Americans voted in the 2026 midterm elections on Tuesday 3 November. Major US news organisations, including CBS News and NBC News, have projected that Democrats won control of both the House of Representatives and the Senate, taking control of Congress from Republicans. President Donald Trump remains in office, so the result sets up a period of divided government from January 2027, when the new Congress is sworn in.
Some races may still be counting, and final seat totals can change as results are certified. This article looks at the issues most relevant to nurses, including the many internationally educated nurses working in or hoping to move to the United States. It does not take sides.
Why the midterms matter to nurses
Congress controls federal budgets, health programmes and immigration law. Decisions made in Washington affect hospital funding, staffing, nursing education grants, student loans and visas. With power divided between a Democratic Congress and a Republican president, major laws will need compromise, and both sides can block each other.
Issues nurses will be watching
1. Medicaid and hospital finances
Medicaid funding is a major source of income for many hospitals, especially safety-net and rural hospitals. Before the election, Democratic leaders said they would seek to reverse Medicaid cuts passed in recent legislation, according to reporting summarised from the New York Times. Republicans have argued the changes were necessary to control spending and target programme integrity. Any reversal would need the president’s signature or enough votes to override a veto. Hospital finances influence hiring, staffing levels and pay, so nurses will watch this closely.
2. Affordable Care Act subsidies
Enhanced premium subsidies for ACA marketplace health insurance expired, raising costs for many families. Democrats campaigned on reinstating them. Changes in insurance coverage affect how many uninsured patients arrive in emergency departments and how hospitals are funded.
3. Immigration and nurse visas
The US relies on internationally educated nurses from the Philippines, India, Nigeria, Kenya, Jamaica and elsewhere. Most come through employment-based green cards (often EB-3), not temporary visas. Key issues include:
- Visa backlogs: long waits for green card numbers. Bills to “recapture” unused visas for nurses have been proposed in past Congresses with bipartisan interest, but have not become law.
- H-1B fee changes: the administration’s proposed high fee on new H-1B petitions affects some health workers, and hospitals have sought exemptions.
- Executive actions: many immigration policies are set by the administration rather than Congress, so the midterm result alone may not change them quickly.
For international nurses, the practical message is: don’t make major decisions based on headlines. Watch for actual changes in law and official guidance from US Citizenship and Immigration Services (USCIS) and the State Department.
4. Nursing workforce and education funding
Federal Title VIII nursing workforce programmes fund nursing education, loan repayment and faculty development. US nursing schools turned away tens of thousands of qualified applicants last year, partly because of faculty shortages. Budget negotiations in the new Congress will decide funding levels.
5. Safe staffing
Nurse unions have long pushed for federal minimum nurse-to-patient ratios, while hospital associations oppose mandated ratios, arguing they are inflexible and costly. Federal ratio legislation has been introduced before without passing. Most staffing rules are set at state level.
6. Workplace violence
Legislation to require health employers to adopt workplace violence prevention plans has attracted support from nurse groups in previous sessions. It could return.
7. Student loans
Changes to federal graduate lending, including limits on graduate PLUS loans, affect nurses studying to become nurse practitioners, nurse anaesthetists and educators. Future changes depend on negotiations between Congress and the White House.
Ballot measures
Voters in several states also decided health-related ballot measures, including on abortion in states such as Idaho and Missouri, and on gender-affirming care for minors in Colorado and Missouri, according to pre-election reporting. Results vary by state; check official state results for final outcomes.
Nurses on the ballot
A record number of health professionals, including at least 16 nurses, ran for Congress and governor this year. Several nurse candidates from both parties competed in close races. Final results for individual races are available from state election officials and major news organisations.
What happens next
- November to December 2026: remaining votes are counted and results certified. The current Congress continues in a “lame duck” session.
- 3 January 2027: the new Congress is sworn in.
- 2027: budget battles, health care negotiations and possible immigration debates.
The bottom line for nurses
Elections change who writes the laws, but changes take time. For nurses in the US, this is a moment to follow your professional associations and unions, learn where candidates and lawmakers stand on staffing, funding and immigration, and make your voice heard. For international nurses planning a US move, keep your NCLEX, VisaScreen and petition plans on track, and rely on official sources for any policy changes.