November 3 is election day, and early voting is already underway in many Northeast states. This year, I got a chance to vote early at the Susan B. Anthony House and stuck my “I voted” sticker on her headstone. People from all over the U.S. come to Rochester to do this and honor Anthony’s contribution to securing women’s right to vote.

As YLE National made clear yesterday, politics and health are intertwined and deeply local. So this week, we’re doing something different by focusing on the midterms and what they mean for us in the Northeast, specifically the roles different positions play in health decisions, key races, and how these races could affect costs and coverage.

Spotlight: Midterm elections and health

Earlier this year, eight in ten people nationally said health care costs would influence their vote. We recently covered the changes coming to Medicaid (though your state may call it by another name), which will likely be on many people’s minds this election week, too. But how does each position we vote for impact these concerns?

We chose these close races because the winner could influence health care costs and coverage. Let us know in the comments if we missed any key races!

Governors

The governor proposes and writes the state budget, which heavily affects health care costs and Medicaid funding, especially how a state uses federal funds and fills coverage gaps with state resources.

With federal changes already in the law, the next governor can impact how these changes reach you:

• How hard it is to prove your Medicaid eligibility
• Whether your doctor or local hospital can afford to take Medicaid patients
• Whether the state helps pay for your insurance

Together, these determine who in your state can get preventive care to stay healthy and care when they are sick.

1. Maine—Hannah Pingree (D) vs. Bobby Charles (R) vs. Rick Bennett (I)

All three candidates agree that MaineCare (Maine’s Medicaid) underpays providers. This affects which providers take MaineCare patients and whether rural hospitals and birthing units stay open. But they propose different solutions:

• Pingree favors adding a state-negotiated public option.
• Bennett supports universal coverage and relief from medical debt.
• Charles opposes Medicaid expansion but has not shared a detailed health plan.

Why it matters: A national study found higher Medicaid payments for doctors led to more office visits and better health, and fewer missed school days for kids.

2. Vermont—Phil Scott (R, incumbent) vs. Amanda Janoo (D)

Both candidates say high insurance premiums are one of the highest costs for Vermont families. They differ on how to fix it:

• Scott wants to make changes within the current system, such as allowing businesses to band together to buy insurance.
• Janoo wants to create free, state-funded primary and preventive care, paid for by an income tax on high earners, though. Scott argues those earners would leave the state.

Why it matters: When the ACA made some preventive services free, more people used them, but the gain was modest because some people didn’t know they were free.

3. New York—Kathy Hochul (D, incumbent) vs. Bruce Blakeman (R)

Both candidates say they’ll invest in rural health care as federal cuts squeeze hospitals in a state with almost 7 million Medicaid enrollees. They differ on where the money comes from:

• Hochul has used state funds to fill what she calls a roughly $10 billion federal funding gap, including a fund for hospitals that are close to closing.
• Blakeman wants to recover what he says is $2 billion in Medicaid fraud, a figure based on a federal claim that state data contradicts.

Why it matters: Although fraud can happen, in 2023, over 80% of improper Medicaid payments resulted from incorrect documentation.

4. New Hampshire—Kelly Ayotte (R, incumbent) vs. Cinde Warmington (D)

The issue here is whether Medicaid enrollees should pay toward their coverage:

• Ayotte’s budget added monthly premiums of $60 to $270 for enrollees at or above the poverty line, starting in July, and raised prescription copays from $1-$2 to $4. She says the budget protects who qualifies, especially children.
• Warmington says the costs could push families off coverage, and she would make reversing both changes “a top priority.”

Why it matters: Premiums have historically made it harder for people to get and keep Medicaid. Even small costs lead people to skip care.

House of Representatives

All 435 House seats are up for reelection every two years. Tax and spending laws often start in the House, including those applying to Medicaid, Medicare, and ACA tax credits.

Republicans currently hold a narrow majority, and two seats are empty. A few close races could shift control and determine key health issues:

• The 2025 Medicaid cuts
• Medicaid work requirements starting Jan. 1, 2027
• Enhanced ACA premium tax credits

Ultimately this can affect how much federal money goes towards health care, what you must prove to stay enrolled, and how much you’ll pay monthly for your premium.

Key races we’re watching:

1. New York—NY-17 Mike Lawler (R, incumbent) vs. Cait Conley (D).

Both candidates support bringing back the ACA tax credits, but they split on Medicaid:

• Lawler defends the 2025 budget bill’s work requirements and eligibility checks, saying only people who no longer qualify will lose coverage.
• Conley supports reversing the cuts and allowing anyone to buy into Medicare regardless of their age.

