Pennsylvania’s next governor may have a role in the accessibility of health care coverage, what reproductive care looks like and how the state protects LGBTQ+ residents. As voters prepare to cast their ballots to determine a number of crucial races across the state, Gov. Josh Shapiro and Republican challenger Stacy Garrity have been making their case for why they should be the one to lead the state.
The two candidates offer substantially different approaches on key issues as they face off in the race for governor during the 2026 midterm election. Shapiro has fought federal Medicaid changes that his administration says will cause hundreds of thousands of Pennsylvanians to lose coverage, defended access to abortion and supported protections for LGBTQ+ people.
Garrity backs the federal changes, arguing that they will reduce fraud and preserve Medicaid for those who need it most. She opposes taxpayer-funded abortion and has made restricting transgender girls’ participation in school sports a prominent campaign promise.
Medicaid
President Donald Trump’s oft-called “Big Beautiful Bill Act” imposes new work-reporting and eligibility requirements for Medicaid recipients while reducing projected federal spending. Nearly one-quarter of Pennsylvanians receive health coverage through Medicaid, according to the state, including 37% of rural residents, making implementation of the law one of the most consequential health issues facing the next governor.
Pennsylvania health advocates have warned that around 310,000 residents could lose coverage as a result of the new requirements or the inability to complete the required paperwork, while hospitals and other providers could face greater financial pressure or even closures. As many as 90,000 Philadelphia residents could be at risk of losing Medicaid, according to city health officials.
Shapiro opposed the changes, warning that they could cost Pennsylvania billions of dollars in federal aid, cause hundreds of thousands of people to lose insurance and threaten rural hospitals. He has joined litigation challenging the federal government’s implementation and directed his administration to help recipients navigate the new requirements.
Garrity supports the federal law and describes its Medicaid provisions as protections against fraud, waste and improper enrollment. Her campaign says she would cooperate with the Trump administration, strengthen provider screening, use data analysis to identify duplicate or impossible claims and require independent performance audits of Pennsylvania’s Medicaid programs. She argues that those measures would protect coverage for children, seniors, people with disabilities and low-income families who qualify for assistance.
Attorney General Dave Sunday, a Republican, has promoted a report by the U.S. Department of Health and Human Services that found Pennsylvania has the highest conviction rate for Medicaid fraud.
Abortion access
When the U.S. Supreme Court overturned Roe v. Wade by holding that the U.S. Constitution does not confer a right to abortion, they effectively left the legality of reproductive health up to the states.
Not much immediately changed for residents of Pennsylvania where current state law aligns with a standard similar to the tenets set by Roe. The state’s Abortion Control Act currently permits abortion before 24 weeks, though it is subject to waiting periods, consent requirements and other restrictions.
Additionally, the state’s Commonwealth Court has ruled that the state constitution protects reproductive autonomy, and the state Supreme Court previously ruled that the constitution’s Equal Rights Amendment protects abortion rights, based on principles of equal protection and privacy.
Anti-abortion activists have since sought to reverse direction on abortion and the two candidates are on opposing sides of the issue.
Shapiro supports preserving legal abortion in Pennsylvania and has promised to veto additional restrictions. He has also said he wants lawmakers to codify abortion rights into state law, making an affirmative right absolute.
Shapiro also declined to defend the Pennsylvania Abortion Control Act, which prohibited the use of Medicaid funds for most abortions when it was attacked in courts. He lauded the Commonwealth Court decision that struck it down, saying “a woman’s ability to access reproductive care should never be determined by her income.”
Garrity has long described herself as “100% pro-life” and praised the U.S. Supreme Court’s reversal of Roe v. Wade. As a candidate for governor, she has said she would respect current law and would not pursue a ban. Garrity criticized the Commonwealth Court ruling as “immoral” and called it “deeply concerning” that the governor did not defend it.
LGBTQ+ and transgender rights
The two candidates have staked out opposing sides when it comes to gender-affirming care and transgender rights, particularly in relation to women’s sports.
Shapiro has opposed efforts to restrict gender-affirming care and joined other states in challenging Trump administration actions that threatened federal funding for providers offering such treatment to young people.
Shapiro has said his administration will defend the rights of gay and transgender individuals and called supporters of a ban on transgender athletes “extremist,” saying politicians should not dictate students’ participation in sports.
Garrity has not included gender-affirming medical care on her platform, including whether she would restrict treatment for minors. However, she has attacked Shapiro’s positions saying “he’s not the moderate that he says.”
“He believes in biological males competing against our girls in sports,” she said.
Shapiro also supports adding sexual orientation and gender identity explicitly to Pennsylvania’s civil rights law through the Fairness Act, which has yet to pass despite several efforts led by Democrats. He reestablished the Governor’s Advisory Commission on LGBTQ Affairs and directed Pennsylvania’s 988 hotline to provide specialized assistance to LGBTQ callers after the federal government discontinued its service.
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