How to Transform the 2022 Midterm Elections into Action for Equity

From coast to coast and state to state, candidates and policies that support equity fared better than expected at the ballot box in the recent 2022 midterms. While the sway of public opinion that drives elections can feel overwhelming (impossible for an individual private citizen to move), these midterms instilled in us a dose of something different: hope. They were a reminder to us to engage—personally and professionally. We are writing to extend that invitation to you.
The fine margin in many races and ballot initiatives defied predictions and demonstrated an opening in public will. The results were far from a total victory for health equity. But to us, they proved both that we can create policy change to promote health equity and that we have much work to do.
What does this shift among voters mean? As much as these results indicate a repudiation of extreme ideologies, we are hopeful that the election results are also an indication of a renewed American spirit: compassion. Connecting the dots of the ballot returns around the country, we see that we collectively care about the people in our communities who need additional resources—or perhaps that we are coming to realize that the line between those of us who are making ends meet and those who are not is finer than we thought. And that spirit might just give us an opportunity to create change.
Here are eight ways in which the midterms showed that we care:


Here’s what we’re taking away from all of this.
These votes (and the ones that were less favorable for health equity) remind us that we and you have more power than we often consider. Our federal legislatures certainly matter, but so do state leaders, state regulatory policy, community policy, and even the policies of the organizations that we interact with every day. Small as we might feel, we have the weight to push for equity in all of these spaces—especially when we push together. The midterms are an indication that if we lean in now, we might just find the wind at our backs. They show us that more of the American public these days gives a damn about giving a damn. 
With this realization in mind, stakeholders at every level can assess their impact on health equity and develop strategies to drive improvements by:


  • Advocating or organizing for policies that bring healing to communities harmed by societal practices. The door is open to support Medicaid expansion in the 11 remaining states, to expand and strengthen the Supplemental Nutrition Assistance Program, and to prioritize the implementation of other important programs. As a provider, you can form or join coalitions that advance policies that bring critical resources to underserved populations, uplift how these programs prioritize equity, and more. One such approach is to disseminate your internal insights into why these programs are vital, how many individuals would be supported, and how these programs actually save money. For example, should the remaining states opt-in to Medicaid expansion, nearly 4 million people would gain access to care—and roughly 60% of these individuals are persons of color. Remarkably, expansion demonstrably leads to increased utilization of care, decreased uncompensated costs, and decreased medical debt. 


  • Aligning resources to improve equity in communities marginalized by societal practices. Unfortunately, the social structures that drive inequity typically result in resource-deprived places—the historical context of which rests in redlining, the racial wealth gap, structural racism, and more. As a community investor (such as an employer, philanthropic giver, or purchaser of local goods and services), examine whether you are leveraging your resources and partnerships to improve equity by place. Intentionally pouring resources into a targeted region amplifies a funder’s ability to build cross-sector relationships and make lasting change because investments can be made from a coordinated, sustainable approach. Place-based public health initiatives can encompass poverty, discrimination, food access, affordable housing, and more, and are furthermore proven to generate both economic and societal value.  


  • Collecting social needs data to identify health inequities. Identifying where inequities exist—by payor, provider, community, county, etc.—requires establishing systems that collect data. Collecting and disaggregating data based on Race, Ethnicity, and Language (REAL data) can identify patterns of inequity within a specific population, therefore granting stakeholders an upstream opportunity to analyze social risk data and unveil why these inequities exist. As a payor, you can work to address equity gaps by working with providers to collect REAL and social risk data, and designing strategies to address and improve health and social outcomes. 


We encourage you, our partners and friends, to see these election results as an opportunity to take a bold stance on equity in your organization, community, AND at the ballot box. The door is open to support Medicaid expansion in the 11 remaining states, and to examine variations in the Medicaid program that result in enrollees in some states receiving less resources and support than those in other states. 
We see a particular opportunity and responsibility now for Medicaid agencies, payors, and providers to drive the systems changes that historically marginalized communities require to have the same opportunity for health. How? Work to change your organizational policies, such as by increasing wages and eliminating practices that may be putting your employees or the people you serve in harm’s way. Forge connections with key organizations in your community doing this work. Work with your state Medicaid agency to advocate for policy changes to address the underlying drivers of health.
If there were a pill or medical intervention that had the same impact on health as high quality and safe housing, nutritious and adequate food, transportation, and economic security, we would not hesitate to align policies and braid funding to include it on every formulary and benefit package. So let’s advance that work now. And let’s not wait. The midterms gave us hope, but they should not make us complacent. Nothing in public opinion holds still. To make an impact, we need to seize this opportunity to act, to build on this moment, and not wait to see what the next election cycle will show us. 
If you take heart in the signs the midterms sent us, and if you use that fuel to propel you into renewed action for health equity—whether on large or local stages, whether for Medicaid or housing, food security or a living wage—we’ll be campaigning right there alongside you.

By Kathryn Jantz, MSW, MPH, Senior Associate and Alexis Taylor, MPA, Senior Program Manager