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Race results for the 11th Congressional District race
Democrat Nancy Mannion, a registered nurse and political newcomer from Manheim Township, is challenging Smucker’s bid for a sixth term.
Democrat surge brings changes to South Carolina politics
The results of Tuesday’s elections will bring major changes to Washington and the South Carolina State House.
An Opportunity for Renewal and Progress on Science and Democracy
The American people have spoken, and they clearly want a Congress that will prioritize their well-being over corporate interests; that will help ease the affordability crisis instead of worsening it; and most of all, a Congress that will stand up to the authoritarian, destructive impulses of Preside
Democrat Paige Cognetti wins election to U.S. House in Pennsylvania's 8th Congressional District
She campaigned as an independent-minded Democrat and corruption-fighting city leader.
Democrat Christina Bohannan wins election to U.S. House in Iowa's 1st Congressional District
The third time was the charm for Bohannan, who lost by just 799 votes in her second race against Miller-Meeks two years ago.
Among Democrats’ first affordability targets: Health care
The incoming congressional majority will work to restore federal Affordable Care Act subsidies and Medicaid funding early next year, officials say.
Jay Feely's Congressional Dreams Have Doinked Off The Uprights
Tuesday sure delivered. The blue wave—a bluenami—is a great relief to people with brains and functioning moral senses, but much of the strongest juice produced Tuesday night was drawn from a few individual races. Some of those were incredibly stirring. It feels amazing to wake up in a world where Susan Collins is out in…
Elections change Congress, but they don’t change trucking’s priorities
Cargo theft does not have a party affiliation. Neither do deteriorating roads and bridges, safety compliance, the shortage of truck parking or lawsuit abuse.
Election 2026: A Political Earthquake
Tuesday's election puts Democrats in position to block some of Trump's anti-environmental efforts while expanding state clean energy policies.
Top health takeaways from the midterm elections
Democrats gained control of both chambers of Congress, and doctors and scientists won key seats. Here are the top health takeaways from the midterms.
Election 2026 live updates: Democrats take Congress as Trump distances himself from historic losses
Democrats have taken control of the House and Senate and are poised to launch a wave of investigations into President Donald Trump's administration.
Election over, the clock starts ticking again on landmark college sports bill in lame-duck House
Next week, Congress could begin debating a bill to overhaul college sports, amid uncertainty from recent Democratic election victories.
Editorial: Voters rejected tariffs. Congress should too
Amid the drubbing Republicans received in midterm elections on Tuesday, one point shouldn’t get lost: Voters have summarily rejected the president’s tariffs, and the new Democratic congressional majority should do
Penn hosts political analyst to discuss midterm elections, future voting trends
“Congressional races offer a brilliant preview of trends in the electorate that are coming down the pike that impact what the presidential race might look like,” Wasserman said.
A 'political meteor strike': Florida Gov. DeSantis talks GOP losses
Florida Republican Gov. Ron DeSantis says the GOP's loss of Congress and key races landed like a \
Healthcare powers Democrats’ midterm rout: 4 takeaways
Voters sent a strong rebuke of the GOP health agenda on Tuesday night as Democrats took control of both chambers of Congress, rejecting Republicans who pushed sweeping healthcare cuts. Here are f…
Video: Democratic Health Professionals Win Seats in Congress
Some Democratic doctors and nurses ran and won congressional seats by centering their campaigns on opposing Health Secretary Robert F. Kennedy Jr.
Post-Election Analysis: The Annihilation of the Trump Coalition
Ten years ago, Donald Trump shocked the political world with an Electoral College victory that hurled defiance at the polls, the pundits, and the traditional tenets of the Republican Party. On Tuesday night, Republicans in Congress received a rebuke from voters that was equally earth-shattering.The sheer size of the Democratic wave — they are on track to flip at least 40 seats in the House and seven in the Senate — is even more impressive given how many of those seats Trump carried by double digits just two years ago.
A ‘STEM wave’: Democratic doctors, scientists win a record number of seats in the midterms
New members of Congress are expected to help shape the health agenda next year.
Election over, the clock starts ticking again on landmark college sports bill in lame-duck House
Next week in Congress, the clock starts ticking on a groundbreaking bill designed to overhaul college sports with nobody quite sure how an overwhelming wave of election-night victories for Democrats across the country will reset the debate.
Watch CNN’s coverage of Election Night in 5 minutes
The 2026 midterms results have revealed a blue tsunami as Democrats take back control of Congress. CNN’s coverage over the night highlights the stunning turn of the tides for Donald Trump’s Republican Party.
Democrats win control of the U.S. House
Democrats win the U.S. House and take unified control of Congress as voters deliver resounding rebuke to Trump.
TN Politics: Election reveals blue shift in a ruby red state
Otis Sanford discusses Tuesday's election results, including the governor's race and new congressional districts.
Democrat Vasquez wins third term after $21.8 million race
By Kevin Hendricks — After months of TV ads, mailers and text messages across southern New Mexico, voters in the 2nd Congressional District gave U.S. Rep. Gabe Vasquez a third term, and it wasn’t close. Vasquez, a Las Cruces Democrat, beat Republican Greg Cunningham 59% to 41% on Tuesday, according to unofficial results from the […]
US stock futures dip as midterm election results loom
Early results showed Democrats making gains in the Senate, although control of both chambers of Congress remained uncertain.
