In race after race around the country, health care took center stage. Congressional candidates fought over drug prices and Obamacare. Gubernatorial contenders sparred over whether and how to expand Medicaid. And through state ballot measures, voters faced decisions about abortion, medical marijuana, and soda and tobacco taxes.

About 40 percent of Americans said health care was the biggest issue informing their vote this year, according to CNN exit polls.

In the Associated Press exit polls, health care was also the top issue on voters’ minds; 26 percent listed it as the most important issue facing the country.

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Here are the results so far, in all the elections that could shape the future of health and medicine in the U.S.:

Congressional races

In Texas, Republican Rep. Pete Sessions was defeated by Democratic challenger Colin Allred. Sessions was targeted by Patients for Affordable Drugs, a drug-pricing advocacy group that spent $750,000 on advertising criticizing Sessions for accepting big contributions from drug companies. Allred campaigned on letting Medicare directly negotiate drug prices.

Republican Bob Hugin, the former CEO of Celgene, lost in his bid to unseat Democratic Sen. Bob Menendez in New Jersey, according to ABC News and NBC News. It might have seemed like a longshot for a pharma executive who oversaw drug price increases to challenge an incumbent in an election when drug prices were a top issue, but Menendez was considered vulnerable after facing corruption charges and a trial that ended in a hung jury.

In Missouri, Democratic Sen. Claire McCaskill lost her seat after making high drug prices and protections for Americans with pre-existing health conditions signature campaign issues. Her opponent, Missouri Attorney General Josh Hawley, is among the plaintiffs on a Republican lawsuit seeking to overturn the Affordable Care Act. In Congress, McCaskill was a top critic of drug makers for price hikes and their role in the opioid crisis.

Democratic Sen. Joe Manchin won re-election in West Virginia over his Republican challenger, state Attorney General Patrick Morrisey. Both had ties to the pharma industry, and they each criticized each other over those ties. Morrisey has lobbied for drug companies, while Manchin is the father of Mylan CEO Heather Bresch. Manchin made protecting health coverage for people with pre-existing conditions a key plank in his campaign.

Illinois Republican Rep. Peter Roskam, who held a key leadership position for health care issues as a subcommittee chairman on the Ways and Means Committee, lost his reelection bid to Democrat Sean Casten. Casten made health care issues — including Roskam’s ties to pharma — a key part of his attacks on the campaign trail.

A federal indictment for insider trading didn’t stop Rep. Chris Collins from netting another term in Congress. Prosecutors allege that Collins, a New York Republican, found out that a drug candidate from an Australian biotech company had failed. He then tipped off his son, who sold shares of the company and avoided losses of hundreds of thousands of dollars. Collins defeated Democrat Nathan McMurray. His trial is scheduled for early 2020.

Republican Rep. Marsha Blackburn will be Tennessee’s next senator, defeating Democrat Phil Bredesen. Blackburn took flak for a 2016 law that critics say hampered the Drug Enforcement Administration’s ability to intercept suspicious opioid shipments. A super PAC aligned with Senate Democratic leadership also cut ads calling out Blackburn’s pharma ties.

Democrat Donna Shalala, the former health and human services secretary in the Clinton administration, flipped a Miami-area congressional seat. She helped push the Clinton administration’s health reform effort that ultimately failed.

Medicaid expansion

Democrat Laura Kelly is projected to be the next governor of Kansas, defeating Republican Kris Kobach. Kansas is one of the 18 states that has not expanded Medicaid under the Affordable Care Act, but Kelly’s win means it is much more likely to extend health benefits to more low-income adults. Similarly, Democrat Janet Mills won the gubernatorial race in Maine over Republican Shawn Moody; now Maine will likely expand Medicaid as well. A pre-election analysis from Avalere found that, depending on a handful of gubernatorial races and state ballot initiatives, 2.7 million people could gain health coverage through expanded Medicaid programs.

Democrat Andrew Gillum, however, conceded the gubernatorial race in Florida to Republican Ron DeSantis, meaning Florida is not likely to expand Medicaid. And Democrat Stacey Abrams was down in her race against Republican Brian Kemp for the Georgia governor’s seat. If Kemp holds on, Georgia probably will not expand Medicaid.

Three states — Utah, Idaho, and Nebraska — were also weighing whether to expand Medicaid through ballot measures, and in early returns, the majority of voters were showing support for the initiatives.

Other ballot measures

In Massachusetts, voters defeated an initiative spearheaded by a nurses union that would have imposed limits on the number of patients assigned to a nurse’s care in hospitals, local media reported. The state’s hospitals fought the measure, arguing it would force them to reduce their services and that it would increase health care costs.

In Ohio, voters rejected a measure that would have reduced criminal penalties for people arrested for drug possession, the Columbus Dispatch reported. Supporters hoped the initiative would reduce the state’s prison population and provide addiction treatment to more people.

Voters in Missouri legalized medical marijuana, the Kansas City Star reported. In Utah, a medical marijuana measure was up in early returns, according to the Salt Lake Tribune. No matter the outcome of the election in Utah, state lawmakers have vowed to enact a revised medical marijuana program in a special legislative session.

In Oregon, voters pushed back an attempt to ban state funding for abortions, The Oregonian reported. Meanwhile, voters in West Virginia and Alabama approved measures to state in their constitutions that abortion is not a protected right, the HuffPost reported. Those laws could face court challenges.

In California, a bill that would have allowed city governments to implement new rent control protections failed by a wide margin. While the measure had nothing to do with health policy, the drug lobbying group PhRMA donated $500,000 to oppose it — a donation seen by some California political experts as retribution against Michael Weinstein, a high-profile HIV/AIDS activist who helped bankroll the housing measure, along with four earlier, failed initiatives around the country to cap drug prices.

Lev Facher and Nicholas Florko contributed reporting. 

This story will be updated as election results continue to come in. 

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