Annie Andrews ran on fixing healthcare. The first big challenge arrives soon.

One of the biggest Election Day surprises unfolded in South Carolina, where pediatrician Dr. Annie Andrews became the state’s first Democrat to win a US Senate seat in almost 30 years. She did so by highlighting familiar concerns—the expansion of data centers, the war in Iran, political corruption, and the exploding cost of living—but also by focusing on a topic that stands to affect nearly every American: the degradation of our healthcare system.

Andrews’ campaign leaned on her medical expertise to outline a particularly in-depth approach to a looming healthcare crisis that will begin to unfold next year, when a boom in ownership by predatory investors, like private equity firms, is set to collide with Trump’s sweeping cuts to Medicaid—upending access and creating a hospital crisis. She laid out plans for stopping both.

In July 2025, the “One Big Beautiful Bill” enacted new work requirements and administrative hurdles for Medicaid that many people won’t be able to meet, leading to an estimated 10 million people losing Medicaid coverage—if not more. In several interviews since her historic win, Andrews has made clear this will be the first thing she tries to undo when she arrives on Capitol Hill this January.

“That’s my number one priority: to stop these Medicaid budget cuts,” she told a local TV station. That’s in part because scaling back the federally funded health insurance will have broad implications for hospital access, emergency room waits, health insurance costs, and virtually every other corner of healthcare, far beyond the nearly 67 million low-income people—including pregnant women and children—who rely on Medicaid.

“Rural hospitals will close. We’ll have more counties without a single hospital,” she said. “It will have a ripple effect across the whole heath care system.”

Throughout her campaign, Andrews—who also will become the first female doctor in the Senate—sought to explain this ripple effect by breaking down how hospital finances actually work. In an interview with Katie Couric last year, she explained that in South Carolina, Medicaid funds nearly half of births and 6 of 10 nursing home beds. “This is what’s going to happen: If we kick this many people, millions of Americans, off of their health insurance, that doesn’t stop them from getting sick or injured,” she said. Instead of getting outpatient care, they’ll wait at home until their conditions become dire. Then they will “show up at the one place that is legally required to offer them care: the emergency room.”

When a larger portion of patients treated by ERs are uninsured, hospitals will pass on those costs to private insurance by charging them more—and then insurance, of course, will pass on those increases by jacking up premiums paid by millions of Americans and their employers. So those who don’t need Medicaid will also suffer. “That’s how they’ll compensate for this giant removal of billions of dollars from the healthcare system,” Andrews said.

This sea change will intersect with other elements of hospital financing that Andrews also has promised to tackle. The first is what has come to be known as the financialization of healthcare—a growing business trend where investors like private equity firms buy up ever more pieces of the healthcare sector and turning them into for-profit machines. In the last decade, private equity firms have spent more than $1 trillion on acquisitions of hospitals, nursing homes, hospices, free-standing emergency rooms, and practices in virtually every medical specialty: dermatology, cardiology, and more.

Andrews has been explicit in saying she hopes to get private equity out of healthcare—not the least of which because these firms’ unique focus on trying to get above-average returns means that they cut costs relentlessly while trying to get more from patients, driving up the cost of care. When she arrives in the Senate, she will join the likes of Massachusetts Sens. Elizabeth Warren and Ed Markey, who have zeroed in on private equity after several large healthcare bankruptcies were precipitated by PE ownership.

Several studies have found that private equity ownership makes patient care worse: One found that private equity–owned nursing homes had a mortality rate 10 percent higher than their non-PE counterparts; another found that during the pandemic, PE-owned nursing homes had a Covid-19 infection rate 30 percent higher than statewide averages. Yet another study noted that patients at PE-owned hospitals are 25 percent more likely to suffer an unrelated injury while admitted.

Andrews’ platform also called out an obscure practice that has been central to private equity’s healthcare acquisitions: Many states ban non-physicians from directly owning medical practices—laws intended to curb investors’ incursions into healthcare. But private equity firms have devised a complex workaround, where they create shell companies and pay physicians to serve as owners in name only—while the PE firm retains true control of the business. She has also called for stronger protections against surprise billing, hospital price transparency, and better oversight of major hospital mergers that stand to create regional monopolies where patients have little choice but to consent to price hikes.

Beyond that, Andrews has proposed changes that would improve elder care: lowering prescription prices, improving insurance that covers Medicare patients’ out-of-pocket costs, and stopping a new federal program that uses AI to decide whether Medicare should cover certain procedures.

Andrews’ healthcare plan is among the most comprehensive and detailed of any of the new members of Congress. But she was one of several Democratic candidates who won in red states after putting healthcare reform at the center of their campaigns. In Texas, James Talarico won his race with a platform that included lowering drug costs and braking up corporate healthcare monopolies. In Ohio, Dr. Amy Acton beat Vivek Ramaswamy for governor after a campaign that spoke extensively about healthcare affordability and medical debt. And in Michigan, Abdul El-Sayed won his Senate race after pitching a vision of Medicare for All.

In the days since her historic win, Andrews has begun to preview some of the concrete steps she’ll take to work toward her healthcare agenda. She told a South Carolina TV station that she’s already scheduled a meeting with South Carolina’s other senator, Republican Tim Scott, to talk about working on Medicaid issues—and that she hopes to stop the cuts within her first year in office.