Democrat Bob Brooks wins election to U.S. House in Pennsylvania's 7th Congressional District
2026 ELECTION COVERAGE: Watch Live | Poll Closing Times | All Live Results | Live Updates | Live Fact Check Democrat Bob Brooks won election Tuesday to the U.S. House of Representatives representing Pennsylvania's 7th Congressional District, defeating Republican incumbent Ryan Mackenzie. Brooks, who worked as a firefighter and union leader, concentrated on his blue-collar background, saying he understood the affordability issues facing voters in the Lehigh Valley battleground district. Mackenzie's ties to President Donald
Brooklyn’s own poised to lead Congress
As Democrats sweep midterm elections, two New York lawmakers, Rep. Hakeem Jeffries and Sen. Chuck Schumer, are expected to lead the House and Senate.
What Democratic control of Congress means for healthcare in 2027
Tuesday’s forecast-busting blue wave puts wind in the sails of Democrats who have promised a stark departure from Trump-era healthcare policy—though whether or not the shifts will be incremental or | Tuesday’s forecast-busting blue wave puts wind in the sails of Democrats who have promised a stark departure from Trump-era healthcare policy—though whether or not the shifts will be incremental or seismic hinges on intra-party debates and the president’s veto.
Maryland voters pass Democratic-backed redistricting amendment
A constitutional amendment passed Tuesday could pave the way for Democratic lawmakers to redraw Maryland’s congressional districts ahead of the 2028 election.
Healthcare powers Democrats’ midterm rout: 4 takeaways
Voters sent a strong rebuke of the GOP health agenda on Tuesday night as Democrats took control of both chambers of Congress, rejecting Republicans who pushed sweeping healthcare cuts.
CVS Health Is Breaking Up. Is The Blue Wave To Blame?
A Democratic Congress would have tried to force the breakup.
After taking control of Congress, Democrats vow major probes into Trump's 'tentacles of corruption'
Corruption topped the list of concerns for voters who ousted Republicans and handed Democrats control of Congress in the midterm elections. Now, the newly empowered Democratic Party is putting the issue front and center as its leaders chart their course for investigations and policymaking.
How Democrats’ midterm wins reshape Farm Bill politics
Democrats’ sweeping gains in this week’s congressional midterms, driven in part by voter frustration in farm states, give the party new leverage in Farm Bill negotiations, according to farmers and farm advocates.
Election Day National Politics
Jonathan Lemire, co-host of "Morning Joe" on MSNOW; writer for MSNOW and contributing writer to The Atlantic, talks about what the Democrats are planning if the blue wave in Congress materializes, plus what the Trump administration has in store for the post-election time.
Democrats dominate Bernalillo County election results
By Jesse Jones, The Paper. — Bernalillo County voters gave Democrats wins in nearly every contested partisan race, from county offices to Congress, while also deciding judicial contests and a slate of ballot questions. Democrat Eric Olivas won another term on the County Commission and Democrat Linda Stover won election as county assessor. Bernalillo County […]
Pearson accepts loss in U.S. District 9 race, but says ‘Tennessee politics will never be the same’
Democratic state Rep. Justin J. Pearson conceded the race to represent Tennessee’s 9th Congressional District Wednesday.
KFF Analyzes the Role of Health Care in the Midterms
The midterm elections mean changing power dynamics and shifting legislative agendas in Congress, both next year and during the upcoming lame duck session—the period between the November election and the new session beginning in January. As policymakers consider next steps, new KFF polling analysis examines the role health care played in voters’ decisions. Key Takeaways […]
New Majorities, New Gavels: What Congressional Turnover Means for Business
Congressional turnover in 2027 could reshape committee leadership, staffing, oversight, and legislative strategy as the 120th Congress begins.
‘Hegseth has been a disaster’: Sen. Kelly tells CNN
Sen. Mark Kelly (D-AZ) called Trump’s handling of the Iran war a “complete disaster,” as he argued Democrats should use congressional power to push for an end to the conflict.
US stock futures tumble as Democrats score key midterm election wins
Wall Street faces fresh uncertainty over what Democratic control of Congress could mean for taxes, government spending and regulation.
Democratic leaders say affordability and accountability will be focus of new Congress
Rep. Hakeem Jeffries and Sen. Chuck Schumer promised to reduce costs and end corruption.
Democrat Debbie Wasserman Schultz wins reelection to U.S. House in Florida’s 20th District
Democrat Debbie Wasserman Schultz won election to the U.S. House of Representatives representing Florida’s 20th Congressional District, defeating Republican Brent Andersen.
'Bad politics': Blue tsunami visible months before it emerged
Voters across the political spectrum became increasingly irritated by President Trump's flippant governance, which congressional Republicans enabled.
Democratic doctors win big in 2026 midterm elections
A political action group says Congress now has a new mandate against Health Secretary RFK Jr.
