Why Are Texas Democratic Candidates Still Struggling On Healthcare Messaging?

How the Medicaid Expansion failure is still shaping Texas politics.

Over the last several years, the Democratic base has increasingly come to want, perhaps even expect, our society to move toward universal healthcare. Even under Nancy Pelosi’s leadership in Congress, hearings were held on Medicare-for-All.

• See: C-Span 2019 - “Medicare for All” House Hearing

And a “Medicare-for-All” bill has been filed in Congress every year for the last several Congressional sessions, including this session, with 111 co-sponsors.

And, as Texas Democratic candidates across the board seem generally progressive on labor, education, and the environment, healthcare is one area I’ve noticed the 2026 slate struggles to develop solid messaging for. And while the consultants and campaign managers are telling the candidates that this election cycle “pocketbook” messaging is most important, candidates (on the federal ballot) need to have a real grasp of where the base is and where the base wants to go, even in Texas.

Why do I think candidates are struggling with this?

And this isn’t a knock on anyone, but more a knock on Texas and the real material conditions on the ground here. I think part of the answer is that Texas never moved forward when the rest of the country did. We never expanded Medicaid. We never normalized the idea that healthcare is something the public sector can guarantee. Instead, Texas spent the last decade arguing over whether poor people “deserved” coverage at all, while other states were already dealing with cost control, access gaps, and how to make universal systems work better.

Texas being behind the rest of the country shapes what voters hear, what candidates fear, and what campaigns think they can safely say out loud.

For a lot of Texas Democrats, especially those who’ve served in the Legislature, healthcare hasn’t been an abstract policy debate. It’s been years of constituent stories about insulin rationing, untreated cancer, people waiting until the ER is their only option, and families losing everything over medical debt. When you govern in a state where millions remain uninsured by design, the fight often becomes about plugging holes rather than redesigning the system. That experience can push candidates toward incremental language, even when they agree with the end goal.

That same history also creates a real knowledge gap. Because Texas never expanded coverage, many voters are still stuck in questions about who pays, who qualifies, and what happens to people who “already have insurance.” Those are questions the rest of the Democratic coalition nationally worked through years ago.

But the base has been moving anyway. Democratic primary voters are increasingly clear that they want a system that works. They want healthcare that isn’t tied to employment, marriage, or luck. They want costs that make sense. And they want to stop watching people die or go bankrupt in a country that can clearly afford better.

Further reading:

• A Democrat’s Guide To Discussing Universal Healthcare

How is this unfolding with the 2026 Texas Democratic slate?

One of the best examples I can think of is the TX18 special election, which actually happened in November, and the runoff is on January 31, but candidates will be battling there again in the March primary. As many of you already know, ⭐Lone Star Left endorsed Christian Menefee⭐. Not only because he was the most progressive candidate in the race, but also because he was explicitly in favor of universal healthcare.

• Most Americans (66%) say the federal government has a responsibility to make sure all Americans have healthcare coverage.

When 2/3 of Americans believe the federal government has a responsibility to make sure all Americans have healthcare, yet the majority of Democrats in the TX18 race were not in favor of universal healthcare. I didn’t see the disconnect then, but as the 2026 primaries have gotten underway, it has become clearer.

For the record: Amanda Edwards, the other candidate in the TX18 runoff, is NOT in favor of universal healthcare.

A few weeks ago, progressives across Texas and elsewhere were losing their mind because, apparently, US Senate candidate James Talarico said in a Texas Observer article that he was in favor of a public option, which is not the most progressive choice, keeps for-profit entities intact, and isn’t really universal healthcare.

That raised red flags for a lot of people, understandably.

And knowing Talarico’s record and his years in the Texas House, that position didn’t make any sense to me.

So I reached out directly to his campaign, demanding answers.

Their response was unequivocal. James Talarico is not taking a for-profit position on healthcare. He supports universal healthcare and would vote in favor of Medicare for All. The way they framed it was as a sequencing argument, that a public option is not the end goal, but a transitional step toward universal coverage, especially in a state like Texas that never expanded Medicaid and still leaves millions uninsured.

That position was later clarified publicly at a town hall and rally just a few weeks ago, where Talarico reiterated that he supports Medicare-for-All and sees a public option as a bridge, not a destination.

Whether people agree with that strategy or not, it’s an important distinction, and it gets to the heart of what’s happening across the Texas Democratic slate. This is a fight over how much explanation candidates think they have to do before they’re allowed to say where they want to end up.

Talarico’s background matters here. He’s spent years in a legislature that refused to expand Medicaid, listening to constituents describe choosing between insulin and rent, waiting until emergencies to seek care, and dying from preventable conditions because coverage was out of reach. When you govern inside that reality, the instinct can become about immediate access first, system redesign later, even if you understand that redesign is ultimately what saves lives and money.

As Talarico’s campaign continues, this will be a position he’ll have to continue clarifying, especially since Jasmine Crockett has signed on to the Medicare-for-All bill this Congressional session.

Further reading:

• A Memo To 2026 Democrats: Make Universal Healthcare The North Star

But it goes much deeper than that.

You know that six-part series we recently did on Democratic primaries? I was researching all the candidates as I went along, and I was surprised at how many Congressional Democratic candidates who seem progressive in other areas are using what I would describe as hedging, or even liberal, language around healthcare.

Protect. Preserve. Adress. Codify. The ACA. Blah, blah, blah.

But not enough Texas Democratic candidates are using universal healthcare or Medicare-for-All language specifically.

Texas Democratic primary voters are increasingly signaling that they’re ready for clarity, not hedging. They understand that universal healthcare isn’t radical. They know that every other wealthy country has figured this out. And they’re voting accordingly.

And this isn’t about purity tests. It’s about honesty.

When candidates default to vague ACA-era language, they’re not actually speaking to the material reality voters are living in. The ACA matters. It saved lives. But it was never designed to be the final system. It was a stopgap in a country that still treats healthcare as a commodity rather than infrastructure.

For voters who are drowning in premiums, deductibles, surprise bills, and provider networks that vanish overnight, that kind of language doesn’t sound reassuring. It sounds like avoidance.

Universal healthcare is pocketbook messaging.

It is about wages that don’t disappear into premiums. It is about being able to leave a job without risking your life. It is about parents not having to choose between rent and medication. It is about small businesses not being crushed by insurance costs. It is about workers having leverage because their healthcare isn’t held hostage by an employer.

Texas Democrats don’t lose voters by saying that out loud. They lose voters when they sound like they’re afraid to.

The throughline here isn’t that Texas Democratic candidates are secretly conservative on healthcare. It’s that many of them are still campaigning as if Texas Democratic voters haven’t caught up to the rest of the country. But they have. Repeatedly. In polling. In endorsements. In primary results. In the questions voters ask at town halls.

The lesson from TX18, from the reaction to Talarico’s comments, and from the broader 2026 slate is simple. The base is ahead of the messaging. And the longer campaigns hedge, the more disconnected they risk becoming from the voters they need most.

Texas Democrats don’t need to invent a new position on healthcare. The position already exists. The voters already understand it. The work now is to say it clearly, explain it honestly, and stop treating universal healthcare like a third rail when it’s increasingly the moral and economic baseline of the party.

2026 isn’t about whether Democrats believe healthcare is a right. It’s about whether they’re willing to say so without apology.

Texas voters are watching.

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