State election impact on health policy

Elections at the state level will also have major implications for health policy.

The details:

• Health care experts elected: The newly elected governor of Ohio, Amy Acton, is a doctor who led the state’s health department, and former Department of Health and Human Services (HHS) Secretary Xavier Becerra won the gubernatorial race in California. Several other state- and local-level candidates ran on health-related issues.
• Ballot measures: States voted on more than 165 ballot initiatives, including several related to substance use. Voters in Massachusetts decisively shot down an initiative that would have repealed marijuana legalization, including forcing adult-use marijuana retailers to close by 2028, tightening possession limits, and removing protections for growing at home. Idaho voters rejected a proposed constitutional amendment that would have declared that only the legislature has the power to legalize marijuana, narcotics, or other psychoactive drugs, meaning it could not be done through citizen initiatives. Arizona approved a measure naming drug cartels terrorist organizations and directing the state’s Department of Homeland Security to address the threat, while Colorado voted to increase criminal penalties for possession, manufacture, and sale of fentanyl. Nebraska voted against two measures that would have allowed legalized online sports betting. South Dakota voters rejected a ballot question that could have triggered a repeal of the state’s Medicaid expansion if the federal funding share fell below 90%.
• Medicaid decisions: Several states that have not expanded Medicaid elected officials interested in doing so, while elected officials in states that have expanded Medicaid are facing decisions about how to implement the upcoming Medicaid work requirements. The election results made Medicaid expansion more viable in Georgia and Wisconsin, as well as Kansas and Texas, though hurdles remain with HR 1 changes and some split state control in Texas and Kansas. Medicaid expansion has been integral to expanding access to addiction treatment. More states expanding would help bolster treatment access. Work requirements threaten to disconnect people from care, but state implementation decisions can help minimize harm for people with substance use disorder.

Read more: 36 states will elect governors in 2026