On election night in Texas, the impossible became possible. Democrats won the governor’s seat for the first time since the 1990s and appear to be on their way to securing control of the state House too. Those massive, unexpected wins have now opened the window for a major policy change that has long been closed: expanding Medicaid to more than a million low-income Texans.
The Affordable Care Act offers generous funding for states to expand Medicaid eligibility to 133 percent of the federal poverty level, which is about $21,000 for one person or $44,000 for a family of three. But the Supreme Court ruled in 2012 that states should have a choice about whether or not to accept the expansion. And even though many other GOP-led states decided to adopt it, Texas is one of the 10 that have steadfastly refused to extend Medicaid coverage to many of its poorest citizens — and it’s by far the biggest. KFF estimates that 1.1 million people in Texas would be eligible for Medicaid expansion, including 605,000 who have no other insurance options without it. In resisting expansion over the years, Republicans have argued that the Medicaid program was broken and already too expensive and that uninsured people should instead be able to get coverage by finding a job that offers health benefits.
Newly elected Democratic Gov. Gina Hinojosa pledged to pursue expansion if elected, framing it as a way to help the state’s children. If she can find a way to get the state legislature on board, Medicaid expansion in Texas would be one of the biggest direct consequences of 2026’s blue tsunami. Texas has the highest uninsured rate of any state in the country at 19 percent.
“We expect expansion to be a priority in the next legislative session. It’s a life-saver in the short term and a money-saver in the long term,” Lynn Cowles, director of health and food justice at the advocacy group Every Texan, told me in an email. “We’re excited to work with our new state cohort and committee chairs in January to make expansion a reality.”
There is still work to do. But Democrats are in the strongest negotiating position they’ve ever had in the Lone Star State. As of Wednesday morning, Dems were leading in enough races to take over the Texas House for the first time in more than 20 years. That will allow them to force a more serious conversation about expansion.
“You should expect to see Medicaid expansion bills filed on November 9, which is our first day for early bill filing,” said Bee Moorhead, executive director of Texas Impact. “Absolutely, it will be on the table.”
It’s not a guarantee because Republicans retain control of the state Senate. Still, there is some optimism that the sweeping Democratic victories in Texas and across the country could make the GOP more amenable to compromise.
Democrats will have one important ally in their fight: Texas hospitals, which have long supported expansion. Their political influence and the threat of Trump-approved Medicaid cuts leading to rural hospital closures — a major theme of Hinojosa’s campaign — could put pressure on Republicans to find a middle ground with the Democrats now in power.
But hospital leaders, having seen dreams of Medicaid expansion in Texas fall short before, aren’t declaring victory yet. Until some of the Texas Senate Republicans who have opposed Medicaid expansion in the past announce that they’re now open to a compromise, the GOP’s control of that chamber could be enough to continue blocking Medicaid expansion in Texas for the time being.
“Everything changed last night. But just because everything changed doesn’t mean everything changes,” John Henderson, president and CEO of the Texas Organization of Rural & Community Hospitals, told me. “We’re gonna have a different climate and different priorities in the next session. But some of these really ambitious policies still have obstacles to clear.”
Texans have been waiting for Medicaid expansion for a long time: A 2020 poll found that 69 percent of the state’s voters supported the policy. But Republican leaders, including now-ousted Republican Gov. Greg Abbott, refused to budge.
There is no guarantee that the stunning midterm results will finally break that logjam. It will require deft politicking by the new Democrats in power. But for the first time, there is real reason for hope.
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