Issue explainer
Healthcare and Families
Independent information project. Not an official government website.
What is the issue?
Healthcare policy decides who has insurance, what care costs, and which services are covered or restricted. Most Americans get coverage through an employer or a public program: Medicare mainly serves people 65 and older, while Medicaid covers many low-income people and is run by states with federal funding. Prices for care and prescription drugs affect both family budgets and government spending. Related family issues include childcare costs and treatment for addiction. Abortion policy has been largely returned to states and Congress since the Supreme Court's 2022 decision in Dobbs v. Jackson Women's Health Organization. Voters weigh access, cost, personal choice, and the role of government differently, and some of these questions are value judgments rather than factual disputes.
What decisions are being debated?
How should coverage and costs be managed?
- Expand public coverage or subsidies, which can widen access but raises government spending.
- Rely more on private insurance and competition, which may lower some costs but can leave gaps in coverage.
- Change how drugs and services are priced, which may lower costs but can affect supply and innovation.
What should Medicaid and Medicare look like?
- Keep or expand current federal commitments.
- Shift more control and funding responsibility to states.
- Adjust eligibility, payments, or benefits to control long-term costs.
Who should decide abortion and reproductive policy?
- Federal standards set by Congress.
- Rules set state by state through legislatures and courts.
- Individual choice or limits on the procedure, a question that largely turns on values rather than data.
What can government do?
- Congress and federal agencies
- Congress writes laws governing Medicare, Medicaid funding, and insurance rules, and federal agencies such as CMS and the FDA implement them. Congress can legislate on abortion within constitutional limits.
- States
- States run Medicaid within federal rules, regulate insurers, license providers, and, since Dobbs, set most abortion law through legislatures and state courts.
- Counties and cities
- Counties and cities run public health departments and some clinics and childcare programs.
- Shared or limited authority
- Medicaid is jointly financed and administered. Courts, at both levels, can strike down or reshape health laws.
Relevant elections:
- U.S. Senate and House races: Congress writes Medicare, Medicaid, and insurance law.
- State election pages: States run Medicaid and set most abortion law.
What evidence should voters consider?
- Health policy research and polling on coverage (external site, opens in new tab)
(KFF; Independent research)
- Centers for Medicare & Medicaid Services (external site, opens in new tab)
(U.S. Department of Health and Human Services; Official data)
- Dobbs v. Jackson Women's Health Organization (opinion) (external site, opens in new tab)
(Supreme Court of the United States; Court decision)
- Overdose prevention (external site, opens in new tab)
(Centers for Disease Control and Prevention; Official data)
Where do candidates stand?
Candidate comparisons for this issue are not available yet. They appear only for races where each position is backed by a source we have verified. A missing position is not support, opposition, or neutrality. Candidate filings for every race are listed on the federal races pages.
Learn more
- Medicaid.gov (external site, opens in new tab) (Centers for Medicare & Medicaid Services; Official data)
- Medicare.gov (external site, opens in new tab) (Centers for Medicare & Medicaid Services; Official data)