Midterms' new populism: Taking on health industries

• The way candidates are tapping into affordability angst varies considerably, but certain races already are becoming barometers for public sentiment on issues like rising premiums.

The big picture: In a brittle environment where more than half of Americans say they can't consistently afford care, it's increasingly less about candidates' votes than their appetite for a fight.

• Here are the races where tone and the candidates' positions on cost and coverage caught our eye:

Senate

1. Michigan: This is easily the nation's largest bellwether for the popularity — or toxicity — of Medicare for All.

• Democrat Abdul El-Sayed, a former public health official, is backing Medicare for All and steps like canceling medical debt, cracking down on hospital mergers and expanding Medicare drug price negotiations.
• His opponent, Republican Mike Rogers, wants to force hospitals and insurers to publish the prices they negotiate, and is calling for penalties on health insurers found to have excessive denials or delays. He'd also expand access to low-cost drugs through TrumpRx.

• While El-Sayed has portrayed Rogers as beholden to industry, Republicans have jumped at the chance to portray El-Sayed as extreme.

2. Ohio: The race mixes bitter divisions over cuts to federal Medicaid funding in last year's Republican budget law with general tough-on-industry rhetoric.

• Democrat Sherrod Brown is focusing on insurer denials and pricing behavior while incumbent Republican Jon Husted wants to overhaul what he calls the "broken" Affordable Care Act and temporarily extend its enhanced tax credits.
• Brown has run an ad featuring a mother accusing Husted of breaking his promise to protect her daughter's care through Medicaid, while Republicans have attempted to flip the narrative and condemn Brown for not supporting the GOP law's rural health fund.
• The race is one test of whether the GOP can neutralize attacks on its Medicaid policy through playing up its efforts to shore up rural health care.

3. Maine: This one juxtaposes Medicare for All against Medicaid and ACA subsidy cuts, even though incumbent Republican Susan Collins didn't actually vote for her party's giant budget law and its scaled-back federal Medicaid spending.

• Democrat Troy Jackson is running openly as a progressive and supports single-payer health care, while Collins has spent years developing a centrist identity on health care.
• Though Collins voted for a procedural motion to bring the GOP bill up for a vote, she ultimately voted no. That's not been enough to insulate her.

4. Iowa: Both candidates have embraced populist anti-industry messaging.

• In her first ad of the campaign, Republican Ashley Hinson declared that "health care companies are ripping you off" and highlighted her work with President Trump to "take on insurance companies."
• Democrat Josh Turek — who was born with spina bifida — has made affordability the defining theme of the campaign and has vowed to "take on" Big Pharma and pharmacy benefit managers to lower prescription drug prices.

House

Iowa's 1st Congressional District: One of the most competitive House races features Republican Rep. Mariannette Miller-Meeks and Democrat Christina Bohannan, who, along with their surrogates, are vying to be seen as tougher on health plans.

• Democrats are hitting Miller-Meeks — a doctor — for taking contributions from the drug and insurance industries and her Medicaid vote, while Republicans are highlighting her role in securing more funding for rural hospitals.
• Bohannan has proposed allowing Americans to buy into Medicare at any age, though she opposes a single-payer system.

Wisconsin's 3rd Congressional District: This race features GOP Rep. Derrick Van Orden versus Democrat Rebecca Cooke. Democrats are linking Van Orden's Medicaid and Affordable Care Act votes to hospital funding cuts and health care's lack of affordability.

• But Van Orden has embraced his vote, recently touting its funding for rural Wisconsin hospitals at the GOP's midterm convention in Dallas.
• "This massive investment would not have been possible without President Trump's Working Families Tax Cut Act," Van Orden said, according to the Wisconsin Examiner. "And shamefully, shamefully, not one Democrat voted for it."
• Cooke has called for expanding Medicare to cover vision, dental and hearing benefits and to lower the eligibility age.

Arizona's 6th Congressional District: Democrat JoAnna Mendoza and her surrogates are hammering GOP Rep. Juan Ciscomani's vote to pass Republican Medicaid cuts.

• Ciscomani says the GOP is protecting the program against fraud and abuse, though he warned about the consequences of Medicaid cuts before ultimately voting for the bill.
• Like others on this list, he has pointed to the law's investment in rural health, but in a recent debate Mendoza countered that funding is "like bringing a glass of water to a fire that you started, Mr. Ciscomani."

Arizona's 1st Congressional District: Democrat and emergency room physician Amish Shah is running on promises to "[lower] health care costs and [stand] up to Big Pharma," but Republicans are portraying him as extreme and dangerous.

• Though he has previously supported Medicare for All, his current health care positions have moved to the center, with his website committing to "expand coverage, protect Medicare, and lower prescription drug prices."
• His Republican opponent is Jay Feely, a former NFL player who's unencumbered by a controversial Medicaid vote.

The bottom line: So far, health care is the top issue in Senate candidates' ads in terms of spending and airtime, and second to taxes in House ads, according to the Cook Political Report.

• That means that even in a chaotic environment with a war and multiple economic concerns, 2026 is still in large part a health care election.