The midterm elections are over, and Democrats are projected to win control of both the House and Senate, Medical Economics reports. For many voters, healthcare costs were a deciding issue.
However, a new Congress won’t instantly change things at your local hospital. Lawmakers aren’t seated until January, President Trump keeps his veto and Senate rules still let the minority block most bills. Meanwhile, major Medicaid changes are already on the calendar, and they’ll take effect before the new Congress can act.
That matters for Black patients, who already face barriers to care, from cost to doctors who don’t listen. Here’s what the midterm elections could mean for local hospitals, especially safety-net hospitals that serve Black and lower-income communities, according to experts.
The Medicaid shuffle: What changing rules mean for hospital budgets
Medicaid is a lifeline for hospitals that serve lower-income patients. Now, the 2025 federal budget law, known as the One Big Beautiful Bill Act, is changing the rules.
Starting by Dec. 31, 2026, most adults ages 19 to 64 who gained coverage through Medicaid expansion must show they work, volunteer or attend school at least 80 hours a month, according to KFF. Some states could get permission to delay until the end of 2028. In addition, these adults will have to renew their coverage every six months instead of once a year.
The Congressional Budget Office estimates the work requirements alone will leave 5.3 million more people uninsured by 2034. More frequent renewals could leave another 700,000 people uninsured, according to CBO estimates cited by KFF. That’s often because of paperwork, like a missed letter or a missing pay stub, not because people stopped qualifying.
That’s why the midterm elections at the state level matter, too. “The governors and state legislators elected this week decide how strictly they’re enforced and how much help people get to stay enrolled,” said Joel Selanikio, MD, a practicing pediatrician at Georgetown and Mary’s Center in Washington, D.C., and a former CDC epidemiologist. “Strict enforcement means more uninsured patients in safety-net ERs and more unpaid bills.”
Community health centers are already preparing for the paperwork. For example, Lynn Community Health Center, a federally qualified health center in Massachusetts, is adding AI tools to help its enrollment staff keep up with the extra workload, according to CEO Brenda Rodriguez‘s team. Medicaid is the center’s largest source of revenue.
The law also changes how states pay for Medicaid. Many states fund their share partly through taxes on hospitals and other providers, and some send extra “state-directed” payments to hospitals that serve many Medicaid patients. Starting in October 2027, the law phases down those provider taxes. Then, starting in 2028, it trims the extra payments, KFF reports.
Source: How The 2026 Midterms Could Impact Medicaid Funding And Your Local Hospital
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