Dear friends,

It’s our honor this month to hand over this newsletter greeting to guest writer Kathryn Jantz, who recently joined HealthBegins as a Senior Associate focused on mobilizing the healthcare system to address the structural drivers of health inequity. We were so compelled by the reflections Kathryn recently shared with us about the meaning of the midterm elections for health equity that we seized the opportunity to share them with you. Enjoy!

In solidarity,

Rishi Manchanda, MD, MPH.                                         Sadena Thevarajah, JD

From coast to coast and state to state, candidates and policies that support equity fared better than expected at the ballot box last week. While the sway of public opinion that drives elections can feel overwhelming (impossible for an individual private citizen to move), these midterms instilled in me a dose of something different: hope. They were a reminder to me to engage—personally and professionally. I am writing to extend that invitation to you.
 
The fine margin in many races and ballot initiatives (some still too close to call) defied predictions and demonstrated an opening in public will. The results were far from a total victory for health equity. But to me, 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, I am 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, I 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 seven ways in which the midterms showed that we care:
 

• We care about civic engagement: Roughly 47% of Americans showed up to vote.

• We care about healthcare access: A healthy margin of 56% of South Dakotans voted to expand Medicaid coverage to adults with incomes up to 138% of the Federal Poverty Level.
• We care about medical debt: Arizona set a limit on medical debt interest and wage garnishment.
• We care about reproductive health: Voters in Kentucky, California, Michigan, and Vermont voted to protect abortion rights.
• We care about housing: Several communities passed rent control or affordable housing ballot initiatives. For example, in Los Angeles, voters approved the development of an additional 5,000 low-income rental units per City Council district. 
• We care about food insecurity: Coloradans, with strong support from healthcare partners, approved a ballot measure to provide free meals to all public school students. 
• We care about adequate wages: In Nebraska, voters chose to increase the minimum wage from $9 to $15 by 2026, and in Nevada, voters increased the minimum wage to $12 by 2024. These increases are positive, though the rates remain well below most calculations of a livable wage. According to the MIT livable wage calculator, in Nebraska a single adult with two children would need to earn $42.68 per hour to live with dignity.

Here’s what I’m taking away from all of this.
 
These votes (and the ones that were less favorable for health equity) remind me that I, you, and we 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 right 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. 
 
I 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. 
 
I see a particular opportunity and responsibility now for Medicaid agencies, payers, 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 so we could include it on every formulary and benefit package. So let’s advance that work now. And let’s not wait. The midterms gave me 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, not wait to see what the next election cycle will show us. 
 
If you, like me and my teammates at HealthBegins, 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.
 
Best,

Kathryn Jantz,

Senior Associate, HealthBegins