A looming deadline to fund the government will shape Congress’ unusual lame duck session
Before Democrats take control, Congress must fund expiring health care programs, confirm HHS nominees
Democrat Eileen Laubacher leads Lauren Boebert in Colorado’s 4th CD
Democrat Eileen Laubacher saw her slim lead over Republican U.S. Rep. Lauren Boebert narrow as late returns posted Thursday in Colorado’s 4th Congressional District, the state’s most heavily GOP seat. The race remained too close to call, with Laubacher leading the incumbent by 2,276 votes, for a margin of just under 0.7%, according to results […]
Health Care: Don’t Just Fix What They Broke
The new Congress must not only repair what Trump has wrought but focus on immediate relief for the already insured.
Missouri live election results: Amendment 3, St. Louis, St. Charles and Jefferson counties
In the Nov. 3 midterm election, Missourians voted on an abortion ban and a measure that would make it harder for lawmakers to override voter-approved statutes and constitutional amendments. U.S. Rep. Ann Wagner faced Democrat Fred Wellman to represent Missouri’s 2nd Congressional District.
AP Voter Poll: Voters want Congress to impose more checks on an unpopular president
The AP Voter Poll, an expansive survey of the electorate, suggests most are deeply unhappy with Trump, with roughly 6 in 10 saying they disapprove of how he’s handling the presidency.
Democrat J.D. Ford wins election to U.S. House in Indiana's 5th Congressional District
In an upset that many analysts did not see coming, Democratic nominee J.D. Ford defeated three-term Rep. Victoria Spartz in Indiana’s 5th Congressional District in Tuesday's election.
Democrats won on affordability. Can they deliver it?
Democrats will hold Congress but President Donald Trump still has the power to block their plans.
Latin Grammy-winner Bobby Pulido wins Texas Congressional District 15
Bobby Pulido becomes the first Latin Grammy winner elected to Congress. He will represent Texas' 15th Congressional District.
Baumgartner lead widens in Eastern WA race for U.S. House
Baumgartner led 50.9% to 48.7% in the 5th Congressional District, a narrow lead but one that has widened since Tuesday night as more votes have been counted.
Democrats capture full control of Congress, NBC News projects, fueled by victories in deeply Republican states
Democrats capitalized on voter anger over Trump and affordability, flipping seats in deep-red and major battleground states alike.
It was a big night for doctors to win seats in Congress, riding the blue wave
Historically, most physicians who served in the House or Senate have been Republicans. In the next Congress, physicians who are Democrats made significant gains.
How Democrats’ Big Win Could Reshape Health Care
Democrats scored huge margins in Congress and made big gains at the state level. What does it mean for health policy in the final two years of the Trump administration and beyond?
Marni von Wilpert flips California House seat, bringing a personal health care fight to Congress
The bisexual lawmaker from California flipped a Republican-held seat amid an overwhelming blue wave.
Democrat Zach Dembo wins election to U.S. House in Kentucky's 6th Congressional District
Democrat Zach Dembo won election Tuesday to the U.S. House of Representatives representing Kentucky's 6th Congressional District, defeating Republican Ralph Alvarado.
Democratic leaders say affordability and accountability will be focus of new Congress
Rep. Hakeem Jeffries and Sen. Chuck Schumer promised to reduce costs and end corruption.
Vance: ‘The reason we lost is the war’
The morning after voters delivered a blistering midterm rebuke of President Donald Trump, with Democrats flipping both chambers of Congress and racking up victories even in deep-red bastions, Vice President
Ranking Member Lofgren Announces She Will Seek Chair of House Science Committee as Democrats Win Control of Congress
The House Committee on Science, Space and Technology
The percentage of people without health insurance is growing
The percentage of working-age adults without health insurance has increased in the past two years, largely because many people can no longer afford Obamacare coverage after Congress allowed federal subsidies
US stock futures mixed as Democrats score key midterm election wins
Wall Street faces fresh uncertainty over what Democratic control of Congress could mean for taxes, government spending and regulation.
The Future of Democracy
The 2026 midterm elections didn’t just determine who controls Congress for the next two years—they also determined whether the United States, 250 years after its founding, remains a democracy, Anne Applebaum says. She explores what citizens and lawmakers can do next to strengthen the institutions and values that have been threatened in the Trump era.
Democrat Denise Powell wins election to U.S. House in Nebraska's 2nd Congressional District
Powell flipped a district that Democrats have been targeting for several election cycles.
Triumphal Arch Set to Win Final Approval Despite Court Challenges
President Trump’s 250-foot arch project is expected to win approval on Thursday from a federal planning board. Court action and Democrats’ upcoming control of Congress could halt the plans.
Reaching Across the Aisle to Lower Health Care Costs
Following a panel organized by Penn LDI and Penn Washington, two health policy experts share how both aisles of Congress can reduce health care costs.
CVS Health Stock Leads Defensive U.S. Dividend Value Picks
Washington has just handed investors a plot twist. A Democratic sweep of Congress, fresh worries over debt ceiling fights and pressure on Treasury yields are shaking sentiment, yet pockets of dividend-paying value stocks may quietly benefit from the reset in expectations. This article walks through three U.S. dividend payers from our value-focused screener that appear closely tied to these political crosswinds and explains why each could deserve a second look now. The three stocks below are...
