Where 2026 Candidates Stand on Nursing and Medicaid: 20 Close Races

Part of Nurses on the Ballot, Nurse.org’s research series on the nurses and nursing issues of the 2026 midterm elections. Unlike our rosters of nurse candidates, this piece looks at the major-party nominees in 20 competitive Senate and governor races, whatever their background. In the 11 closest of those races, we found that six of the 22 candidates have taken a specific position on nursing this year. Here is where each stands on nursing and Medicaid, plus nursing records in nine more competitive races.

Nurses have a lot riding on the 2026 midterms. Governors shape hospital staffing laws, nurse practitioner scope of practice, and Medicaid. Senators vote on nursing workforce funding, federal staffing rules, and Medicaid’s federal share, which pays for care at the hospitals and nursing homes where many nurses work.

We reviewed the 20 Senate and governor races the Cook Political Report rates Toss Up or Lean. We tracked seven nursing issues (pay, staffing, workplace violence, retention, burnout, education funding, and scope of practice) and each Toss-Up candidate’s stance on Medicaid after the One Big Beautiful Bill Act, the 2025 budget law that added Medicaid work requirements and reduced projected federal Medicaid spending. Throughout, a position is a specific stance a candidate stated in 2026; a record is a bill, vote, signed or vetoed law, or legal action from any year. When we say we found no position or record, that means we did not find one in our review, not that the candidate has no view on the issue or opposes it.

These races are moving: 14 of the 20 now carry a different rating than Cook first gave them, 13 of them closer to Democrats, several in the past month alone. More changes are likely before Election Day on Nov. 3. Ratings were checked Oct. 19 (Cook last updated them Oct. 6 for Senate and Oct. 13 for governor); see Cook’s live Senate and governor pages for the latest.

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Where Toss-Up Candidates Stand on Nursing and Medicaid

• We found six of 22 Toss-Up candidates with a specific nursing position this year: Keisha Lance Bottoms in Georgia, Aaron Ford and Joe Lombardo in Nevada, David Crowley in Wisconsin, Susan Collins in Maine, and Abdul El-Sayed in Michigan. Four are Democrats and two are Republicans.
• In our review, governor candidates addressed nursing more often than Senate candidates: four of eight, compared with two of 14.
• Most Senate candidates with nursing records are not campaigning on them. Eleven Senate candidates (Sherrod Brown, Ashley Hinson, Jon Husted, Troy Jackson, Roger Marshall, Ken Paxton, Mary Peltola, Mike Rogers, Dan Sullivan, James Talarico, and Josh Turek) have nursing-related legislative or official records but, in our review, no specific 2026 nursing position.
• On Medicaid, the Senate candidates divide largely by party, though on different questions. In our review, all seven Democrats oppose the 2025 budget law’s Medicaid cuts, and five call for reversing them. Five of the seven Republicans support Medicaid work requirements, including Collins, who voted against the law over its Medicaid cuts. Sullivan and Husted argue the law did not cut Medicaid for their states.
• In the governor races we reviewed, Medicaid positions do not split cleanly by party. Both Nevada candidates have defended their state’s Medicaid expansion, and both Georgia candidates promise some form of expansion, of very different kinds.

2026 Toss-Up Senate and Governor Races: Candidate by Candidate

Each race lists the state’s rank on Nurse.org’s Nursing Workforce Benchmark, which ranks states by the severity of their nursing shortage (1 is most severe; states without public hospital vacancy data are unranked), and its rural hospital closures and conversions since 2010, from the University of North Carolina’s Sheps Center. Candidates are listed alphabetically by last name.

