November 30, 2022

2023 Key Election Updates

The majority of election results in the United States have finally been called and we have a better sense of what that means for HIV-related policies, funding and issues of importance to Academy members.

U.S. House: Republicans won a slim majority in the U.S. House of Representatives (currently 220 Republican seats to 213 Democratic seats), and the vote to determine whether Rep. Kevin McCarthy (CA-23) will assume the speakership will be held on January 3, 2023. Already, there is political posturing to determine which faction of the Republican party will control the direction of the House. The role of Speaker of the House is to preserve a unified party for policy gains, but in this instance, will influence the degree to which bipartisan work can occur.

House Republicans have already identified prioritizing investigations into the Biden administration, Dr. Fauci over pandemic response, and others, and will likely block discretionary (health care) funding that isn’t paired with added cuts and/or more defense spending. We are hopeful that appropriators will stay out of the political fray and find areas of compromise, a necessity for reaching an end to the HIV epidemic.

On the Democratic side, Speaker Nancy Pelosi (CA-12) announced that she would not seek a leadership position, making way for the next generation of leaders. The role of Minority Leader will now go to Rep. Hakeem Jeffries (NY-08), who was elected today and will assume the post in January. Rep. Jeffries is the first Black lawmaker to be a leader in either chamber. Majority Leader Steny Hoyer (MD-05) also announced that he would step down. Rep. Katherine Clarke (MA-05) is expected to take over the number two leadership spot within the Democratic caucus.

U.S. Senate: Democrats hung onto the majority in the Senate with a Georgia runoff election happening in early December. If Democrats win that seat as well, it will mean they have a slight buffer to weather losing moderate Democrats on certain issues, as we saw over the past year with infrastructure and social safety net programs. A Democrat-controlled Senate will likely support opposing policy priorities compared to the Republican-controlled House, but a split Congress also means few of the Biden Administration’s priorities will move forward.

However, one area in which the Senate has purview, but the House does not, is judicial nominations. The party that controls the Senate usually impacts the types of federal judges who get appointed to the bench, an important factor in whether civil rights are expanded or contracted as we’ve seen with voting rights and reproductive rights. Democrats’ majority will likely mean a more diverse judicial pool.


There were 36 gubernatorial elections on the ballot. Each party won 18 seats – Republicans losing two seats and Democrats picking up two seats. In state legislatures, there were a number of surprises, including chambers that flipped party control. However, due to gerrymandering and other factors, Republicans still control the vast majority of legislative chambers across the country. Going into the election, it was 61 to 37 Republican control, and after the midterm elections, it is now 57 to 40 (the Alaska statehouse is split).

Academy members likely care about who controls the legislature, as it generally determines the types of bills that can be passed either to protect vulnerable populations, limit the reach of pharmacy benefit management companies and/or insurers, broaden access to testing and treatment, and expand Medicaid eligibility (or not). Readers can learn more about the impact of legislative control and which states have changed over time here.

Ballot Initiatives

There were a number of consequential ballot initiatives, including ones on voting rights and abortion access.

Six states had ballot initiatives on voting access and election rules, with some expanding early voting and others attempting to make voting more difficult through certain eligibility standards. The full outcome of these initiatives can be viewed here.

Five states had ballot initiatives related to abortion access, some attempting to enshrine the right to reproductive health care, while others intended to go in the opposite direction. All were successful in either preserving access to abortion or beating back efforts to further restrict access, but full results can be viewed here.

While most of these ballot initiatives would’ve dictated patient access, some would also determine whether a provider is criminally liable for providing certain types of patient care.

South Dakota voters voted 56% to 44% to expand Medicaid eligibility, becoming the 39th state to do so.

View the latest Policy Update here.