Health Brief: Health care’s election night watch list
The health care stakes in the fight for Congress, key governor’s races and ballot measures
Health Brief: Medicare’s big payment shake-up
Plus: A new “STEM wave” is headed to Congress, with doctors and other medical professionals ready to take on health policy fights.
Blue wave fizzles in Florida races: Inside Florida Politics podcast
Florida's GOP firmly keeps power including the state's first black governor Byron Donalds, and multiple Congressional and State legislative races.
A Democratic Sweep Gives Congress an Opening to Reassert Itself
President Trump usurped power from the legislative branch with Republican help for two years. Democrats are now positioned to try to claw back some of Congress’s prerogatives.
US midterm elections 2026 live updates: key House and Senate races to determine control of Congress for remainder of Trump’s term
Key states like Florida, Georgia, Michigan and North Carolina see record turnout as Americans decide the direction of Congress for remainder of Trump’s term
'Bad politics': Blue tsunami visible months before it emerged
Voters across the political spectrum became increasingly irritated by President Trump's flippant governance, which congressional Republicans enabled.
House Speaker Mike Johnson will not stay on as Republican leader after GOP losses
The Louisiana Republican told staff on a call Wednesday morning that he will not run to lead his party as House minority leader in the next Congress.
Health care is in rough shape in Massachusetts. Can the new Congress help?
Any moves by Congress to change health policy face the potential of a presidential veto.
U.S. Congressman Tim Moore, a longtime fixture of NC politics, defeated in reelection bid
Before moving to Congress, Moore was the longest-sitting Speaker of the N.C. House of Representatives.
Democratic leaders say affordability and accountability will be focus of new Congress
Rep. Hakeem Jeffries and Sen. Chuck Schumer promised to reduce costs and end corruption.
Election over, the clock starts ticking again on landmark college sports bill in lame-duck House
Next week, Congress could begin debating a bill to overhaul college sports, amid uncertainty from recent Democratic election victories.
Progressives in Congress Can Now Sway Funding, Investigations, Health Policy
Progressives may soon have the best opportunity in decades to influence the direction of the Democratic Party.
'Bad politics': Blue tsunami visible months before it emerged
Voters across the political spectrum became increasingly irritated by President Trump's flippant governance, which congressional Republicans enabled.
Advocates for science funding energized by midterm rout
Some hope a Democratically controlled Congress can restore funding for scientific research that has been cut by the Trump administration
WATCH: Republican Byron Donalds speaks after winning election for governor in Florida
Donalds, who will become the nation's first elected Black Republican governor, fended off David Jolly, a former Republican congressman who switched parties and ran a centrist campaign.
Democrats secure historic majorities in the midterms — and are poised to win even more seats
The party is poised to have strong majorities in Congress for the final two years of President Trump’s term. Follow for live updates.
The Blue Tsunami Swept Doctors and Scientists Into Office
More than 80 percent of congressional candidates backed by the pro-science PAC 314 Action won, including Michigan senator-elect and epidemiologist Abdul El-Sayed.
Report: Japan's Tashima to stand against Infantino for FIFA presidency
Kozo Tashima, the honorary president of the Japanese Football Association (JFA), will challenge Gianni Infantino for the FIFA presidency, according to reports. Infantino’s position appeared under threat after a dropped plan for private investment in the World Cup caused consternation, but he has rallied and now looks to be in a strong position to win a fourth term at FIFA Congress in Morocco next year.
Health: How Can Congress Combat The Rising Cost Of Healthcare?
The cost of most necessities is rising right now. And healthcare is no exception.In 2026, the average employer-based family healthcare plan cost a little over $28,000. And employees contributed over $7,400 more to those plans than in 2025. That’s according to analysis from the health research group KFF.And the nearly 20 million Americans who rely on the Affordable Care Act for health insurance are facing a 13 percent premium increase next year.Two days out from the midterm elections, what can Congress do to keep healthcare affordable in the United States?Find more of our programs online. Listen to 1A sponsor-free by signing up for 1A+ at plus.npr.org/the1a.
Voters decide key ballot measures on abortion rights, congressional redistricting and voter ID laws
2026 ELECTION COVERAGE: Watch Live | Poll Closing Times | All Live Results | Live Updates | Live Fact Check WASHINGTON (AP) — A battle over abortion rights is playing out in several states Tuesday as voters decide 145 proposed laws and constitutional amendments, including some that could affect voting for future elections. The ballot measures provide a political undercard for a high-profile midterm election that will determine which party controls Congress, state legislatures and
Campaign cash keeps coming: $21.8 million and counting pours into Vasquez-Cunningham race
By Kevin Hendricks, The New Mexico News — If you live anywhere between Albuquerque’s South Valley and El Paso and own a TV, you already know somebody really wants your vote in the 2nd Congressional District. Actually, several somebodies – and each has several million dollars. Campaign donors and outside political action committees have spent […]
Democrat Janelle Stelson wins election to U.S. House in Pennsylvania's 10th Congressional District
Democrat Janelle Stelson won election Tuesday to the U.S. House of Representatives representing Pennsylvania's 10th Congressional District, defeating Republican incumbent Scott Perry.
