Republicans are likely to take control of one or both houses of Congress when all the votes are counted, but Democrats on Wednesday were celebrating after their party defied expectations of substantial losses in the midterm election. The backlash over the Supreme Court’s decision in June to overturn 49 years of abortion rights was apparently a big reason.

Inflation and the economy proved the most important voting issue, cited as the motivation of 51% of voters in exit polls conducted by the Associated Press and analyzed by KFF pollsters. But abortion was the single-most important issue for a quarter of all voters, and for a third of women under age 50. Exit polls by NBC News placed the importance of abortion even higher, with 32% of voters saying inflation was their top voting issue and abortion ranking second at 27%.

The predicted “red wave” of Republicans toppling Democrats in the House and Senate did not happen, although as of Wednesday afternoon, it seemed likely that Republicans would gain the handful of seats they needed to take over the House majority.

In the Senate, where Republicans needed just one pickup to take control, no incumbent had officially lost, and Democrats captured the Pennsylvania seat being vacated by Republican Sen. Pat Toomey. Several other close races had yet to be called, and control of the chamber may well rest on a December runoff in Georgia between Democratic incumbent Sen. Raphael Warnock and Republican Herschel Walker. In recent decades, the party that controls the White House has generally suffered serious setbacks in congressional power in the midterms.

Among other issues facing voters Tuesday, residents of South Dakota approved an expansion of Medicaid under the Affordable Care Act. That made it the seventh state to expand the program over the objections of a Republican governor and/or state legislature. Previous successful initiatives passed in Idaho, Maine, Missouri, Nebraska, Oklahoma, and Utah. South Dakota’s approval will reduce to 11 the number of states that have not expanded the program to people with incomes up to 138% of the federal poverty level, although included in that list are the heavily populated states of Texas, Florida, and Georgia.

On the issue of abortion rights, voters in five states across the political spectrum showed direct support through ballot initiatives. In the most closely watched of those measures, Michigan voters approved a constitutional amendment guaranteeing reproductive freedom, thus preventing a ban from 1931 from taking effect.

Kentucky voters narrowly rejected an amendment that would have declared in its constitution that there was no right to abortion. That made it the first Southern state to express direct support for abortion rights.

Other abortion rights ballot questions were approved in Vermont and California. The California measure, which passed with 65% of the vote, enshrined the rights to both abortion and contraception.

In Montana, a ballot measure to require that infants born alive after attempted abortions be given medical care was losing with 80% of the votes in. Such a requirement already exists in federal law.

In addition, in several key states where the legality of abortion hangs in the balance, governors and candidates who favor abortion rights defeated anti-abortion challengers, including Pennsylvania, Wisconsin, and Michigan.

Abortion was also an issue in contested Supreme Court elections in at least six states, where challenges to abortion laws or constitutional interpretations could decide whether the procedure remains legal. One state saw party control of its high court flip: North Carolina, where a Republican challenger defeated a Democratic incumbent to give the GOP a 4-3 majority. Democratic judicial majorities appeared to be holding in Illinois and in Michigan, which holds nonpartisan judicial elections after the candidates are nominated by political parties. In Ohio, Republicans kept their majority on the high court.

In Kentucky, Justice Michelle Keller defeated challenger Joe Fischer, a Republican state legislator who sponsored Kentucky’s abortion trigger law. Montana incumbent Justice Ingrid Gustafson defeated her challenger, James Brown, a Republican endorsed by the state’s GOP governor and party leaders seeking to reverse a 1999 court ruling that the state constitution protects the right to an abortion.

Abortion was not the only health issue on state ballots Tuesday.

In Arizona, a ballot question to limit interest on medical debt won easily with 66% of the vote counted. In Oregon, however, a mostly unenforceable question declaring a “right to health care” in the state constitution was losing narrowly with 64% of the votes in.

California voters approved a ban on the sale of most flavored tobacco products while voters in Massachusetts supported dentists over insurance companies in approving a requirement that at least 83% of dental insurance premiums be spent on direct dental care. Massachusetts is the first state to impose such a requirement.

In Iowa, gun rights advocates scored a victory with easy passage of a constitutional amendment declaring that Iowans have “a fundamental individual right” to keep and bear arms, and that any restrictions on guns must stand up to “strict scrutiny” in court.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


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By Julie Rovner, Kaiser Health News
Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.