A million people could gain health insurance in Texas after Democrats’ shocking win
Vox · Dylan Scott ·
Healthcare costs were a major theme for Democrats in Texas in the 2026 election. Can they use their governor and state legislative wins to pass Medicaid expansion?
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.
New Democratic Gov.-elect 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.