Here’s what to expect on healthcare from a Democratic Congress
The Democratic takeover of Congress will revive fights over Medicaid cuts, insurance subsidies and healthcare affordability.
Elon Musk spent $445 million to help Republicans. Their losses put his businesses in the crosshairs
Elon Musk spent at least $445 million to try to help Republicans keep control of Congress
Democrats seize Congress in sweeping midterm repudiation of Trump
Democrats seized control of both the Senate and House of Representatives on Tuesday, scoring sweeping victories in Republican strongholds for the first time in generations.
Congress gave Nebraska millions for rural healthcare. Most isn’t getting to rural hospitals.
Much of the $218 million Nebraska has received to soften the blow of looming Medicaid cuts has gone to big cities and out-of-state contractors. DHHS leaders argue more money will make its way to rural areas.
Emboldened Democrats gear up to challenge Trump over Iran war, Gulf business ties
Democrats are weighing options to enforce Congress’ authority to declare war.
AFGHS co-signatory countries ask health care users to help fill the financing gap
Hundreds of thousands of Ugandans living with HIV on antiretrovirals could be targeted for user fees or community health insurance schemes requiring modest premium payments, according to the April 2026 version of the country’s America First Global Health Strategy implementation narrative.1 As part of the “sustainable financing for the private not for profit sector” strategy, 491 facilities will be targeted for a phased introduction of user fees and scale up of community health insurance programs.2 In the Ugandan context, PNFP facilities include faith-based hospitals and other health facilities, US missionary organizations and centers of excellence—services that are often co-located at government facilities but run with additional financial and technical resources. 402,000 people—or about 28 percent of the total Ugandan adult PLHIV population on treatment—get ART from the private not for profit sector. The selected facilities provide the majority of ART and prevention of mother to child transmission (PMTCT) services. The plan doesn’t give the total number of clients served by the 491 facilities, so it is not possible to give a precise number. But the majority of 402,000 is a figure in the hundreds of thousands—hence the estimate I’m using.3 The April draft of the Ugandan implementation plan narrative is the only one I’ve been able to review. But the government of Uganda is not alone in turning to health care users to help fill the financing gaps caused by the abrupt withdrawal of US funds. In July 2025, the Government of Liberia introduced user fees for previously free services including “registration, accommodation, patient feeding, hospitalization, and a wide range of surgical and diagnostic procedures.”4 Earlier that year, Liberia rolled out a revolving drug fund designed to stabilize drug supplies by “allowing patients to pay a small fee for standardized, quality medications,” according to a Ministry of Health press release.5 (Both of these approaches had been proposed in the National Health Policy 2022-2031; media coverage explicitly connects the launch with the US foreign aid cuts.) The health financing strategies proposed by Uganda and established in Liberia are qualitatively different from user fees officially adopted by specific health facilities to cover funding shortfalls caused by the new US approach.6 The latter is a stopgap, adhoc change. The former is a national governmental adoption of policies that pass costs on to health care users, despite evidence that such approaches can exacerbate inequities and leave deficits unfilled. Two countries does not make a pattern, but they do point to urgent questions: Have other countries, including Liberia, included user fees or community health insurance schemes in their implementation plans? If so, do any of these narratives have what Uganda’s lacks: a fall-back plan in place in case these strategies for sustainable health systems fail to deliver—as they have before? I wonder if you think about it Subscribe Predictable pitfalls Both community-based health insurance and user fees are as old as the hills. And after decades of people climbing up these hills, duking it out, climbing back down—neither strategy has shown the results the Ugandan implementation plan is counting on. This is, in fact, a hill some folks are willing to die on. (You knew I’d get there, right?) In November 2025, an African-led team of health system experts published a paper directed at low- and middle income country governments trying to figure out how to create self-sustaining health systems. The money wasn’t coming back. It had been more than nine months since the season of freezing, waivering and wood-chippering; two months since AFGHS tumbled into the world touting co-financing requirements and reductions in future US government health aid. Governments were looking for strategies for sustainable, self-financed health systems, the authors wrote. For countries considering user fees and community health insurance to fill the financing gaps, they had a simple message: Don’t. On user fees, the paper states: “Reliance on user fees is ultimately a regressive and inequitable approach. It places a disproportionate burden on the poor and undermines health system goals of equity and financial protection. […] There is overwhelming evidence that user fees mobilise very limited resources for the public health sector, making it an inefficient mechanism for revenue mobilisation.” On community health insurance: “Attempting to shift the burden of funding previously donor-funded services, such as HIV care and management, and TB treatment, onto contributory schemes would exacerbate their fragility and fail to protect the population.”7 The WHO says that community-based health insurance “cannot be expected to provide a major source of funding or coverage,” and noted that most schemes offer only moderate benefit to individuals paying into them, and exclude the poorest segment of the population.8 And yet, the US-Ugandan implementation plan says that community health insurance is “the central pillar of this [PNFP] sustainability strategy” and that this approach that will generate “pre-paid pooled funding at facility and community level [that] improves financial risk