Alaska Senate Race: Peltola (D) vs. Sullivan (R)

• Rating: Toss Up (was Solid R). A second candidate named Dan J. Sullivan is also on the ballot.
• Workforce: Seventh for shortage severity, with a 20% hospital RN vacancy rate in 2025.
• Rural hospitals: One closed or converted since 2010, in 2019.
• Mary Peltola (D): The former U.S. representative was an original cosponsor of the 2023 Public Health Nursing Act, which would have funded hiring and training registered nurses for public health departments. It did not pass.
• Dan Sullivan (R): In a July 2025 letter to constituents, the incumbent wrote that the budget law’s rollback of the federal nursing home staffing rule “will help prevent the closure of vital nursing homes.”
• Medicaid: Alaska has expanded Medicaid. In their Oct. 15 debate, Peltola said reversing what she called the budget law’s “damage to Medicaid” is her “immediate priority,” and Sullivan, who voted for the 2025 budget law, said it “did not cut Medicaid for Alaskans.” In his July 2025 letter, Sullivan wrote that he supports the law’s “Medicaid work and volunteer requirements for those who are able.”

Georgia Governor Race: Bottoms (D) vs. Jackson (R)

• Rating: Toss Up (unchanged).
• Workforce: 16th for shortage severity, with a projected 21% RN shortfall by 2035.
• Rural hospitals: Eight closed or converted since 2010, most recently in 2020.
• Keisha Lance Bottoms (D): The former Atlanta mayor’s CARE Plan pledges to “Support nurses with safer staffing and stronger workplace protections so patients get better care and nurses can stay in the profession.” The plan also expands state loan repayment and scholarships for nurses and opposes lower federal loan limits for graduate nursing students.
• Rick Jackson (R): He founded and leads Jackson Healthcare, whose companies include the nurse staffing firms Jackson Nurse Professionals and Avant Healthcare Professionals. In an interview with the Georgia Higher Education Healthcare Initiative, he said nurses, “and especially nurse practitioners and PAs and so forth, leave Georgia, because they’re only practicing to 50% of their license.” Georgia requires nurse practitioners to work under physician delegation. In the remarks we reviewed, he described the problem but did not propose a specific change.
• Medicaid: Georgia has not fully expanded Medicaid. Bottoms’s health care plan would expand it to cover adults earning up to 138% of the federal poverty level, the Affordable Care Act standard, and in a July 2025 statement she called the 2025 budget law “nothing less than an all-out assault on Medicaid.” Jackson promises “intelligent Medicaid expansion” through a state waiver that keeps work requirements, and said in their Oct. 6 debate that he would “expand Medicaid to cover everybody.” His campaign has not said how it would qualify for the higher federal match that full expansion receives, the Georgia Recorder reported.

Iowa Senate Race: Hinson (R) vs. Turek (D)

• Rating: Toss Up (was Solid R). Open seat.
• Workforce: Unranked; our review found no public hospital vacancy data for Iowa.
• Rural hospitals: Two closed or converted since 2010, most recently in 2024.
• Ashley Hinson (R): The U.S. representative sponsored the bipartisan RNs for Rural Health Act in 2025, which would let registered nurses at rural health clinics provide Medicare annual wellness visits. The bill has not advanced out of committee.
• Josh Turek (D): As a state representative, he voted in 2025 for Iowa laws expanding assault protections for health care workers and creating a health care workforce incentive program that can fund training for registered nurses.
• Medicaid: Iowa has expanded Medicaid. In their Oct. 7 debate, Hinson, who voted for the 2025 budget law, defended its “common sense work requirements,” and Turek said it brought “huge cuts to Medicaid.”

Kansas Senate Race: Hamilton (D) vs. Marshall (R)

• Rating: Toss Up (was Solid R as recently as Aug. 4), the fastest-moving race in our review.
• Workforce: 28th for shortage severity.
• Rural hospitals: Eight closed or converted since 2010, most recently in 2023.
• Adam Hamilton (D): The Methodist pastor has no nursing position or record in our review.
• Roger Marshall (R): The incumbent practiced obstetrics and gynecology for more than 25 years, and his wife is a neonatal intensive care nurse. He cosponsored a 2023 bill to block the federal nursing home staffing rule, saying the mandate “will have costly and devastating impacts on Kansas seniors’ access to care.” He was also the only original cosponsor of Sen. Bernie Sanders’s 2023 bill to expand the primary care workforce, including nurses and nurse practitioners. Neither bill became law.
• Medicaid: Kansas has not expanded Medicaid. Hamilton told the Johnson County Post, “I’d vote to reverse the Medicaid cuts in last year’s budget law.” Marshall voted for the law and defended its work requirements, though during negotiations he said he would “make nursing homes immune” from a proposed cut to provider taxes, which states use to help fund Medicaid.

