The caregiving crisis and the 2026 vote

In his February 2026 State of the Union address, President Trump confidently declared that “The roaring economy is roaring like never before.” Unfortunately, the gap between his political rhetoric and the reality for many American families is growing. In the upcoming midterm elections, both political parties will propose a litany of policy options to address pressing pocketbook concerns—surging costs for gas, groceries, and utilities; a deepening housing crisis; rising unemployment; and the escalating financial burden of health, child, and elder care. Escalating health care costs and out-of-pocket medical expenses are at the top of the list of economic worries, while the cost of child care is pushing women out of the workforce. Recent economic data indicate that 42% of 455,000 women who voluntarily exited the labor market in 2025 reported it was due to the high price of caregiving and caregiving responsibilities. Consequently, health care, the care economy, and broader affordability are set to be defining issues for voters in the 2026 midterms and general election.

The care economy encompasses people who provide services, such as child care providers, home health aides, practitioners, transportation drivers, and other domestic care workers who tend to the well-being of children, the elderly, and people with disabilities. The World Economic Forum estimates the care economy in the U.S. to be approximately a $648 billion market; this market includes individuals who are engaging in paid, underpaid, and unpaid labor caring for others. As many as 1 in 5 care providers are immigrants, and nearly half are Black or Hispanic women; of the 2.2 million domestic care workers in the U.S., 90.2% are women, 28.6% are Hispanic, and 21.6% are Black. A recent report on child care costs indicates that the national annual cost of child care is $13,128; child care expenses account for 10% of median household income for married couples, compared to 35% for single parents.

President Trump signed the One Big Beautiful Bill Act (OBBBA) into law on July 4, 2025. Through enhanced tax credits, the OBBBA seeks to address child care affordability—a primary barrier for employers seeking talent and workers forced to weigh care costs against their take-home pay. An analysis by the Tax Policy Center, however, suggests the OBBBA’s tax changes are modest and will primarily benefit middle- and upper-income families. More critically, the Institute on Taxation and Economic Policy argues that the OBBBA’s complex structure, which partitions the credit into refundable and non-refundable categories, effectively strands children in the bottom 20% of households. By tethering the benefit to specific income floors and tax liabilities, the policy creates a structural barrier that keeps meaningful support out of reach for families who need it most.

The OBBBA’s other tax code changes include making the 2017 Tax Cuts and Jobs Act (TCJA) permanent, altering how individuals access health care, and cutting several social safety net programs, with some of the largest cuts to Medicaid and the Affordable Health Care Act (ACA). These policy changes risk stifling employment opportunities for care workers and constraining the growth of the care economy. Multiple organizations have warned that the OBBBA will cut $1 trillion from Medicaid, a program designed to cover low-income adults, children, pregnant women, elderly adults, and people with disabilities, while ACA insurance marketplaces are designed to help working and middle-class families afford health insurance through subsidies.

Cutting these two programs will result in millions losing health care coverage while raising costs for millions of others. For instance, a study by the Center on Budget and Policy Priorities shows that roughly 15 million people will lose health care coverage by 2034, while an additional 4.2 million will lose ACA marketplace coverage. The OBBBA is projected to increase the number of uninsured and underinsured people, as legislative shifts drive up annual premiums. The brunt of Medicaid cuts will fall on long-term care facilities, such as nursing homes, where the legislation also defers federal standards of care. By waiving specific staffing requirements while simultaneously imposing cost-cutting measures, the OBBBA forces senior living operators into a precarious new policy environment—one likely to compromise operational efficiency and, ultimately, the quality of resident care.

Additional policy changes in the OBBBA will impact both community caregivers and Medicaid beneficiaries. Medicaid plays a critical role in supporting family caregivers by providing them with health insurance coverage. The OBBBA introduces new community engagement rules, also known as work requirements, for certain beneficiaries. Under these rules, participants must work at least 80 hours per month, though those serving as caregivers are exempt. While the law broadly excludes family caregivers, this protection is not automatic; states must proactively ensure these individuals are exempt from the requirement.

KFF, a nonpartisan health policy organization, forecasts that deep partisan divisions in Congress will continue to stall health care reform through 2026. Given the looming midterm elections, major legislation is unlikely to reach the floor. Instead, any federal progress will likely be limited to incremental actions. Nevertheless, as the campaign cycle intensifies, the rising cost of care will remain a point of universal economic concern for Republicans, Democrats, and Independents alike.

The Republican health care agenda centers on market-oriented approaches to address rising health care costs, specifically through the expansion of Health Savings Accounts (HSAs) and tax credits, a restructuring of ACA subsidies, and the implementation of the “TrumpRx” pharmacy program. While the GOP platform emphasizes maximizing price transparency and defending the OBBBA, the legislation’s role in allowing certain ACA marketplace plans to expire may provide an opening for Democrats to sway voters toward candidates promising to restore or protect coverage.

The Democratic health care agenda centers on the caregiving economy, framing it as a pillar of broader affordability policies. Democrats are prioritizing the reinstatement of ACA tax credits to curb rising insurance premiums, alongside proposals to slash out-of-pocket costs and expand Medicaid under the ACA.

Heading into the 2026 midterms, voters increasingly hold President Trump and congressional Republicans accountable for rising household and health care costs, including the expiration of ACA subsidies. Recent KFF polling shows Democrats maintaining a substantial lead in public trust across several key health care issues, a critical factor as voters identify medical costs as their primary economic anxiety. While public sentiment toward the ACA has shifted since 2010, the program and its insurance marketplaces currently enjoy high favorability, offering Democrats a strategic opening to campaign on enhancing health care tax credits and repealing OBBBA cuts to ACA subsidies. However, despite a Democratic advantage on health care, neither party has gained a clear mandate on the cost of living, with voters expressing little faith in President Trump or either party in Congress to solve the overall affordability crisis.