protection for households, reduces catastrophic out-of-pocket expenditure, and generates structured, transparent revenue streams that can progressively absorb recurrent costs including health worker salaries.” Unfortunately, Uganda’s own history suggests the pillar might not be able to bear this weight. Ugandans Have Been to this Rodeo Before—and Some Want Their Money Back Uganda introduced its first community health insurance scheme in 1996 with support from international donors.9 Thirty years later, somewhere between 0.2 and 0.3 percent of the population is covered by CHI; just over 1 percent has any kind of health insurance.10 User fees were universally introduced in 1993 as a condition of a World Bank loan.11 They were abandoned in 2001, and in 2004—the year I moved to Uganda to watch the free HIV program get underway—a definitive study found that the fees did not improve health systems and outcomes.12 In 2004, most clinics and hospitals had ‘free’ and ‘fee for service’ options for getting care.13 The fee for service, or “cash and carry” programs had often been established in the years prior to PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria. People who could afford to paid for the drugs, often at facilities in the private-not-for-profit (PNFP) sector. When free drugs arrived, some people who’d been paying kept on doing so, perhaps because of shorter wait times, greater confidentiality, convenience or other factors. But in the year that I spent visiting the same clinics around the country week after week—including a “center of excellence” that maintained separate days for cash and carry clients and those accessing free ARVs—lots of people who had been paying tried to switch to the free option. They’d paid because they had no other choice. They’d sold pieces of family land, begged family members for loans, bought pills by the week, and sometimes by the day. Or they were just cash-strapped, like most of us, and wanted the funds for other things. 14 Twenty-two years later, this hasn’t changed. Ugandans pay out of pocket for 30-40 percent of their health care costs, leading one paper to declare that “falling ill is more than a health crisis. It is a financial emergency.”15 One recent study found that up to 48.5 percent of households dealing with tuberculosis sold something, took out a loan or dug into savings to defray the costs of TB care—which is supposed to be universally free.16 The Ugandan implementation plan does anticipate challenges. It proposes a phased approach, with 187 facilities introducing user contribution systems in Year 1, 152 in Year 2, and 153 in Year 3. Willingness to pay and feasibility studies will precede roll out; fees will be tiered by region, and a waiver system is proposed to ensure that no one has to pay who is unable to. Moreover, the plan provides for quarterly reviews of epidemiological data to “ensure that user contributions do not compromise epidemic control gains, ART continuity for the client cohort, TB case management, or PMTCT services.” Alt text: A screenshot of a table included in the implementation plan narrative that is the subject of this stack. It’s got a fetching pink bar at the top. It uses the abbreviation “CHI” which is Community Health Insurance, and FBO which is Faith Based Organizations, and it details the number of facilities that will implement user fees with waivers and community health insurance schemes over the five years of the agreement. As I said in the footnote, this is a super interesting document with a lot of other rich material. Tell me what you see—and what you would have focused on. And if you’ve seen something like this, or anything else that strikes you, in another implementation plan, tell me that too. You can use the Substack message platform or try me on Signal at @endaplague_again.25 (because @mercoonfan was, weirdly, taken). But the plan doesn’t fully explain what will happen if this approach doesn’t work out. Yes, progress will be monitored, and corrective action triggered. However, there is no specified funding replacement if premium and fee revenue prove inadequate. Instead, the authors write, “Currently, COEs serve a total client cohort of over 180,000 across 28 facilities. In the initial years, the U.S. Government (USG) will provide financial support for clients; over time, user fees generated by COEs will become the primary source of funding for sustaining their services.” Failure does not really seem to be an option. Health insurance schemes are more acceptable to the Ugandan population than user fees. Members of Parliament and civil society traveled to Ethiopia to see how that country’s scheme worked. In a follow up report, a veteran civil society group recommended allowing the “health insurance ecosystem to grow organically and [to] keep reviewing the law and regulations as this growth takes root.”17 One study found that more than three-quarters of Ugandans were willing to join a health insurance program.18 However, coverage of community-based health insurance is minimal, as is coverage of any kind of insurance—including private plans.19 A national health insurance scheme bill has been stalled for several years and presently sits with President Yoweri Museveni.20 Community-based health insurance scheme that do exist are expanding in number, but losing enrollees. Between 2022 and 2026, the number of community-based health financing schemes across the country increased by 42 percent, while the number of people enrolled decreased by nearly 11 percent.21 None of this means that community-based health insurance should not happen in Uganda—or that people do not want insurance. It doesn’t even mean that user fees and waivers won’t ever work. But there is highly relevant evidence from Uganda and the surrounding region that it is quite optimistic to describe community health insurance and user fees as central supports for sustainable financing in any sector of the health system. And now for the best-case scenario In the best-case scenario22, the Ugandan approach does exactly what it sets out to do, and so does the Liberian fee structure and revolving pharmacy fund—though I’ve not confirmed that these are in the MoU. In one best-case scenario, Uganda is an outlier, and user fees and community health insurance are not recurrent pillars of self-sustaining financing in other countries’ implementation plans. In another best-case