Insights^

Polls take up a lot of time in the coverage of any given election cycle. These polls often focus on the candidates for office themselves. However, issue-based polling gives insight into what voters care about and teaches candidates what issues to focus on in their campaigns. This blog post will look at 2024 Election Polling related to health care issues.

Specifically, we look at an issue-based poll from the Kaiser Family Foundation conducted between October 31, 2023, and November 7, 2023. Respondents to this poll labeled multiple health care issues as very important for presidential candidates to discuss. However, smaller percentages of respondents ranked these issues as the most important. This blog post explores the poll’s findings about these issues and examines the implications of this poll for the 2024 election.

Voters Want Candidates to talk about Health Care

The KFF poll provides evidence that voters care about health care issues.

• 80% of respondents to the poll said that it is very important for 2024 presidential candidates to talk about the affordability of health care. A February 2024 KFF poll found the same percentage of respondents agreeing that it is very important for 2024 presidential candidates to talk about this issue.
• 75% said it is very important for candidates to discuss the future of Medicare and Medicaid. The February 2024 KFF Poll found 73% of respondents said this is a very important issue for 2024 presidential candidates to talk about.
• 70% said access to mental health care is an issue that is very important for candidates to talk about.
• 64% said prescription drug costs is an issue that is very important for candidates to talk about.
• 53% said the opioid crisis is a very important issue for candidates to talk about.
• 52% said abortion is a very important issue for candidates to talk about. Respondents also identified other health care issues as very important for candidates to talk about, even if smaller percentages of respondents answered in the affirmative.
• 49% said the future of the Affordable Care Act (ACA) is a very important issue for candidates to talk about.
• 22% said COVID-10 is a very important issue for candidates to talk about.

But Smaller Percentages of Respondents Pick Health Care Issues as Most Important

The KFF poll also asked respondents to identify their most important issue. Respondents asked to pick a most important issue picked a health care issue at much lower rates than non-health care issues.

• Only 8% of respondents said the affordability of health care is most important.
• 6% said the future of Medicare and Medicaid is most important.
• 4% chose abortion as the most important issue.
• 3% picked access to mental health care as the most important issue. Only 1% selected prescription drug prices, the opioid crisis, or the future of the ACA as the most important issue.
• 0% named COVID-19 as the most important issue.

So What’s the Punchline?

The poll shows evidence that the American people care about health care issues, but when asked to name their most important issue, significantly smaller percentages of respondents choose a health care issue.

What This 2024 Election Polling Mean for Candidates

General topics, such as the affordability of health care and the future of Medicare and Medicaid, outrank more specific health care issues, such as prescription drug costs and access to mental health care. Additionally, campaigns need to remember that the race to the White House occurs at that state level. Campaigns looking to maximize message success can look for ways to personalize their messages to meet the specific constituencies in each state they are competing in. The KFF poll provides guidance on how to do this. For example, The KFF poll shows the future of Medicare and Medicaid is the most important health care issue for registered voters 65 years of age and older. This finding supports spending more time on this issue in states where more registered voters are 65 years or older. This type of analysis is a key step for campaigns wanting to ensure their health care platforms are helping propel them to victory.

Inflation.  Baby formula.  Gun control.  Countless important issues are at the top of voters’ minds as the midterm election approaches.  However, unlike previous election years, many voters aren’t saying health care is the most important issue to them.  How does health care stack up against a plethora of other important issues this year, and what could change in the coming months to bring health care to the forefront of the national conversation?

What the Polls Tell Us

According to a Kaiser Family Foundation (KFF) poll conducted in March 2022, health doesn’t appear to be a leading issue among voters.  When asked to name what they think will be the most important factor when voting for the 2022 midterm election, 37% of voters cited the economy, inflation, and rising prices.  Other issues mentioned by voters include climate change (4%), crime (3%), the Russian invasion into Ukraine (3%), and the COVID-19 pandemic (2%).

With inflation having reached a 30-year high of 8.5% in April 2022, it shouldn’t be surprising that voters are naming economic-related issues as their top concern.  However, what’s unusual about the 2022 polling is that compared to previous election years, health care isn’t even close to being a top issue for voters.

In October 2020, for example, 12% of voters told KFF that health care is their top issue, making it the fourth most-cited issue.  Meanwhile, the economy was a top issue for 29% of voters, while the COVID-19 pandemic and public safety each respectively garnered 18% and 13%.

Health care was even more important to voters in 2018, a midterm election year that saw Democrats regain control of the House after flipping 41 seats.   That year, 26% of respondents told KFF that health care was their top issue, placing it third on the list of topics important to voters.  Corruption in Washington came in first place with 32%, while the economy and jobs came in second with 27%.

Even though voters might not cite health care as a top concern now, several factors could change in the coming months that could make health care top of mind for voters come November.