Maine Senate Race: Collins (R) vs. Jackson (D)

• Rating: Toss Up (was Lean R).
• Workforce: 26th for shortage severity, with a 10.1% RN vacancy rate.
• Rural hospitals: Four closed or converted since 2010, most recently in 2025.
• Susan Collins (R): The incumbent is one of four senators behind the Title VIII Nursing Workforce Reauthorization Act, which funds nursing education, faculty, and retention. At the committee vote that advanced it 21-1, she said Maine “continues to face a serious shortage of nurses, particularly in rural communities.” She also sponsors a bill letting nurse practitioners treat injured federal workers; it and the Title VIII bill have cleared committee and await Senate votes. Collins also cosponsored the 2023 bill to block the nursing home staffing rule, which did not pass. In April 2026, the American Association of Nurse Anesthesiology gave her its National Health Leadership Award, citing her support for Title VIII nursing workforce funding.
• Troy Jackson (D): The former Maine Senate president became the nominee after primary winner Graham Platner withdrew in July. As Senate president, he cosponsored a 2024 nurse staffing bill and voted to advance it; the bill later died. He is endorsed by National Nurses United.
• Medicaid: Maine has expanded Medicaid. Collins voted against the 2025 budget law, saying her vote “stems primarily from the harmful impact it will have on Medicaid,” while supporting “work requirements for able-bodied adults.” In their first debate, Jackson called the $50 billion rural health fund Collins pushed for “a pittance” next to the cuts. He supports Medicare for All.

Michigan Senate Race: El-Sayed (D) vs. Rogers (R)

• Rating: Toss Up (unchanged).
• Workforce: Unranked; our review found no public hospital vacancy data for Michigan.
• Rural hospitals: Four closed or converted since 2010, including Sturgis Hospital, which converted to a rural emergency hospital in 2023 and closed entirely in June 2026.
• Abdul El-Sayed (D): He holds a medical degree and a doctorate in public health and led Detroit’s health department. At a Sept. 15 FOX 2 Detroit debate that Rogers declined to attend, a nurse asked him about a federal bill to set hospital nurse-to-patient ratios. He answered, “I’m looking forward to working alongside anyone and everyone who’s willing to establish safe staffing ratios,” without committing to the bill or a specific ratio. He is endorsed by National Nurses United.
• Mike Rogers (R): As a U.S. representative, he cosponsored the Nurse of Tomorrow Act of 2001, which would have funded grants for nurse recruitment, retention, and education, and a 2003 bill on Medicare payment for certified nurse-midwives. Neither passed.
• Medicaid: Michigan has expanded Medicaid. El-Sayed’s platform pledges to “immediately repeal Medicaid and ACA subsidy cuts” from the 2025 budget law. Rogers’s 2026 health care plan does not address Medicaid. Earlier record: in 2013, he voted to repeal the Affordable Care Act.

