Democrats captured both chambers of Congress, while Missouri Democrats gained 16 seats in the state House and two in the state Senate, ending Republican supermajorities.

In Missouri, voters also rejected a Trump-backed redistricting plan and a proposed abortion ban, and Democrat Fred Wellman defeated Republican U.S. Rep. Ann Wagner.

Calling the election result shocking and historic, Hawley urged Christians to gather at the U.S. Capitol on Dec. 15 for an hour of fasting and prayer.

Hawley said Republicans lost because they had abandoned working people, poor and needy people, and pro-life voters, citing Medicaid and rural hospital funding cuts alongside other spending and rising costs.

As Republicans debated whether to delay their leadership election to assess the losses, Hawley declined to commit his vote to the current Senate leadership; Ron Johnson and Dave McCormick called for postponement, while John Thune said the vote should proceed.

In July 2025, Hawley voted for President Donald Trump’s tax and spending law, which the Congressional Budget Office estimated would cut federal Medicaid spending by nearly $1 trillion over 10 years; the Senate passed the measure on a tie broken by Vice President JD Vance.

Before voting for the law, Hawley had called its Medicaid cuts “morally wrong and politically suicidal,” but said he supported the final version after it added a $50 billion rural health fund and delayed some reductions, while pledging to oppose the remaining cuts.

Two weeks later, Hawley introduced a bill to reverse some Medicaid reductions and increase the rural health fund to $100 billion, but it was referred to the Senate Finance Committee and had not advanced.