Texas Democrats Swept Statewide Races. Now Comes the Hard Part of Solving Healthcare Angst.
Democrat Gina Hinojosa, the governor-elect of Texas, speaks during a news conference at the University of Texas-Austin on Nov. 5. (Jordan Vonderhaar/Bloomberg via Getty Images)
Texas Democrats spent three decades trying to regain control of the governor’s mansion and other top state leadership positions. This Election Day, they pulled off a decisive upset, taking statewide offices and the state House, partly due to voter anger over healthcare costs and the difficulty of getting care.
Now the state’s newly elected leaders have two months before the next legislative session to figure out how to deliver on their promises on healthcare affordability and other thorny issues, such as abortion. And they need to do it in the face of bruising political opposition over a frenetic 140-day legislative session that begins Jan. 12.
“Democrats are still putting together something of an agenda in essentially what is a ‘dog catches car’ scenario,” said James Henson, director of the Texas Politics Project, a polling and political analysis group at the University of Texas-Austin.
Texas was at the crest of the nationwide blue wave that flipped control of Congress. The traditionally deep-red state elected James Talarico to the U.S. Senate, and Democrats picked up a seat in the U.S. House, despite efforts by Republicans to draw districts in their favor and at least $225 million spent by Elon Musk to elect Texas GOP candidates.
But the biggest changes for Texans could come from the state-level elections that Democrats also dominated on Nov. 3. And the stakes are high: Texas routinely ranks among the lowest in the nation in health outcomes and has the most uninsured people in the country.
Democratic Gov.-elect Gina Hinojosa and Lt. Gov.-elect Vikki Goodwin, both state lawmakers, are scheduled to be sworn in on Jan. 19, a week after the legislative session opens. Hinojosa will become the first Democrat to occupy the governor’s mansion since Ann Richards moved out in 1995. Hinojosa defeated Republican Gov. Greg Abbott, a popular, well-funded incumbent who had never lost an election before this one.
For three terms, Abbott, along with Lt. Gov. Dan Patrick, fought against expanding Medicaid, contested the Affordable Care Act, oversaw the gutting of abortion rights, and weakened vaccine mandates.
While campaigning, Hinojosa and Goodwin said their top health priorities were expanding coverage, bringing down healthcare costs, and improving women’s health. Goodwin has proposed creating a state health insurance plan, funded through Texas’ $24 billion “rainy day fund.”
As state House members, Goodwin filed bills to expand Medicaid and restore abortion rights and Hinojosa filed or signed on to bills to broaden exemptions to abortion bans and add doulas to the state’s maternal mortality review committee. Few of those bills got floor votes.
Political watchers and lobbyists in Austin, Texas’ capital, say it’s too early to tell how Hinojosa, Goodwin, and other newly elected top Democrats will shape legislation for the upcoming session, whom they will appoint to top agency leadership positions, and how they will maneuver around opposition from Republicans who will still hold the majority in the state Senate.
This may be the new leaders’ best shot to figure things out. After the legislative session is over at the end of May, Texas’ legislative schedule doesn’t call for another regular session until 2029 — following the 2028 presidential election, when the entire state House will again be up for reelection.
The State of the State’s Health
About 5 million of Texas’ nearly 32 million residents lack health coverage. That includes 1 million children without insurance. Texas is one of 10 states that didn’t expand Medicaid to cover more low-income adults. New moms in Texas continue to die at higher rates than they do nationally. And healthcare costs topped lists of voter concerns in the state, according to polls in recent months.
On the federal level, Congress didn’t renew enhanced subsidies for Affordable Care Act premiums last year, passed a budget bill with new restrictions on food and healthcare assistance, and cut the federal health budget.
Because of rising costs and enrollment glitches, hundreds of thousands of Texans recently lost health coverage, said Lynn Cowles, director of health and food justice at the policy group Every Texan.
Rachel Elsberry, an insurance broker in Austin who has clients in more than a dozen states, witnessed the challenges people faced with affordability.
“Whether you voted red or blue, every client I talk to, regardless of where they are on the political spectrum, says healthcare costs are too high,” she said. She said she routinely turns away Texas clients who don’t qualify for subsidies on ACA plans or low-cost or free federal health programs.
“It’s heartbreaking,” she said.
Cowles has already met with Hinojosa’s staffers, who she said were receptive to more than a dozen steps her group suggested the governor take to make it easier for people to sign up and stay covered under state health programs.
“It’s an incredibly different world,” Cowles said. “It’s amazing to say these things out loud.”
About 1 million Texans would be newly eligible for Medicaid coverage if state leaders expanded the program. Even though the federal government would foot 90% of the bill for those enrollees, Democratic state leadership still faces steep odds.
“To thread that needle even after dramatic changes like last night is going to be challenging,” John Henderson, president and CEO of the Texas Organization of Rural & Community Hospitals, said the day after the election.
Legislators have a very narrow window to pass bills in the Texas Statehouse, said Charles Miller, director of health and economic mobility at Texas 2036, a nonpartisan policy research and advocacy group. And few measures succeed: During the state’s last regular session, in 2025, of 11,503 bills filed, 3,534 went into effect.
“The clock is ticking,” Miller said.
Senate Republicans Pledge To Hold the Line
Newly elected Democratic leaders are expected to face stiff opposition from the Republican-controlled state Senate. Republican state Sen. Charles Schwertner, a physician who chairs the state Senate’s Business and Commerce Committee, pledged a GOP fight in a social media post after the election: “Texas stands as long as the Texas Senate Republican caucus holds the line,” he wrote. “We will.”
With such Republican opposition, Miller said Democrats will need to look for measures that can garner wide support, such as boosting healthcare price transparency, tackling healthcare monopolies, and figuring out how to draw down more federal healthcare dollars without tapping the state budget.
A bipartisan state House committee on healthcare affordability that has been meeting this year is set to deliver recommendations before the start of the session.
Historically, lieutenant governor has been one of the most powerful elected state posts, with single-handed authority to appoint committees and committee chairs and decide which bills get a floor vote. As lieutenant governor, Patrick used a Republican majority to expand his authority, lowering the state Senate debate threshold to allow partisan bills to pass without Democratic support.
But political observers speculate that Senate Republicans may try to pass procedural rules to significantly weaken the lieutenant governor’s power to steer the chamber for when Goodwin takes office.
“The rumors are flying in Austin,” Henson said.
Nathan Johnson, a Democratic state senator who will soon assume the post of Texas attorney general, told The Texas Tribune that even if the state’s abortion laws don’t change, he won’t use the power of his office to sue out-of-state doctors who send abortion medication to the state.
Dorcaus Robinson, 46, said changes cannot come soon enough on healthcare costs. Robinson, who lives in Houston with her two younger sons, said she voted for Hinojosa and other top Democrats but broke with the party in other races.
This year, Robinson said, she is paying $730 a month for an ACA health plan, up from $500 a month last year. Robinson, publisher of The Houston Sun, has multiple sclerosis and relies on her plan to cover a shot that would otherwise be $10,000 a month.
But when her insurer called after the election to let her know her premium would be rising again next year, she said, her first thought was, “Is it too late for me to benefit from this blue tsunami?”
Robinson said she recalled that after President Donald Trump took office last year, he began filing executive actions and making changes on day one. She expects the same from the Democrats she supported.
“It’s like football: The next man is up,” she said. “Let’s go in and get this done. I hope they have their plan and they are ready.”
But she added: “Is it realistic? Can it be done? I don’t know.”