Nevada Governor Race: Ford (D) vs. Lombardo (R)

• Rating: Toss Up (unchanged). Two Fords are on the ballot: Democrat Aaron D. Ford and nonpartisan candidate Danielle Ford.
• Workforce: Unranked; our review found no public hospital vacancy data for Nevada.
• Rural hospitals: One closed since 2010, in 2015.
• Aaron Ford (D): The attorney general’s health care plan pledges to keep “experienced nurses and physicians from leaving the state.” He joined 17 other attorneys general in comments opposing the repeal of federal nursing home staffing standards, calling the repeal “morally abhorrent,” and opposed federal loan limits for graduate nursing students.
• Joe Lombardo (R): The incumbent’s campaign plan pledges to “Train more doctors, nurses, and health professionals in Nevada, and give them real incentives to stay,” including down payment help for nurses buying homes. In 2025 he vetoed a hospital nurse-to-patient ratio bill, writing that it “removes the flexibility that hospitals and care teams need.”
• Medicaid: Nevada has expanded Medicaid, and both candidates have defended it. Ford pledges to protect Medicaid and joined a 2026 lawsuit over how federal officials apply the new work requirements to medically frail patients, who can qualify for an exemption. Before the 2025 budget law passed, Lombardo wrote legislative leaders that he opposed “Rolling back critical expansion population funding.”

Ohio Senate Race: Brown (D) vs. Husted (R)

• Rating: Toss Up (was Likely R).
• Workforce: Unranked; our review found no public hospital vacancy data for Ohio.
• Rural hospitals: Three closed or converted since 2010, most recently in 2024.
• Sherrod Brown (D): The former senator sponsored the 2023 federal bill to set hospital RN-to-patient ratios and, with Collins, a bill letting nurse practitioners treat injured federal workers. He also cosponsored a healthcare workplace violence bill. None of the three became law. In our review, none of this is part of a specific 2026 campaign position. He is endorsed by the Ohio Nurses Association.
• Jon Husted (R): The incumbent introduced a 2026 bill extending authority for nurse practitioners and other clinicians to conduct VA disability exams across state lines. The House passed its version in 2025; the Senate has not voted on it.
• Medicaid: Ohio has expanded Medicaid, and new federal work requirements start in 2027. Brown told the Ohio Independent, “My plan is to rescind the $1 trillion in cuts to Medicaid that has put hospitals at risk across Ohio.” Husted voted for the 2025 budget law and, in an op-ed, defended its “modest work requirements.”

Ohio Governor Race: Acton (D) vs. Ramaswamy (R)

• Rating: Toss Up (was Likely R). Open seat.
• Workforce: Unranked; our review found no public hospital vacancy data for Ohio.
• Rural hospitals: Three closed or converted since 2010, most recently in 2024.
• Amy Acton (D): A physician, she led the Ohio Department of Health early in the COVID-19 pandemic and is endorsed by the Ohio Nurses Association. In our review, she has no nursing-specific proposal.
• Vivek Ramaswamy (R): No nursing position or record in our review.
• Medicaid: Ohio has expanded Medicaid. Acton’s platform pledges to “protect against attacks on Medicaid,” and she told WOSU that “we need to have the requirements and easy ways to do it,” while noting that most Ohioans on Medicaid already work and some can’t meet the requirements. Ramaswamy’s campaign told WOSU it backs “basic work requirements for those who are able,” and his Medicaid plan pledges to make “fighting Medicaid fraud a top priority.”

Texas Senate Race: Paxton (R) vs. Talarico (D)

• Rating: Toss Up (was Solid R). Open seat.
• Workforce: Sixth for shortage severity, with a 16.4% RN vacancy rate.
• Rural hospitals: 22 closed or converted since 2010, the most of any state in this review.
• Ken Paxton (R): The attorney general sued in 2024 to block the federal nursing home staffing rule, warning in a news release that it “could worsen rural care shortages.”
• James Talarico (D): As a state representative, he voted in 2023 for Texas laws funding nursing scholarships and requiring workplace violence prevention plans in health care facilities.
• Medicaid: Texas has not expanded Medicaid. In our review, Paxton has no Medicaid position in this race. Earlier record: in 2018, he led a lawsuit seeking to strike down the Affordable Care Act. Talarico calls for reversing federal Medicaid cuts and in 2023 filed a bill to create a Texas Medicaid buy-in program that did not pass.

