Brodie M, Kirzinger A. Tracking the Role of Health Care in the 2020 Election—What Do the Polls Tell Us? JAMA Health Forum. Published online February 28, 2020. doi:10.1001/jamahealthforum.2020.0253
With 3 state electoral contests completed in the 2020 presidential election campaign, a consistent message from Democratic voters is that health care is an important issue when deciding their vote. Exit polling from Iowa, New Hampshire, and Nevada found that health care was the dominant issue for Democratic primary voters and caucus-goers. An analysis of AP VoteCast data found health care was among the top issues for all New Hampshire primary voters, regardless of which candidate they prefer.
These results are consistent with the latest national polling from the Kaiser Family Foundation (KFF), which found that Democratic and independent voters rank health care at the top of their list of issues for the 2020 presidential campaign. More than one-third (36%) of Democratic voters and 30% of independent voters say health care is the most important issue in their 2020 vote. Health care ranks lower for Republican voters (12%), who prioritized the economy (34%), immigration (19%), and foreign policy (17%). However, with 26% of all voters prioritizing health care over any other issue and with Republican and Democratic candidates believing that health care plays well with their respective bases, candidates from both parties will be talking a lot about health care over the next 8 months. What can we expect to hear about health care during the campaign?
The health issue that has dominated the Democratic primary is the divide between candidates advocating Medicare for all and those supporting a public option. The focus on Medicare for all has largely come from Senator Bernie Sanders, who has made the push for a single-payer health insurance program a touchstone of his primary campaign. The Kaiser Family Foundation has been tracking the public’s view on a national single-payer plan since 1998 and recently found that slightly more than half of Americans favor such a proposal, a share that has grown to a majority since the 2016 election. However, while this type of plan garners support among 7 in 10 Democratic voters and approximately 4 in 10 independent voters, few Republican voters (17%) favor it.
Attitudes toward Medicare for all are also extremely malleable. While a slight majority may favor the idea, levels of public support vary dramatically when people hear arguments commonly made by supporters and opponents of Medicare for all. For example, opposition can go as high as 58% if people hear that a national health plan would eliminate private health insurance companies or as low as 27% if they hear that it would guarantee health insurance as a right for all Americans. Other, more incremental, changes to the current health insurance system garner higher levels of support. For example, the February 2020 KFF Health Tracking Poll found that 66% of voters favor a government-administered public option, including most Democratic (82%) and independent (69%) voters and nearly half of Republican voters (44%).
The divide between a national Medicare for all plan and a government-administered public option illustrates the chasm between the more progressive and moderate wings of the Democratic Party. The question remains how Medicare for all would play in the general election. Among swing voters (ie, those who have not yet decided whether to vote for President Trump or the Democratic nominee), 49% prefer a government-administered public option while only 25% prefer a national Medicare for all plan. For Republican candidates, framing Medicare for all as a government takeover of health care works well to motivate their base, so President Trump is likely to equate any plan to expand public health insurance programs with socialism throughout the campaign.
Beyond Medicare for all, the costs of health care and the future of the Patient Protection and Affordable Care Act (ACA) also loom large for voters, with 55% of the public now favoring the ACA—marking the highest overall favorability recorded since KFF began tracking opinions on the law in April 2010—and 37% of Americans viewing the law unfavorably. The ACA’s protections for people with preexisting medical conditions were a dominant issue in the 2018 midterm election, with Democratic candidates benefiting from a backlash against Republican efforts to repeal the ACA and the potential loss of these protections. However, Republican candidates, including President Trump, are now eager to position themselves as defenders of these protections. While Texas v. United States, a federal case seeking to invalidate the ACA, will not be decided by the Supreme Court this year, the future of the ACA will definitely be debated in the 2020 campaign. Additionally, voters repeatedly told us what they really care about is the cost of health care, with one-fourth of Democratic, independent, and Republicans voters saying that is the top health care issue to their vote.
While health care has been a prominent focus of the 2020 election cycle so far, only 8% of voters identified health care as the issue that would motivate them to vote in 2020. Many more voters said the issue that will motivate them to vote in 2020 is defeating President Trump (20%), while about 1 in 10 voters said making sure he gets reelected is their top motivation. Especially for Democratic voters, it is more important that the candidate has the best chance to defeat President Trump (59%) than that the candidate agrees with their views on the issues (39%).
Regardless of who is the eventual Democratic nominee, one point is certain: as the campaign unfolds, candidates will continue to talk about health care, whether trying to convince voters they have a plan that can win in the general election or to show they understand and care about the strain that health care costs are placing on families. Even if health care is not the deciding factor for most voters, we expect to hear a lot about it from candidates over the next 8 months.
Open Access: This is an open access article distributed under the terms of the CC-BY License.
Corresponding Author: Mollyann Brodie, PhD, Kaiser Family Foundation, 185 Berry St, Ste 2000, San Francisco, CA 94107 (firstname.lastname@example.org).
Conflict of Interest Disclosures: None reported.
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