The drivers of the 2026 midterm elections are crystallizing. The voters are deciding what this election is about. Of course, as a midterm, our sitting president, Donald Trump, plays a significant role, but he’s by no means the only factor. Once again, the economy holds center stage.

The media has branded this year’s form of economic concern the affordability crisis, and to some degree, that moniker fits. In that context, one expense is quickly emerging as the fastest driver of budgetary pain for millions of Americans. And that would be the unbearable rise in the out-of-pocket costs of health insurance. This issue is not about access to coverage. It’s about the rapid rise in the cost of coverage and the ever-shrinking nature of that coverage.

The vast majority of voters are now certain that health insurance companies are taking advantage of them with price-gouging, vertical integration, and a lack of transparency, with next to nothing being done to stop it. Today, voters are primed to reward a candidate who is willing to fight back against the insurance giants with their vote.

As pollsters, we’ve tracked voter sentiment on the issues they will take to the ballot box for decades. This year, health insurance costs have cemented themselves as a primary driver of cost-of-living concerns.

In our recent national polling, 36% of voters said healthcare costs were a top concern, trailing only groceries and gas. Of those top three concerns, healthcare costs are the area where our elected officials can make the most impact.

Over the last 14 months, our polling shows an increase in concerns over rising health insurance costs. And voters in focus groups routinely tell us this is an area neither party is addressing.

The voters are loud and clear on what they want the government to do. Overall, 60% say Congress should focus on health insurance companies to solve the problems affecting them the most, with majorities across party lines pointing their fingers in the same direction. Comparatively, 18% say they should focus on pharmaceutical companies, 8% hospital systems, and 6% on Pharmacy Benefit Managers.

Voters are looking for the federal government to go much farther in taking on health insurance companies with policies that punish them for shady practices. Over 90% support requirements to report insurance coverage denial rates and requiring transparency for drug mark-ups — telling patients what extra health insurance profits actually fund. Similar shares support requiring insurers to cover all FDA-approved drugs so they can’t only cover the most profitable ones, and banning health insurance companies from cutting deals with the pharmacies and clinics they own.

They don’t stop there. A whopping 70% of voters say they would be more likely to vote for a candidate who wants to break up big health insurance companies. What’s more telling is that it includes 70% of Democrats, 70% of Independents, and 70% of Republicans. That’s not a typo. In the age of hyper-political polarization, this issue is a bipartisan unicorn.

Being beholden to health insurance companies is as politically damning as any hit we’ve seen this election. Nationwide, 86% are less likely to vote for a candidate who was funded by big health insurance companies.

The path to expanding coalitions of voters with real wins on healthcare and costs-of-living is out there. Standing up to big insurance companies and the politicians who have sold out to them is as politically ripe as any issue today. When healthcare comes up in the halls of Congress or on the campaign trail, the voters will be listening, and they know what they want to hear.

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Wes Anderson is a founding partner, and Henry Parkhurst is a pollster with OnMessage Inc., a political consulting firm with decades of experience in advising Republican campaigns and public affairs communications.

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The Growing Frustration That Could Flip Races And Neither Party Is Ready