What's on the line for health care in the midterms

The big picture: It's hard to see Democrats not making health care affordability a top priority in the next Congress, regardless of whether they win only a narrow majority in the House or sweep both chambers in a blowout.

• But the party isn't aligned on an agenda, and a strong showing by progressives could drag things leftward.

Reality check: Any Democratic victory — no matter the size — will be tempered by the realities of split government, with President Trump still in office for the next two years.

• Larger Democratic majorities may bring greater leverage in negotiations over spending packages or raising the debt limit.
• And the boldest changes will probably be reserved for the campaign trail, as 2028 presidential contenders begin to vie for the party's nomination.

Here's what we're watching:

Medicare for All vs. moderates: What happens in Michigan's Senate race — and Maine's, to some extent — will almost certainly shape how much sway progressives have in the next two years.

• Democrat Abdul El-Sayed has made Medicare for All central to his campaign, unabashedly supporting the idea in a race that could determine which party has control of the Senate next year.
• The same is true of Democrat Troy Jackson in Maine's Senate race, though Jackson has a lower national profile than El-Sayed.
• But Medicare for All supporters looking for a vote on the measure face an uphill battle: Despite the policy's growing popularity among the public, moderates unwilling to abolish private insurance will make up a sizable portion of any Democratic majority.

The doctors-turned-politicians: Doctors are on the ballot in key races this year, and the question is how much public trust translates into votes.

• El-Sayed, an epidemiologist who went to medical school but isn't a practicing physician, is one example.
• There's also pediatrician Annie Andrews, who's mounted a strong challenge to Republican Sen. Darline Graham in South Carolina, and Ohio governor candidate Amy Acton, who has focused on pediatrics and preventive medicine.
• "We've seen in our research over the last six-plus years that [doctors are] among the most trusted potential candidates for office, hands down," said Erik Polyak, executive director of 314 Action.

MAHA on the line: Health Secretary Robert F. Kennedy Jr.'s "Make America Healthy Again" movement has focused its attention largely on the Iowa governor's race in the final weeks of the election, going all in for Republican Zach Lahn, who's pledged to take on Big Agriculture interests and the use of farm chemicals.

• Calling it an "existential" vote, MAHA Action founder Tony Lyons told MAGA influencer Steve Bannon that the race will be "the test of what's possible in a state, of whether we can actually take the country back from these corrupt companies, from these corrupt politicians, and really protect people."

California's tax plan: Golden State voters will decide the fate of a controversial one-time wealth tax on billionaires, with most of the proceeds to be used to fund health care services.

• The money is intended to partly make up for Republican cuts to federal Medicaid spending but the tax is opposed by Gov. Gavin Newsom, a likely 2028 Democratic presidential contender.
• The measure tests voter sentiment in one of the bluest states to tax the super rich in order to fund health benefits — a potential prelude to a national debate over expanding the federal government's role in health care and how to fund it.

Abortion ballot measures: Voters in four states will determine what reproductive rights in their states look like, another round of post-Roe abortion policymaking via ballot initiatives.

• Nevada and Virginia will consider constitutional amendments protecting the right to abortion, while Missouri will weigh a measure backed by the state legislature to repeal a 2024 pro-abortion rights amendment.
• Idaho voters will determine the fate of a state law guaranteeing a right to abortion until fetal viability, generally considered to begin around 23 to 24 weeks into a pregnancy, or after that in the case of a medical emergency.