scenario, all countries that include these strategies enjoy success beyond anyone’s evidence-informed wildest dreams: reliable funding generated by health care users fees, great health care outcomes for everyone, no exacerbation of inequities, no crippling household debt. No sold land, repurposed school tuition or high-interest loans. In the best-case scenario, not one of the hundreds of thousands of Ugandans living with HIV receiving antiretrovirals from 491 PNFP facilities misses a refill or leaves care because of user fees or community health insurance premiums. This is the best-case scenario for these people for their own health, and for their families. It is also the best-case scenario if Uganda wants to stay on the path to eliminating HIV as a public health threat. According to the country’s most recent data, 96.5 percent of people living with HIV on antiretrovirals are virologically suppressed. Epidemic control depends ensuring that 95% of people living with HIV know their status, 95 percent of those individuals are on ART, and 95% of those individuals are virologically suppressed. Uganda is still struggling with the first “95"—a frankly abysmal 85.3 percent. If HIV epidemic control and the attendant prevention of new infections, avoidable suffering and premature death matter, the country cannot afford to lose any clients who are currently in care.23 As I write this a couple hours before the polls close for the US elections in the city I live in, I say with soul-deep sincerity: I am rooting for the best-case scenario. I think it’s safe to say that we all are.24 I think it’s also safe to say that if the US and co-signatory governments have inked plans that lead to successful expansion of community health insurance and strategic use of user fees, we all would like to know, now, so that we don’t miss the opportunity to celebrate when success happens. The implementation plan narratives have to enter the public domain. They are the fullest expression of a strategy co-created by two governments. There are assumptions and details that people living in the US and co-signatory countries need to understand that are not available in the MoUs or, to date, in the Congressional Notifications. Some of these details can help other countries that are, as I write this, still working on implementation plans. Others, like a solid count of how many other countries have plans for expanding user fees or health insurance, are important for regional and global health architecture reform initiatives. No matter how this election night turns out, there will be a slew of new Congressional member orientations, briefings and talking points papers in the next few months. Release of implementation narratives should be a bullet point in every context that AFGHS is discussed. These documents can be redacted so that procurement sensitive information isn’t disclosed. There is much more historical precedent for sharing such documents than there is for relying on user fees to fill health financing gaps. Let’s look at the information together so we can hope for the best and prepare for, you know, the other thing. Alt text: A substack first: a bicep selfie! It’s my arm - peachy-white skin, black shirt (flannel, notch neck, too hot for this appallingly balmy November weather, if you’re wondering) and a sticker that says I VOTED 2026. Beige letters on red for I voted. Beige on blue for 2026. You bet I did.25 In your wildest dreams. Subscribe 1 This is a really, really rich 95 page document. There are fascinating ideas and detailed plans in it. It is all worth reading AND I have, in this post, highlighted an instance of content that could pose challenges and certainly posits success of strategies that haven’t worked before. I would love to hear what readers’ see that’s interesting and should be lifted up as something to check for in other implementation plans. I will also shortly be adding a static page to the substack site where implementation plan documents will live. I will put the url into this footnote and it will also be there on emilybass.substack.com by the end of the week. Uganda Implementation Narrative Section 4 April 22 2026 Draft 1.51MB ∙ PDF file Download Download 2 User fees are costs charged for visits, labs, medicines or other health services, usually at the time they are provided. Community health insurance, or community-based health insurance, is what the World Health Organization calls “micro insurance,” which is health insurance targeted at low-income people. 3 As usual (by which I mean always), please prove me wrong. 4 https://smartnewsliberia.com/liberias-ministry-of-health-announces-2025-hospital-service-fees-for-public-facilities/?utm 5 https://moh.gov.lr/news/2025/grand-cape-mount-leaders-residents-embrace-new-community-pharmacy-program/?utm 6 https://www.christianitytoday.com/2026/09/hiv-usaid-pepfar-africa-foreign-aid-cuts-mission-hospitals/?utm 7 https://gh.bmj.com/content/10/11/e021270 8 https://www.who.int/news-room/fact-sheets/detail/community-based-health-insurance-CBHI 9 https://pmc.ncbi.nlm.nih.gov/articles/PMC2827475/ 10 https://pmc.ncbi.nlm.nih.gov/articles/PMC10861328/#b3-jpmph-23-110 11 https://pmc.ncbi.nlm.nih.gov/articles/PMC527704/ 12 Same citation as the footnote 2 - the article is called “Learning from failed health care reform in Uganda.” To which I say: If only. If. Only. 13 There is a whole taxonomy of user fees to be aware of, if not commit to memory. Out of pocket costs are everything that someone pays for themselves. In this Stack, user fees are planned and policy-supported out of pocket costs. There are also out of pocket costs that people pay to buy drugs or receive tests or health care assessments that would be free if the drugs were on the shelves, or the machines or kits were available, or the staff were on site. A user fee is usually designed to be modest, pegged to willingness to pay, and may be waiveable at the point of care for anyone who is unable to do so. The costs for things that would otherwise be free are whatever the market will bear and people either have to pay them or go without. Out of pocket costs for services and stuff that aren’t available in public facilities are different again from bribes or unofficial fees that some health workers may impose, even though most are indefatigable, tireless and tired, and devoted to their clients. 