The first wave of 2026 midterm primaries is giving us an early look at the political environment heading into November. As of May 28th, statewide primaries have been held in Arkansas, North Carolina, Texas, Mississippi, Illinois, Indiana, Ohio, Nebraska, West Virginia, Louisiana, Alabama, Georgia, Idaho, Kentucky, Oregon and Pennsylvania, with Texas also holding runoffs on May 26th.

A few themes are already coming into focus. Republican primaries are continuing to function as loyalty tests. From Senator Cassidy in Louisiana to Senator Massie in Kentucky, and Senator Cornyn in Texas, Trump’s support or opposition has been one of the most crucial factors in several major races. Redistricting is also shaping the map in real time, with some primaries delayed or complicated by litigation.

Below are key primary race outcomes:

Louisiana

Louisiana produced one of the most important health policy results so far. Sen. Bill Cassidy, a physician and former chair of the Senate HELP Committee, failed to make the Republican runoff after Trump-backed Rep. Julia Letlow and state Treasurer John Fleming advanced. Cassidy’s loss was driven by backlash over his impeachment vote against President Trump. Cassidy has been one of the Senate GOP’s most active health policy voices on issues like Medicare, Medicaid, public health, and healthcare affordability.

Louisiana’s House primaries were also disrupted after the state suspended May congressional primaries due to litigation over the state’s congressional map. That is part of a broader trend this cycle: redistricting is still not settled in several states, and it could affect the House battlefield before November.

Texas

In the Democratic Senate primary, state lawmaker James Talarico defeated Rep. Jasmine Crockett and Ahmad Hassan. On the Republican side, Sen. John Cornyn and Attorney General Ken Paxton advanced to a runoff, where Paxton ultimately defeated Cornyn on May 26th. This is another sign that Trump-endorsed candidates remain very powerful in Republican primaries.

Texas also saw disruption in House races, including the defeat of Rep. Daniel Crenshaw in the Republican primary and the runoff defeat of longtime Democratic Rep. Al Green by Rep. Christian Menefee in a redrawn Houston-area district.

Georgia

In the governor’s race, Trump-endorsed Lt. Gov. Burt Jones and billionaire healthcare executive Rick Jackson advanced to a June 16th runoff. In the Senate race, Republicans Mike Collins and Derek Dooley advanced to a runoff for the chance to challenge Democratic Sen. Jon Ossoff.

In the 11th Congressional District’s Republican primary, AdventHealth neurosurgeon Dr. John Cowan received the most votes and will go to a runoff election on June 16th. Secretary of State Brad Raffensperger lost the Republican gubernatorial primary, while former Lt. Gov. Geoff Duncan, who switched parties and ran as a Democrat, also lost.

Ohio

Former U.S. Sen. Sherrod Brown won the Democratic Senate primary and will face Republican Sen. Jon Husted. In the governor’s race, Vivek Ramaswamy won the Republican nomination and will face Democrat Amy Acton. Both candidates have extensive healthcare experience, with Ramaswamy being a biotech entrepreneur and Amy Acto being Ohio’s former state health director.

Kentucky

Kentucky produced one of the strongest examples yet of President Trump’s influence in Republican primaries. Rep. Thomas Massie, one of Trump’s most vocal Republican critics, lost to Trump-backed Ed Gallrein in the 4th Congressional District. Additionally, Rep. Andy Barr won Kentucky’s Republican Senate primary on Tuesday, after being endorsed by the President. Barr will be the heavy favorite to succeed Sen. Mitch McConnell.

Arkansas

Arkansas helped kick off the primary season on March 3rd. The major statewide races were relatively uneventful, with Gov. Sarah Huckabee Sanders and Lt. Gov. Leslie Rutledge unopposed in their Republican primaries. On the Senate side, Democrat Hallie Shoffner advanced to challenge Republican Sen. Tom Cotton, though the race is still expected to heavily favor Republicans.

North Carolina

North Carolina’s March 3rd primaries set up several key Senate and House contests in a state that remains politically competitive and increasingly important for health policy. North Carolina’s marquee statewide race is the open U.S. Senate contest, where former Democratic Gov. Roy Cooper and former Republican National Committee Chair Michael Whatley won their primaries to compete for the seat being vacated by Sen. Thom Tillis. Health policy could be a meaningful part of the race, given Cooper’s role in North Carolina’s Medicaid expansion debate and broader voter concerns around affordability and healthcare access.

Mississippi

Mississippi’s March 10th primaries were fairly predictable at the top of the ticket. Sen. Cindy Hyde-Smith faced only nominal Republican opposition, while Democrats selected 16th Judicial District Attorney Scott Colom to challenge her in what is still a strongly Republican state. Rep. Bennie Thompson also won the Democratic nomination in Mississippi’s 2nd Congressional District.

Illinois

Illinois held one of the first major open-seat Senate primaries of the cycle. Lt. Gov. Juliana Stratton won the Democratic nomination to succeed retiring Sen. Dick Durbin, defeating a crowded field that included Reps. Raja Krishnamoorthi and Robin Kelly. She will face Republican Don Tracy in November.

Indiana

Indiana’s May 5th primaries were quieter at the top of the ticket because the state does not have a U.S. Senate race this year. Still, the state showed how powerful Trump’s influence remains inside the Republican Party. Several Republican state legislators who opposed a Trump-backed redistricting plan lost to Trump-endorsed challengers, including Blake Fiechter’s win over incumbent Sen. Travis Holdman and Tracey Powell’s win over incumbent Sen. Jim Buck.

Nebraska

Cindy Burbank won the Democratic nomination but said she planned to withdraw before the general election to clear a path for independent Dan Osborn to challenge Republican Sen. Pete Ricketts. In the Omaha-area 2nd Congressional District, Denise Powell won the Democratic primary for the open seat being vacated by Republican Rep. Don Bacon.

West Virginia

West Virginia’s May 12 primaries set up a Senate race between Republican Sen. Shelley Moore Capito and Democrat Rachel Fetty Anderson. The state also used a new photo ID requirement for in-person voting during the primary, which officials said caused minimal issues, but critics have argued could create barriers for some voters.

Alabama

Alabama’s primary featured statewide and congressional races, but several House primaries were postponed until August 11 because of redistricting litigation. That means some ballots already cast in affected districts may not ultimately count for those congressional races.

At the statewide level, Rep. Barry Moore advanced in the Republican Senate contest, while former Sen. Doug Jones and Sen. Tommy Tuberville won their respective gubernatorial nominations.

Idaho

Idaho’s primaries were mostly a status quo night at the top of the ticket, with Republican incumbents Sen. Jim Risch, Gov. Brad Little, Lt. Gov. Scott Bedke, Attorney General Raúl Labrador, and Secretary of State Phil McGrane all positioned to move forward in a deeply Republican state.

Oregon

Oregon’s primary set up a gubernatorial rematch between Democratic Gov. Tina Kotek and Republican Christine Drazan. In the Senate race, Republican David Brock Smith won the nomination to challenge Democratic Sen. Jeff Merkley. One of the most interesting policy outcomes was not a candidate race but a ballot measure: voters overwhelmingly rejected a 6-cent gas tax increase for transportation funding.

Pennsylvania

Pennsylvania’s primaries were a win for Gov. Josh Shapiro, whose endorsed congressional candidates all won their primaries. On the Republican side in Pennsylvania, the primaries mostly set up the party’s general election challengers, including Treasurer Stacy Garrity against Gov. Josh Shapiro and Dave McCormick seeking reelection to the U.S. Senate, while several GOP House nominees will now compete in districts that could help determine control of Congress.