In the closing stretch of the 2026 midterm elections, health care remains a highly contested issue, with Republicans and Democrats presenting starkly different perspectives on how to address the challenges facing American families. The debate centers largely on whether the focus should be on combating fraud within government programs or reducing the overall cost of care.

In western Wisconsin, Representative Derrick Van Orden, a Republican incumbent running for a third term, has made rooting out Medicaid fraud a centerpiece of his campaign. Speaking alongside hospital executives, Van Orden emphasized the need to ensure that every dollar allocated to Medicaid supports those who truly need medical care or food assistance. His message resonates with his party’s broader approach, which polls show prioritizes fraud prevention as a critical concern. The Republican National Congressional Committee has also highlighted efforts to lower health costs for working families, although some health policy advisers argue that focusing on fraud does not directly translate into lower expenses for patients.

Meanwhile, Van Orden’s Democratic challenger, Rebecca Cooke, is emphasizing the rising financial burden on patients, particularly the sharp increase in premiums and deductibles following the expiration of enhanced Affordable Care Act (ACA) tax credits earlier this year. Cooke, who previously benefitted from these credits and faced higher insurance costs after their expiration, anchors her message on affordability. She points to small-business owners and ordinary residents who are struggling to keep up with premiums that have surged significantly. According to reports, premiums have risen about 58 percent since the credits ended in January, leading some Americans to drop their insurance coverage.

This focus on cost aligns with broader Democratic concerns, as many argue that health care affordability has emerged as a top cost-of-living issue. Enhanced ACA tax credits, introduced during the pandemic, helped subsidize coverage but were allowed to lapse amid opposition from the Republican Congress. Additionally, last year’s domestic spending bill, championed by former President Trump and the Republican-controlled Congress, included significant cuts to Medicaid funding over the next decade. Although some funds were allocated to stabilize rural hospitals, critics like Cooke argue the amount is insufficient, especially in districts where hospital closures have already occurred.

The contest in Wisconsin reflects similar debates in other states, such as Pennsylvania, where Republican Representative Scott Perry and Democrat Janelle Stelson clash over health care priorities. Perry advocates for price transparency and wellness initiatives, citing Medicaid fraud rates as a key issue, while Stelson warns that recent legislation threatens vulnerable hospitals and harms access to care.

Van Orden’s stance has included a rare bipartisan move: he voted to extend the ACA tax credits temporarily to prevent his constituents from losing health care access despite his party’s general opposition. His alignment with prominent Republican figures, including former President Trump and Secretary of Health Robert F. Kennedy Jr., has brought national attention to the race. Conversely, Cooke positions herself as a centrist with support from moderate Democratic groups and endorsements from figures like Senator Bernie Sanders, who back her measured approach to expanding Medicare without adopting universal coverage proposals.

The contrast between Van Orden and Cooke underscores the broader health care divide in the 2026 midterms: Republicans focus on eliminating fraud within existing systems, while Democrats highlight soaring costs and the urgent need for increased affordability. Voters across the country continue to grapple with rising premiums, high drug prices, and concerns about the future of Medicaid and hospital access—issues that will significantly shape the electoral landscape as campaigns reach their final days.