💡 What’s Happening?
The Nov. 3 ballot won’t list “increase hospital reimbursement,” “stronger healthcare workforce” or “insurance regulation,” but the Texas electorate will have a hand in deciding who makes those decisions.
With the 2026 midterm election less than a month away and the 90th Texas Legislature and 120th U.S. Congress beginning in January, healthcare has emerged as a major campaign issue. In an August poll, 83% of Texas voters said they were more likely to support a candidate aiming to reduce healthcare prices.
But campaign priorities and policymaking are different things. A lower number on a hospital bill does not necessarily mean affordable healthcare overall.
So, when campaign signs come down and the policy conversation shifts toward 2027, what healthcare issues will policymakers encounter as they consider the affordability concerns that have been front and center this election season?
🔥 Topics of Conversation
For patients, affordability remains front and center. Out-of-pocket costs, premiums, deductibles and coverage limitations can all affect whether someone can afford to seek care.
As THA explored in Mind the (Access) Gap, those financial barriers can compound with other obstacles to care – potentially affecting patients before they ever reach a hospital.
The final cost of care for patients is closely tied to coverage, but an insurance card does not automatically make healthcare affordable. Payment practices can also influence the cost and timing of care. Prior authorization, for example, is intended by insurers as a cost-control mechanism, but delays can create consequences for patients and providers.
“Prior authorization policies require a patient’s insurance company to approve covered treatments or medications before medical providers can provide care. These are often done as a cost-saving step for insurers, as preemptively rejecting a claim means less that it has to pay, or so the logic goes. ‘Reports received by the OAG indicate that [Blue Cross Blue Shield TX] may have denied or delayed coverage for procedures deemed medically necessary or urgent,’ [the announcement] said. ‘Such delays can worsen a patient’s condition, increase the risk of complications, allow disease progression, cause disability or death, and increase administrative costs.’”
KSLT Concho Valley: Texas to investigate Blue Cross Blue Shield over prior authorization delays
THA has already dug into the underlying question for hospitals: How do we make care more affordable without making it harder to provide? The healthcare patients receive in hospitals, emergency rooms and clinics requires increasingly expensive labor, supplies, technology and other operating costs, which ultimately contribute to the cost of care. It’s a complex situation given hospitals also operate within a payment environment they do not fully control. It’s a dynamic that becomes especially important when hospitals provide care that is not fully reimbursed.
Texas also contends with the significant role of uninsured and Medicaid patients in the healthcare system. For hospitals, coverage and reimbursement are closely connected: When payment falls short of the cost of care, the effects can extend beyond a hospital’s balance sheet to the services and resources available to its community.
“In an earnings call with analysts last Friday, executives at HCA Healthcare, the nation’s largest for-profit hospital chain, said patients who were previously enrolled under the Affordable Care Act appeared unable to find other sources of coverage but still needed emergency care from a hospital. They had ‘migrated almost one for one to uninsured,’ Sam Hazen, the chief executive of HCA, said. The American company, which operates 190 hospitals in 19 states and Britain, said the impact was greatest at its hospitals in Florida and Texas as well as South Carolina and Georgia.”
The New York Times: Uninsured Patients Rise Sharply, Hospitals Report, Citing Obamacare Cuts
Then there’s the question of who will provide that care. Healthcare access depends on more than whether a service exists. It also depends on whether there are enough people available to provide it. Texas has spent years working to strengthen its healthcare workforce, but challenges remain in graduate medical education and training capacity, recruitment and retention, burnout and shortages. This is particularly prevalent in communities and specialties where providers are most needed – including rural communities and behavioral health.
Hospitals are major employers and economic anchors in cities and towns statewide, particularly as they provide emergency care 24/7, 365 days per year. As the only medical facilities required to do so, hospitals require a reliable payment environment to sustain them while caring for all patients experiencing an emergency.
“Like many rural hospitals, the Mangold Memorial Hospital faces challenges based on patient demographics – which tends to skew older and lower-income – staffing, and general expenses. …Rural hospitals have the same fixed costs and 24/7 demands for emergency services and staff as their larger counterparts, but fewer patients. Fewer patients means fewer payments. …Labor and delivery services at Mangold Memorial were discontinued in 2016. …There was a decrease in the number of patients giving birth at the hospital. Birthing care also has significant staffing and training requirements, anesthesia coverage, and – at the time – low Medicaid reimbursements.”
KWBU (Waco): Rising costs and increased closures put pressure on West Texas rural hospitals to do more with less
“The billions in restored Medicaid funding came after months of negotiations with the federal agency, according to Abbott’s office. The governor’s office in early August wrote a stern letter to Health Secretary Robert F. Kennedy Jr. about the situation. In the letter, Abbott criticized the lack of clarity in the federal agency’s requirements on taxing, and he also said the state would be willing to collaborate on changes to the tax system.
…‘This funding is a major victory for Texas patients,’ Abbott’s statement said. ‘Emergency rooms will stay open, rural families will retain local care, and Texans will have access to the treatment they need.’”
Longview Journal: After months of negotiations, Feds approve almost $12B in Medicaid funding to Texas
A healthcare system that can accurately meet the needs of its patients requires more than hospital capacity alone. Ultimately, these pressures converge to the question of what conditions are necessary to maintain access to essential healthcare services in communities across Texas.
⭐As the 2026 election season gives way to the 2027 legislative session, these competing pressures will remain part of the healthcare conversation.
📖 Learn More
How Will Healthcare Show Up on the Ballot in Texas Midterms?
What Texas Voters Need to Know About the 2026 Midterm Election
Cap Recap (Episodes resume Oct. 13)