Wisconsin Governor Race: Crowley (D) vs. Tiffany (R)

• Rating: Toss Up (unchanged).
• Workforce: Third for shortage severity, with an 18% projected RN gap.
• Rural hospitals: One closed since 2010, in 2011.
• David Crowley (D): The Milwaukee County executive’s campaign plan proposes “targeted loan repayment pipelines for high-need professions like nurses, teachers, and mental health workers in underserved communities.”
• Tom Tiffany (R): The U.S. representative cosponsored a 2025 bill to block the federal nursing home staffing rule. The bill has not passed; the 2025 budget law paused the rule, and federal regulators later moved to repeal it.
• Medicaid: Wisconsin’s Medicaid program, BadgerCare, covers adults up to the poverty line, but the state has not fully expanded Medicaid. Crowley’s BadgerCare proposal would “Open BadgerCare enrollment to any household that wants it,” with sliding-scale premiums. Tiffany voted for the 2025 budget law and, in a congressional newsletter, defended its work requirements, describing them as asking adults without young children to “work, train, or volunteer for 20 hours each week.” The law sets the threshold at 80 hours a month.

2026 Lean Senate and Governor Races: Where Candidates Stand on Nursing

• Alaska governor (Lean D): Former Attorney General Treg Taylor (R), one of four candidates, joined the 2024 lawsuit against the nursing home staffing rule.
• Arizona governor (Lean D): Arizona ranks eighth for shortage severity on the Benchmark. As a U.S. representative, Andy Biggs (R) cosponsored a 2017 bill letting nurse practitioners and clinical nurse specialists supervise Medicare cardiac and pulmonary rehabilitation programs, and sponsored a 2023 bill to limit funding for the National Institute of Nursing Research. Neither passed. Gov. Katie Hobbs (D) signed a budget continuing state funding for community college nursing programs.
• Florida governor (Lean R): As a legislator, Byron Donalds (R) voted for Florida’s 2020 law letting qualifying advanced practice registered nurses practice independently in primary care. David Jolly (D), then a Republican U.S. representative, cosponsored the National Nurse Act of 2015, which would have designated a National Nurse for Public Health; it did not pass.
• Iowa governor (Lean D): Neither Zach Lahn (R) nor Rob Sand (D) has a nursing position or record in our review.
• Kansas governor (Lean R): Cindy Holscher (D) voted against Kansas’s 2022 law letting advanced practice registered nurses prescribe without a supervising physician; Ty Masterson (R) voted for it. Democratic Gov. Laura Kelly signed it.
• Michigan governor (Lean D): Jocelyn Benson (D) has the Michigan Nurses Association’s endorsement. John James (R) proposes a retention tax credit for workers in shortage occupations, including nurses, and cosponsored a federal bill opening nursing workforce grants to community colleges; it did not pass.
• New Hampshire Senate (Lean D): Rep. Chris Pappas (D) campaigns on “debt forgiveness for students who enter high-demand careers like nursing.” As a U.S. representative, former Sen. John E. Sununu (R) sponsored a 2002 bill to create a task force reviewing the patient assessments home health nurses must complete, and cosponsored a bill letting Medicare pay certified registered nurse first assistants directly. Neither passed.
• Oregon governor (Lean D): This is the only race here that has moved toward Republicans over the cycle. Christine Drazan (R) voted against Oregon’s 2025 healthcare workplace violence law on final passage. Gov. Tina Kotek (D) signed it, along with Oregon’s 2023 hospital nurse-to-patient ratio law.
• Texas governor (Lean R): Gov. Greg Abbott (R) signed 2023 laws funding nursing scholarships and requiring healthcare workplace violence prevention plans, and he is endorsed by the Texas Association of Nurse Anesthetists PAC. Gina Hinojosa (D) voted for both laws.