Why it matters: Work requirements haven’t historically panned out. When Arkansas tried work requirements in 2018, more than 18,000 people lost coverage before a judge halted the program, with no change in employment.

2. Pennsylvania—PA-1, PA-7, PA-8, PA-10.

Pennsylvania has an unusual cluster of swing votes on health care. Three of the current House members in these districts (Brian Fitzpatrick, Rob Bresnahan, and Ryan Mackenzie) also signed a 2025 petition that forced a vote to extend the ACA tax credits.

Why it matters: Even if you don’t live in Pennsylvania, these races could decide whether the tax credits that lowered monthly premiums come back.

3. Maine—ME-2 Matt Dunlap (D) vs. Paul LePage (R)

ME-2 is a rural district held by retiring Democrat Jared Golden, where a major issue for voters is whether or not they can access health care, particularly maternity care.

• Dunlap says he’ll vote to reverse the Medicaid cuts.
• LePage vetoed Medicaid expansion as governor. His focus is a new $50 billion federal rural health fund and says Medicaid works if hospitals are paid what care costs.

Why it matters: Five obstetrics (OB) units in the Lewiston, Bangor, Auburn, and Presque Isle district have closed over the last five years, worsening access to vital health services.

4. New Jersey—NJ-07 Tom Kean, Jr. (R, incumbent) vs. Rebecca Bennett (D)

Here, the ACA tax credits are less of a dividing line than they seem. Kean voted to extend them, and Bennett wants them back. The real choice is Medicaid:

• Kean defends the 2025 budget bill’s Medicaid changes.
• Bennett would undo these changes.

Why it matters: Kean says the new rules keep Medicaid for people who qualify. Bennett says they’ll cut off people who still need it. The winner could help decide which rules stay.

5. New Hampshire—NH-01 Stefany Shaheen (D) vs. Anthony DiLorenzo (R)

This race has the sharpest differences.

• Shaheen backs Medicare for All.
• DiLorenzo calls the ACA “not, in practice, affordable” and wants price transparency and competition instead of “government-run health care.”

Why it matters: When it comes to politics, slogans tend to leave out nuances. YLE National recently wrote about the practicalities of Medicare for All.

Senate

Senators serve six-year terms, and 35 of the 100 seats are on the ballot this year. Republicans hold 53 seats, so Democrats need a net gain of four to take control.

Most bills need 60 votes, but budget bills need only 51.

With the split this close, the next Senate could decide:

• Whether the 2025 Medicaid cuts, which passed 51 to 50, get revisited
• Whether ACA credits that lowered premiums come back, after a December 2025 vote to extend them fell short at 51 votes
• Who leads agencies that set health policies, like HHS, CMS, FDA, and CDC

Ultimately, the Senate decides whether health policy changes approved in the House become law and who runs the agencies behind your coverage, the safety of your medicines and vaccines, and the health of your community.

Key races we’re watching:

1. Maine—Sen. Susan Collins (R) vs. Troy Jackson (D)

Neither candidate is a clear winner, so the race is too close to predict. Collins voted to advance the 2025 budget bill, then voted against final passage, citing its “harmful impact” on Medicaid. Jackson pushed for MaineCare expansion as a state senator and supports Medicare for All, which Collins opposes.

Why it matters: Collins chairs the Senate Appropriations Committee, which sets discretionary funding for agencies that include the NIH and CDC. If she loses, someone else will take that role, regardless of which party controls the Senate.

2. New Hampshire: Chris Pappas (D) vs. John E. Sununu (R)

Both candidates say health care costs too much but differ on how to bring it down.

• Pappas voted against the 2025 budget bill and against the November 2025 deal to end the shutdown because it didn’t extend the ACA credits.
• Sununu wants insurers to compete across state lines, providers to post their real prices, and health savings accounts to be open to anyone.

Why it matters: Pappas backs federal assistance while Sununu wants competition to bring down prices. Which side comes out on top could shape what your care is going to cost.

Bottom line

Here’s what you can do: Check who is on your ballot this year.

• Ballotpedia’s sample ballot lookup lets you enter your address and see what your ballot will look like.
• ISideWith can help you figure out which candidates you align with.

Love,

The YLE NE Team

Julia Tellerman, MPH, is an epidemiologist in Rochester, NY. Asuka Koda is a health journalist in New Haven, CT. Tamara Rissman, MPH, is an epidemiologist and professor in New Haven, CT.