2026 Midterm Elections Take Center Stage Ahead of August Primaries

Get ready for Washington’s 2026 midterm elections with key insights on legislative and congressional races, ballot initiatives, voter turnout, physician candidates, and WAMPAC resources to help the physician community stay informed on campaigns and issues affecting the medical community.

Political dynamic

Traditional wisdom holds that the party out of power in the White House gains seats up and down the ballot during midterm elections as voters exhibit fatigue or dissatisfaction with the current administration. That was certainly the case in 2018, the midterm elections held during President Donald Trump’s first term, when Democrats picked up 10 legislative seats, gaining broad majorities they have held since.

Voter turnout is another important consideration during midterm election years with data from the Washington secretary of state’s office indicating that voter turnout during primary elections for the past two midterm years has held at around 40%. Primary elections often serve as a temperature check on the disposition of the electorate in a given year ahead of November’s elections.

This year, Democrats will be seeking opportunities to grow their majorities by campaigning on voter discontent with the federal administration. There are also a significant number of legislative races with Democrat incumbents facing intraparty challengers from more left-leaning candidates. Legislative Republicans will look to separate themselves from the national climate by prioritizing the state budget dynamic and the recent passage of a state income tax on millionaires. The overarching theme of affordability will be at the forefront of campaigns of both parties.

State Legislature

More than two-thirds of the state Legislature is up for election this year, including the entirety of the state House of Representatives and roughly half of the state Senate. Over 10 legislators decided to retire or seek higher office following the 2026 session, including Rep. Timm Ormsby (D-Spokane), who was the key budget writer in the House, and longtime House Health Care Committee member Rep. Michelle Valdez (formerly Caldier) (R-Gig Harbor).

Of particular note for the physician community, Dr. Pam Kohlmeier is running as a Democrat for the open house seat in the state’s 3rd Legislative District (Spokane). Dr. Kohlmeier is an emergency medicine physician by training, as well as an attorney. Currently, there are no physicians elected to the Washington State Legislature.

Dr. Kohlmeier is supported by WSMA’s campaign arm WAMPAC, the Washington Chapter of the American College of Emergency Physicians, and the Washington State Society of Anesthesiologists. To learn more about Dr. Kohlmeier’s campaign, opportunities to support, or to make a contribution, visit her website here.

Federal

All of the state’s 10 congressional House seats are up for election. With no statewide offices on this year’s ballot, the state’s 3rd Congressional District of southwest Washington will take center stage as Democrat Rep. Marie Gluesenkamp Perez defends her seat against a number of Republican challengers in what is considered one of the most competitive districts in the country. Elsewhere, longtime congressman Rep. Dan Newhouse of the 4th Congressional District in Central Washington is retiring, creating an open seat.

Top of mind for the house of medicine is physician candidate Rep. Kim Schrier’s fourth reelection campaign to the 8th Congressional District. Rep. Schrier has served in Congress since 2018 and has been a great partner in office to the WSMA and the physician community.

Initiatives

It’s not just candidates on this year’s ballot: there will also be initiatives for voters to consider that will only appear on the general election ballot in November.

Initiatives to the people directly amend state statutes, allowing voters to directly approve, amend, or reject state laws. At the time of this writing, two initiatives have been certified for the ballot by the state secretary of state, including:

• IL26-638, which would block transgender girls from competing in girls’ sports by requiring medical certification of sex.
• IL26-001, which would roll back changes legislators made last year to an earlier initiative that delineates
  information public schools do and do not have to provide to parents.

Another initiative has been submitted with the required signatures to appear on the ballot and is awaiting the secretary’s certification:

• IP26-645, which would repeal the state’s recently passed 9.9% income tax on individuals and households earning over $1 million annually, also known as the millionaire’s tax.

The initiatives will impact the dynamic around campaigns, with Republicans generally favoring them and Democrats opposing. Approval of the income tax initiative, which would repeal the operative portions of the law, would have a significant impact on the state’s budget in 2027 and beyond.

WAMPAC Legislator Report Card

Every biennium, WAMPAC, the WSMA’s nonpartisan campaign arm, compiles a state legislator report card based on issues important to the house of medicine. This year’s edition includes votes from the 2025-26 legislative sessions, including legislation ranging from access to vaccines and Medicaid reimbursement rates to scope of practice and prior authorization reform. We know you care about electing candidates friendly to the physician community, so plan to use this resource when filling out your ballot to assess your local legislators’ track records on issues important to you and your patients.

A physical copy of WSMA’s 2026 Legislative Report, which features the WAMPAC Legislator Report Card, was delivered to your mailbox. You can also review the report card online.

With questions regarding WAMPAC or our engagement on campaigns, please reach out to WAMPAC Director Alex Wehinger at alex@wsma.org.