14 For the record—which really is these footnotes—I would give a whole stack of fridge magnets for a systematic analysis of the economic and social impact of the Mass Unemployment Event in AFGHS countries among the very people who used to be able to afford and cover user fees, both for themselves and vast family networks. Locally employed USAID technical staff, house cleaners, caregivers, drivers and technicians were financial anchors for cousins, friends, friends’ children, friends’ childrens’ cousins, teachers, pastors, neighbors and so many other kinds of kin. Aid recipients lost direct funding; many other people who had not been aid recipients, but parts of the elaborate care webs that function as safety nets for so many people, lost crucial support too. And that’s even before we get to the people who worked at the hotels and restaurants and bars where people employed by the US and its implementing partners used to spend disposable income. Those businesses have lost revenue; those folks have lost jobs. It will be some time coming—and someone will have to fund this work—but I do hope it happens. And I hope, as usual, to be proven wrong. 15 https://eprcug.org/blog/how-out-of-pocket-healthcare-costs-keep-driving-ugandans-into-poverty/ 16 Another straight-to-the-point journal article title. Households experiencing catastrophic costs due to tuberculosis in Uganda: magnitude and cost drivers. https://pubmed.ncbi.nlm.nih.gov/32938411 17 https://www.cehurd.org/download/technical-policy-brief-on-community-health-insurance-scheme/?wpdmdl=13661&refresh=6ae9122f5d4ed1793659439 18 https://pmc.ncbi.nlm.nih.gov/articles/PMC10125197/ 19 https://pmc.ncbi.nlm.nih.gov/articles/PMC10861328/#b3-jpmph-23-110 20 https://ugandapost.news/uganda-to-make-health-insurance-mandatory-by-2026/ 21 https://shu.org.ug/download/235 22 With a nod, tip of the stack hat, and wag of the Mercoon tail to a deeply valued reader who told me that I have a tendency to speculate about the worst-case scenarios a little too much of the time. 23 https://news.mak.ac.ug/2026/10/uphia-2025-shows-ugandas-hiv-status-awareness-gap-despite-strong-treatment-outcomes/ As you’ll see in the next footnote, I’ve already written a subSubstack on another topic, so I will be brief with regard to the study referenced in this article. The Uganda Population-Based HIV Impact Assessment, or UPHIA, will never happen in this way again. For more than a decade, PHIAs have been supported by the US government as a way to generate accurate estimates of country progress on key HIV indicators. They are a holdover from the PEPFAR program that was laser focused on ensuring US taxpayer dollars subsidized progress in pandemic control. There may be other population-level surveys and the data may even be publicly released, as the entire set of FY2026 MER data have not. But PHIAs will never happen again. If you’re wondering whether the estimates of HIV progress at country level might get less reliable….you’re not alone. 24 Ooh baby, I hate “we” in almost all forms. But sometimes I go there, when I am looking for company, which I am. Because this Stack moves into the somewhat-uncharted territory of assessing what the implementation plan narratives may suggest about co-signatory countries’ roles and responsibilities to the people living within their borders. The MoUs, specimen and data sharing agreements were templates. Countries’ answers fit into pre-specified questions that did not include, “how are you going to fill financing gaps and stabilize your health system as this plan unfolds?” In contrast, the implementation narratives are open form—the product of co-creation between the two governments. Co-creation can mean lots of things, but nothing leads me to believe that implementation plans are ghost-written by the US government, or that contents were imposed by the US counterparts. Instead, I think the parts of the plans that read like country government initiatives are endorsed, if not initiated by, those governments. For instance, the Ugandan implementation plan narrative describes plans for revenue-generation through fees charged for equipment calibration, repair and maintenance provided through Uganda’s National Equipment Calibration Laboratory, and laboratory accreditation through the Uganda National Accreditation Service (UGANAS), targeting private sector, PNFP, research and academic clients. That’s super specific and also quite ambitious. It doesn’t read like an American idea. There’s also a provision for solar panels, and other stuff that feels country owned and driven. This is where it gets interesting. If co-creation is the case, then both the US and co-signatory governments are accountable for the contents and the outcomes. Most discourse about AFGHS to date has focused on the decisions that America has made, or demanded that other countries make. The AFGHS architects have monopolized the hot seat. As they should, in so many ways. America absolutely created the conditions under which countries needed to come up with health financing strategies to fill unanticipated, catastrophic funding gaps. And with not-too-long a lens, we can look back and see that America is also on the hook for its role in the Bretton Woods institutions that made user fees and health system fiscal austerity conditions of loans during the era of structural adjustment. But in the here and now, it is not at all clear to me that the US is requiring Uganda or any other country to implement specific approaches to sustainable financing. Instead, it is as the authors of that paper up in footnote 6 suggest: African governments have agency. As implementation plans roll out—whether or not the narratives are shared—it will be important to understand what this agency looks like and what it means for people, including the poorest of the poor. And it will be important to figure out how to talk about it safely, respectfully and critically in places other than the literal and metaphorical footnotes. 25 This week’s song is “Once upon a time” by the Moody Blues. (I know, this is gonna be a weird, largely banger-free end of 2026 playlist. HMU with requests.) AND please do watch the video and appreciate the truly amazing opening sequence—a drum kit wasteland, a coupla plastic bags, a bit of sand. Sort of like the hill where fiscal austerity policies that put costs on health care users might go to perish. But then there’s a lady with amazing hair. It’s worth it.