Where Candidates Stand on the Federal Nursing Home Staffing Rule

The 2024 federal rule would have required nursing homes, not hospitals, to keep a registered nurse on site around the clock and meet minimum nursing hours per resident, with deadlines phased in over several years. Supporters said it would protect residents; opponents said facilities, especially rural ones, could not hire enough staff to comply. Federal courts struck down key parts of it in 2025, the 2025 budget law barred enforcement through 2034, and federal regulators moved to repeal it in December 2025.

Six candidates in this review opposed the rule, in different ways: Paxton (Texas Senate) and Taylor (Alaska governor) through lawsuits; Collins (Maine Senate), Marshall (Kansas Senate), and Tiffany (Wisconsin governor) as cosponsors of bills to block it, none of which passed; and Sullivan (Alaska Senate) in a 2025 letter praising the law’s rollback of it. Ford (Nevada governor) joined 17 other attorneys general in comments opposing the repeal. Candidates held different offices at different times, so the absence of an action here does not mean a candidate supported or opposed the rule.

Cook rates races on a seven-point scale, from Solid D through Toss Up to Solid R. Here is how each race in this review, listed alphabetically by state, has moved since Cook’s first ratings of the 2026 cycle, released in January 2025 for governor races and February 2025 for Senate races. Current ratings are from Oct. 6, 2026 (Senate) and Oct. 13, 2026 (governor).

In the governor races, candidates are making specific promises on nurse staffing, retention, education funding, and Medicaid. In the Senate races, the clearer signal is often a candidate’s record, so look at how they have voted and what they have sponsored, not just what they say on the trail. If a nursing issue matters to your vote, ask the candidates directly.

Early voting is underway in many states, and Election Day is Nov. 3.

Nurse.org is running a Nurse Voter Survey to capture how nurses are approaching this election. Take two minutes to add your voice, then check your voter registration at Vote.gov.

More From Nurses on the Ballot

🤔 Which nursing or Medicaid issue do you most want the candidates in your state to address? Tell us in the comments below.

Races. Every 2026 Senate and governor race the Cook Political Report rated Toss Up, Lean D, or Lean R as of Oct. 19, 2026. Candidates are listed alphabetically by last name.

Sources. Campaign websites, official records (bills, votes, laws signed or vetoed), debates, news coverage, and nursing organization endorsements through Oct. 16, 2026. In the Lean races, we did not review debates.

Counting. A 2026 position is a specific stance a candidate stated in 2026, on the campaign trail or in office. It counts if the candidate’s own words say what they would do or support, or if the statement is made in support of a specific bill or policy they back. Describing a problem, or general support for nurses, does not count in our review. Retention includes keeping nurses in a state’s or community’s workforce. Loan repayment or scholarships that name nurses count as education funding. Bills, votes, signed or vetoed laws, and legal actions are records, whatever the year; they are listed separately and are not counted among the six candidates with a 2026 position. Lawsuits and formal comments filed by attorneys general count as records when the attorney general publicly stated a policy view; legal opinions that interpret existing law do not. For Medicaid, we did not include earlier campaign statements or candidates’ projections of coverage losses.

Endorsements and backgrounds. We note endorsements from nurses’ unions and nursing associations. We did not include endorsements from Nurses for America, a Democratic-aligned nurse political group that endorsed the Democrat in most races here. Healthcare backgrounds appear only for clinical credentials, public health leadership, or businesses that employ or place nurses.

Data. Workforce figures come from Nurse.org’s Nursing Workforce Benchmark; rural hospital closures and conversions since 2010 come from the University of North Carolina’s Sheps Center. Benchmark figures mix current vacancy rates and longer-term projections, so they are not directly comparable across states.

Limits. Our review was not exhaustive. We searched the same sources for every candidate, but a position or record can still be missed. For candidates with long legislative careers, we reviewed nursing-related bills they sponsored or cosponsored and major recent votes, not every vote they cast. “None found” means we did not find one in our review, not that the candidate has no view. This piece does not cover campaign finance, advertising, party platforms, or reproductive health policy. We update it when we identify positions our review missed.

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