The aim of this article is to examine trends of democratic backsliding associated with the long standing reform work on regional institutions and policies in Sweden. To this end, democratic backsliding is conceptualized in a different manner compared to conventional understandings. By doing so, the article highlights a missing aspect in the research on democratic backsliding that concerns how well-intended reforms designed to strengthen democratic institutions can also harbor non-democratic consequences. In Sweden, a new political arena was created when the former county councils were transformed into so-called called regions in 2019. As part of this, the regions have been assigned responsibility for both health care and regional developmen...