spokeswoman Payton Fuller told the Times that "judges issue warrants when people repeatedly miss court dates, not doctors."

Steven Johnson, a former lawyer for Marshall who handled many of the collection cases, told the Times that Marshall decided which cases to send to his firm but did not weigh in on the steps it took in court. Johnson said Marshall's office set the 18% interest rate.

Later in September, Marshall called the report "totally a hit job by left media" in an interview with Fox News Digital. "I would never want anyone to be arrested because of money that they owe myself or the hospital," he said.

Marshall's lawyers also sent Hamilton's campaign a cease-and-desist letter calling a campaign ad featuring former patient Meischa Zimmerman defamatory, Kansas Reflector reported. The letter said Zimmerman was arrested for failing to appear in court, not for a missed payment.

On Oct. 29, Zimmerman filed a lawsuit in Barton County District Court seeking class-action status on behalf of former patients. It alleges Marshall and Heartland Regional OBGYN charged interest above the 15% rate allowed under Kansas law. Marshall declined to comment and referred questions to his communications team, KCUR reported.

About two weeks before the election, Marshall had his own film crew record a 60-second video responding to the medical debt attacks after his top advisers argued against it, the Times reported Nov. 1, citing four people with knowledge of the matter.

"My involvement in any patient's account ended the minute it was turned over to an outside agency," Marshall said in the video. "I never had anyone arrested."

The video became public after Kansas City talk radio host Pete Mundo posted it on X (formerly Twitter). Campaign spokesman Alex DeGrasse told the Times the campaign had not posted the video or run it as an ad.

In the House, physician incumbents who won include Reps. Andy Harris, M.D., M.H.S. (R-Maryland), Ronny Jackson, M.D. (R-Texas), John Joyce, M.D. (R-Pennsylvania), Rich McCormick, M.D., MBA (R-Georgia), Bob Onder, M.D., J.D. (R-Missouri), Ami Bera, M.D. (D-California), Maxine Dexter, M.D. (D-Oregon), Kelly Morrison, M.D. (D-Minnesota), Raul Ruiz, M.D., M.P.P., M.P.H. (D-California) and Kim Schrier, M.D. (D-Washington).

Rep. Herb Conaway, M.D., J.D. (D-New Jersey) was projected to win reelection. Rep. Mariannette Miller-Meeks, M.D., M.S. (R-Iowa) lost.

Among newcomers, pediatrician Richard Pan, M.D., M.P.H. (D-California) won, and surgeon Adam Hamawy, M.D. (D-New Jersey) and neurosurgeon John Cowan, M.D. (R-Georgia) were projected to win. Ralph Alvarado, M.D. (R-Kentucky) lost.

Races involving Reps. Scott DesJarlais, M.D. (R-Tennessee), Mike Kennedy, M.D., J.D. (R-Utah) and Greg Murphy, M.D. (R-North Carolina), along with emergency physician Amish Shah, M.D., M.P.H. (D-Arizona), were uncalled as of Wednesday morning.

Twenty physicians serve in the current Congress, a record-tying number, according to the American College of Gastroenterology. "After the midterm elections, the new Congress looks like it will have even more physicians," Chief Healthcare Executive reported.

Read more from Chief Healthcare Executive: Election 2026: Doctors who won and lost races for Congress

Governors and Medicaid

Democrats flipped governorships in Georgia, Iowa, Nevada, Ohio and Texas and now hold 28 to Republicans' 20, with two races uncalled, according to the National Conference of State Legislatures.

In Ohio, Amy Acton, M.D., M.P.H., who led the state's COVID-19 response, won after campaigning on protecting Medicaid access, forgiving medical debt, addressing surprise billing and creating a state prescription drug plan, STAT reported.

In Georgia, Governor-elect Keisha Lance Bottoms has promised to replace the state's partial Medicaid expansion with full ACA expansion, according to STAT. The current program, which covers low-income adults who prove they are working, expires at the end of the year.

In Nevada, NBC News projected that Democrat Aaron Ford would unseat Gov. Joe Lombardo.

Ballot measures

South Dakota. Voters rejected Amendment I, which would have removed the state's constitutional requirement to cover the Medicaid expansion population if the federal share of costs fell below 90%.

The Associated Press (AP) called the race at 1:22 a.m. Wednesday with 56% opposed and more than 80% of votes counted, South Dakota Searchlight reported.

"By rejecting Amendment I, voters chose to protect healthcare access for more than 30,000 hard-working South Dakotans and their families," Deb Fischer-Clemens, a nurse, Democratic former state lawmaker and former senior vice president of Avera's Center for Public Policy, told the outlet.

Republican Will Mortenson, who sponsored the amendment, told the outlet that "fiscal policy is a tough sell on the ballot."

California. NBC News projected that voters would reject Proposition 44, which would have required private nonprofit community clinics to spend at least 90% of revenue on patient care, with about 82% opposed as of Wednesday morning. The California Medical Association opposed the measure.

Proposition 40, a one-time 5% tax on billionaires' net worth with 90% of revenue earmarked for health care, had not been called but trailed with about 56% opposed, according to the AP.

Proposition 3, which would make permanent the income tax rates on the state's highest earners, led with about 59%.

Abortion. Missouri voters rejected Amendment 3, which would have repealed the 2024 "right to reproductive freedom" amendment and written a ban on "cross-sex hormones or puberty-blocking drugs" for minors into the constitution, according to the AP. The measure failed about 55% to 45% in complete but unofficial results.

Idaho voters rejected Proposition 1, which would have established a statutory right to "reproductive freedom and privacy," about 55% to 45%, the AP reported.

Virginia voters approved Question 1, adding a "fundamental right to reproductive freedom" to the state constitution, according to NBC News.

Nevada voters approved Question 6 for the second time, completing the state's two-election requirement to amend its constitution, NBC News reported.

Colorado. Proposition 135, which would prohibit surgeries for minors "for the purpose of altering biological sex characteristics," led 51.5% to 48.5% Tuesday night but remained too close to call, The Colorado Sun reported.

Amendment 87, a graduated income tax that would direct new revenue to education, health care and child care, led with 50.6% as of 10 p.m. Tuesday, while the competing Proposition 136 had 47% support, Colorado Newsline reported. Neither had been called Wednesday morning.

What comes next

"House Democrats will be united around the effort to reverse the Medicaid cuts and extend the Affordable Care Act tax credits right out of the gate," House Democratic Leader Hakeem Jeffries (D-New York) told reporters in October, ABC News reported.

President Donald Trump keeps his veto, and Senate rules let Republicans block most legislation.

Before the vote, a former congressman and two health policy advocates said shutdown standoffs would likely set the terms of any health care deal next year.

"Medicare physician payment is broken, and patients are paying the price," American Medical Association (AMA) President Willie Underwood III, M.D., said in a July statement welcoming a bipartisan payment reform effort.

The AMA has urged Congress to tie annual physician pay updates to the Medicare Economic Index, a measure of practice cost inflation.