Abortion protections survived in Missouri, Virginia and Nevada but fell in Idaho; South Dakota refused to put Medicaid expansion on a trigger; California buried a clinic-spending measure; and Texas sent James Talarico to a Senate that just gained two doctors.
Written: Katie Coffee
Photo: James Talarico at a Whataburger in Texas. Brandon Bell / Getty Images
Health care did not have its own line on most ballots Tuesday. It did not need one. It was in the abortion amendments in four states, the Medicaid question in South Dakota, the clinic and billionaire fights in California, and, if you squint, in the Senate map itself, which now has a few more white coats on it.
Here is the morning-after chart. All numbers are unofficial and some counts were still moving when this was written.
The abortion measures: three to one
Missouri was the big test, and the first state to be asked whether it wanted to take back abortion rights it had voted for two years earlier. Amendment 3, which would have repealed the 2024 protections, banned most abortions and written a prohibition on gender-transition procedures for minors into the constitution, failed. The Associated Press called it at 10:18 p.m. Central with No near 55 percent. Opponents under the Stop the Ban banner had reported more than $27 million in donations by mid-October.
Virginia voters approved Question 1, adding a right to reproductive freedom, including contraception and fertility care, to the state constitution with roughly 62 percent. Nevada gave Question 6 its required second approval, around 63 percent with most of the vote counted, locking abortion rights until viability into its constitution.
Idaho went the other way. Proposition 1, a citizen initiative to replace one of the country’s strictest bans with a viability standard, lost about 55 to 45. The LDS Church had put $1 million into the opposition. The near-total ban stays.
Medicaid: South Dakota says no to the trigger
South Dakota’s Amendment I would have let the state drop Medicaid expansion if the federal match ever fell below 90 percent, a live possibility under last year’s reconciliation law. Voters rejected it, about 56 to 44, with all precincts reporting. Expansion stays in the state constitution, which is where voters put it in 2022.
California: clinics, billionaires and a very expensive argument
Proposition 44, a union-backed rule forcing community clinics to spend 90 percent of revenue on patient care, was crushed, running above 80 percent No. Proposition 40, the one-time 5 percent tax on billionaire wealth that would have funneled most of its take into health programs, was trailing at about 56 percent No and had not been called. Proposition 38, an $8.4 billion bond for immunology and immunotherapy research, was leading at about 57 percent with half the vote in. Nearly $1 billion was spent across the state’s 14 propositions, which would buy a great many lab coats.
Colorado’s Proposition 135, a ban on gender-related surgeries for minors, was too close to call Wednesday morning.
The big one: Texas
James Talarico, a Democratic state representative and former public school teacher from Austin, beat Attorney General Ken Paxton for the U.S. Senate, NBC News projected. With about 90 percent counted he led by roughly 12 points. He is the first Democrat to win a Texas Senate seat since Lloyd Bentsen in 1988. His stump speech leaned on cost of living and expanding access to affordable health care, which in Texas, the state with the nation’s highest uninsured rate, is not an abstraction.
Texas was one of seven Senate flips Democrats recorded, alongside Maine, Ohio, Iowa, Kansas, North Carolina and South Carolina. Networks projected Democrats would control both chambers.
The clinical footnote
The Senate just swapped one physician for two. Kansas Sen. Roger Marshall, an OB-GYN, lost to Democrat Adam Hamilton. South Carolina elected pediatrician Annie Andrews, the state’s first Democratic senator since 1998. Michigan sent epidemiologist Abdul El-Sayed. Ohio picked Amy Acton, who ran that state’s COVID response, as governor. Whatever you think of their politics, the next Senate HELP hearing is going to have fewer people asking what a formulary is.
What is actually in play now
Hakeem Jeffries said in October that House Democrats would move immediately to reverse last year’s Medicaid cuts and restore the enhanced ACA tax credits that expired in January, after which enrollees who kept their plans saw premiums roughly double. Medicaid work requirements under the 2025 law start January 1, 2027. Medicare’s temporary 2.5 percent physician pay bump dies December 31.
My opinion, labeled as such: none of that passes easily. The Senate filibuster is intact and President Trump still holds a veto pen. But the ballot measures tell a cleaner story than the horse race. Where voters were asked directly about keeping coverage or keeping a right they already had, they kept it, in red states and blue. Idaho is the exception, and even there the margin was ten points, not thirty.
Tomorrow we will look at what the lame-duck Congress can realistically do before January, and what the courts are likely to say about the rest.
References
Medical Economics, “Democrats win Congress as voters in six states settle health care ballot measures,” Nov. 4, 2026. https://www.medicaleconomics.com/view/democrats-win-congress-as-voters-in-six-states-settle-health-care-ballot-measures
KCTV5, “Missouri voters say no to abortion amendment,” Nov. 3, 2026. https://www.kctv5.com/2026/11/04/missouri-voters-no-abortion-amendment/
VPM, “Virginia voters sign off on all 3 constitutional amendments,” Nov. 3, 2026. https://www.vpm.org/elections/2026-11-03/va-constitutional-amendments-results/
Newsweek, “Abortion Rights Score Three Wins in Midterm Elections,” Nov. 4, 2026. https://www.newsweek.com/abortion-rights-score-three-wins-midterm-elections-12662092
KUER / Boise State Public Radio, “Abortion measure in Idaho defeated as Nevada tally drags on,” Nov. 4, 2026. https://www.kuer.org/politics-government/2026-11-04/abortion-measure-in-idaho-defeated-as-nevada-tally-drags-on
KOTA Radio, “Statewide amendment results: voters reject Medicaid repeal,” Nov. 4, 2026. https://www.kotaradio.com/2026/11/04/statewide-amendment-results-voters-reject-medicaid-repeal-approve-citizenship-requirement/
NBC San Diego, “Election results for all 14 California props,” Nov. 3–4, 2026. https://www.nbcsandiego.com/news/local/election-results-for-billionaire-tax-voter-id-measure-and-other-california-props/4096284/
CalMatters, “What we know about results in all 14 California ballot propositions,” Nov. 3–4, 2026. https://calmatters.org/politics/elections/2026/11/california-election-result-propositions/
KPRC/click2houston, “NBC News projects James Talarico as winner of Texas U.S. Senate race,” Nov. 3, 2026. https://www.click2houston.com/decision-2026/2026/11/04/nbc-news-projects-james-talarico-as-winner-of-texas-us-senate-race-defeating-ken-paxton/
Newsweek, “Midterms map shows Senate before and after,” Nov. 4, 2026. https://www.newsweek.com/midterms-map-shows-senate-before-and-after-abdul-el-sayed-troy-jackson-12656795
Forbes, “7 Health Issues On The Ballot In The 2026 Midterms,” Oct. 27, 2026. https://www.forbes.com/sites/jessepines/2026/10/27/7-health-issues-on-the-ballot-in-the-2026-midterms/
Ballotpedia, “South Dakota Constitutional Amendment I (2026).” https://ballotpedia.org/South_Dakota_Constitutional_Amendment_I,_Medicaid_Expansion_Conditioned_on_90%25_Federal_Funding_Amendment_(2026)
