US health care expenditures represent a substantial portion of public spending and are therefore likely to be affected by partisan political control. At the federal level, for example, the budget for and organization of health care were heavily debated by Republicans and Democrats during the enactment of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act in 2010 as well as the American Health Care Act of 2017. The health care budget is debated

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... only at the federal level but also at the state level, which results in considerable variation across the United States. 1 At the state level, the Medicaid budget competes with other state spending priorities, such as education, pensions, and welfare. At 27.4% of total state spending, Medicaid represents the largest single component of total state expenditures 2 and constitutes a 30.7% share of nursing homes' (NH) revenues. 3 e aim of this study was to improve the understanding of the impact of political control on US NHs. We empirically assess how political control of the state legislature and of the state governorship affects the financial performance, the staff structure, the resident composition, and selected resident outcomes at the facility level. The findings of this empirical analysis may shed some light on the debate on political control and its impact on the real world. The study closes the gap between studies exploring the effect of political control on