November 2, 2022

Mid-term Elections 2022

What’s at Stake?

With early voting already underway in most states, and election day fast approaching on November 8, we want to help Academy members understand the most salient issues on the ballot. There are several elected offices and ballot initiatives that could impact public health, healthcare access, and your ability to deliver high-quality HIV care, prevention and research. Research on each candidate is necessary to understand their position on the issues you care about most.

Reproductive and Sexual Healthcare: After the Dobbs decision in which the U.S. Supreme Court essentially overturned Roe v. Wade, the fight to protect legal abortion moved from the courts to the ballot box. Currently, abortion is banned or severely restricted in more than half the states, many of which criminalize healthcare providers for providing abortion care or even counseling a pregnant person on the procedure or referring to another provider. Reproductive healthcare is part of broader healthcare and its legality affects many issues, including Medicaid access, availability of contraception, maternal health and mortality, and gender affirming care and transgender rights. The outcome of this election will in many cases determine whether there are efforts to restore or further restrict those rights.

There are ballot initiatives to protect legal abortion in California, Michigan and Vermont. There is also an initiative to declare that the state constitution does not protect abortion rights on Kentucky ballots.

LGBTQ Rights: The LGBTQ community continues to be under threat in many states as legislators introduce bills to erode LGBTQ civil rights, ban gender affirming care, and enact so-called ‘bathroom bills’ or youth sports bans that vilify transgender and non-binary young people. Currently, six states have taken action to ban gender affirming care for adolescents (Alabama, Arizona, Arkansas, Florida, Tennessee and Texas) and many more have banned Medicaid coverage of gender affirming care (Arizona, Arkansas, Florida, Georgia, Hawaii, Kentucky, Missouri, Nebraska, Ohio, Tennessee, Texas and West Virginia). All 12 of these states have state legislators who are up for re-election this year.

Medicaid Expansion: Currently, there are 12 states that have not expanded Medicaid, which affects approximately 4 million nonelderly, uninsured people. These states are Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming. This year, 36 governors are up for re-election, including governors in 10 non-Medicaid expansion states (Alabama, Florida, Georgia, Kansas, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming). Learn more about gubernatorial elections in your state here.


Elected officials who have the greatest impact on healthcare:

1.) State legislators: State senators and state house/assembly members can influence state healthcare in many ways. Your representatives can determine whether reproductive healthcare is legal in your state, choose the extent to which public health – including HIV – gets funded, and decide to protect or criminalize HIV. As well, they can pass legislation that would support or ban school-based sexual education, gender affirming care, and protections for the LGBTQ community. Also, they can determine whether the state expands Medicaid.

This election, 46 states will choose 6,279 legislators. This will be the first election since the decennial redistricting process and there are more seats available. That means seats are theoretically more competitive, though gerrymandering has disenfranchised many voters.

Generally, the party in control of both chambers of the state legislature determines which bills get sent to the governor and whether a governor’s signature or veto of a bill can be overridden. Learn more about the makeup of your state legislature here.

2.) Governor: The “chief executive” of the state, governors sign or veto bills passed by the legislature while also pursuing legislation and statewide budgets of their own. Governors and their respective administrations often play the greatest role in determining the breadth of the state’s participation in Medicaid, including the ACA Medicaid expansion option.

3.)  State Attorney General: Attorneys General are considered a state’s top law enforcement officer. The office has the power to interpret how laws are applied within the state and it can prioritize how laws are enforced in the state. For instance, after the Dobbs decision, some attorneys general committed to not enforcing abortion restrictions. Conversely, attorneys general also can support a fraudulent election narrative and can target certain groups for extra-judicial scrutiny. Attorneys General in 30 states will be on the ballot. Read about your state here.

4.)    Members of U.S. Congress (House of Representatives and Senate): Among many other things, Members of Congress are responsible for enacting: the federal budget, drug pricing reform, a possible federal ban on abortion or a federal protection, and other interventions that affect healthcare access or cost. Overall party majorities, “super majorities” and voting blocks also play a key role in supporting or rejecting presidential priorities and in generally deciding which fiscal and legislative priorities get passed. All 435 members of the House are up for election and 35 Senators are up for election.

5.)    Judges: Many judges are on the ballot and often little is known about them or their respective record. Yet, judges decide many facets of our everyday lives, including whether to honor judicial precedent or disregard the rule of law in favor of a political agenda. Read more here about how to choose the best judicial candidates and other resources for educating yourself about what’s at stake with judicial elections.

How to Find Candidate Information

Here are some ways to identify candidates and elected officials who support HIV care, LGBTQ+ rights, and/or access to reproductive healthcare:

  • Consult the website/s and past statements of your local candidates.
  • ·Look to trusted organizations that have endorsed candidates in your area:
  • Search for endorsements made by state parties and/or their respective federal counterparts (Democratic Congressional Campaign Committee, National Republican Congressional Committee, National Republican Senatorial Committee, Democratic Senatorial Campaign Committee)

Take Action

Organizations that provide volunteer opportunities:

View the latest Policy Update here.