• Expiration of enhanced ACA premium tax credits.  The American Rescue Plan Act of 2021 increased Premium Tax Credits (PTCs) for Marketplace insurance coverage and extended eligibility for PTCs to more individuals, making health insurance more affordable for millions in America. However, those ACA premium subsidies expire at the end of the year, and if Congress fails to renew them, 13 million Americans will start 2023 with higher insurance premiums that they may not be able to afford.  Importantly, those impacted would start receiving notices about their premium increases in October, just a month before they’re set to vote in the midterm election.  Furthermore, higher insurance premiums would make consumers less likely to receive care, potentially resulting in a combined $5.1 billion decline in spending on hospitals and physician practice services.   Democratic lawmakers that face difficult midterm races are already sounding the alarm, it remains unclear if the Senate can pass any type of legislation before the election that includes a renewal of the ACA premium subsidies.
• Higher Medicare Part B premiums.  The Medicare Part B base premium increased by 14.5% from $148.50 a month to $170.0 a month in 2022.  On top of this, the annual deductible for all Part B beneficiaries increased from $203 in 2021 to $233 in 2022.  When the Biden administration finalized Part B premiums and deductibles in November 2021, inflation for the upcoming year wasn’t anticipated to be much different from the usual level of 2%.  However, with inflation currently hovering above 8%, higher Part B premiums are especially difficult for seniors to absorb, and continued higher-than-average inflation over the coming months could make health care costs a more important issue for seniors.
• End of public health emergency (PHE).  The administration has repeatedly pledged to provide 60 days’ notice before letting the PHE expire.  The end date for the current PHE is July 16, 2022, and since the administration declined to say in mid-May that it will let the PHE expire, it is all but certain that come mid-summer, the PHE will be extended through October 2022 – less than a month before the midterm election on November 8.  The end of the PHE would immediately trigger a 151-day period for temporary Medicare telehealth waivers to unwind and a 365-period for states to initiate redetermination of Medicaid eligibility for all Medicaid enrollees.  While the end of telehealth waivers and loss of Medicaid coverage for certain individuals wouldn’t occur until long after Election Day, starting the countdown less than a month before voters cast their ballots could cause some voters to consider health care as an important issue.   However, due to the potential political implications of ending the PHE in October, it seems safe to assume that the administration will ensure the PHE remains in place until after the midterm election.

Inflation, foreign conflicts, and public safety are likely to continue to dominate voters’ thinking as the 2022 campaign season continues.  However, a loss of ACA premiums subsidies, pressure from high Part B premiums, and the end of the PHE all have the potential to change the calculus for some voters as they decide who to cast their ballots for on November 8.

Republicans are favored to do well in the 2022 midterm elections – after all, the party that occupies the White House historically almost always loses seats in Congress.  But Republicans don’t just want to rely on tried-and-true historical trends to win more seat this fall.  Instead, they’re focused on replicating a strategy that delivered better-than-expected gains for 2020 – supporting female candidates for congressional seats.

The 2018 midterms marked a low point for female Republican lawmakers, especially in the House.  That year, the number of GOP women holding House seats declined from 23 to 13 – which was the same number of Republican women serving in the House in 1989.  In contrast, 2018 saw 36 new Democratic women elected to the House.

To reverse the trend, Republicans adopted a new strategy: support GOP women running at the primary level.  Numerous organizations and political action committees (PACs) like Republican Women for Progress, Elevate PAC, Winning for Women, VIEW PAC, and Elise Stefanik’s E-PAC stepped up to offer their support, based on how the Democrats used Emily’s List to back their female candidates.  Additionally, more GOP women opted to run in 2020, probably in reaction to Democrats’ success in 2018.

Issues matter, too.  With more and more college-educated men and women increasingly voting for Democratic candidates, many of the Republican women who ran for Congress in 2020 focused less on typical pro-business, main street policies that typically won over moderate voters.  Instead, they focused more on issues related to gun control and abortion that are more popular with the Republican Party’s base.

The new strategy paid off.  The number of GOP lawmakers in the House rose from 23 to 38 in the House after November 2020, beating the previous record high of female Republican representatives of 30.  In contrast, the number of Democratic female lawmakers grew from 89 to 106.  More so, every Republican who flipped a Democratic House district in 2020 was a woman or person of color.  There are now 144 women who are  members of the 117^th Congress, compared to 127 in the 116^th Congress

Based on the GOP’s success in 2020, the Republican Party is now trying to replicate its strategy of supporting female candidates to regain control of Congress this November.  According to the National Republican Congressional Committee, a record high number of 253 female Republicans have filed to run for House seats, with key recruits in competitive districts like Monica De La Cruz (Texas), Esther Joy King (Illinois), and Jen Kiggans (Virginia).  Additionally, Republicans are also keen on keeping female freshman of the 117^th Congress in their seats.

There are many factors that will affect the midterm elections, like the state of the economy and President Biden’s approval ratings.  However, given historical trends favoring Republicans and the success of Republican women in the 2020 elections, the GOP may have found a winning combination to ensure success in 2022.  And with the Senate split 50-50 and Democrats only having a five-seat majority in the House, it won’t take much for a record high number of female Republican candidates to move the needle and shake up Congress this fall.

Welcome to primary season.  The 2022 midterm primaries officially kicks off today in Texas, where polls are open until 10pm local time this evening.  For those curious about how the primary season will unfold, Texas is the state to watch.  That’s because the results of these races could provide some clues on how some major trends could play out in the upcoming midterms and provide insight on how voters view the political parties.

How Much Influence Does Trump Have Over the GOP?

Ever since Donald Trump’s defeat in the 2020 presidential election, pundits have wondered how much loyalty to Donald Trump will matter to Republican candidates and voters going forward.  Polls have indicated that the former president’s hold on GOP voters is waning – a January 2021 poll found Republican voters were evenly split on whether they considered themselves supporters of Trump or the Republican Party, while a January 2022 found a majority of Republicans said they support the party and not Trump.

In Republican primary races across the nation, pro-Trump candidates are facing off against candidates who signal a stronger loyalty to the GOP, and one Texas race could preview which camp might fare better in the 2022 Republican primaries.

Back in 2020, Rep. Van Taylor (R-TX) won his district comprising the norther suburbs of Dallas by a comfortable margin.  At the same time, Trump only narrowly won against Biden in what is officially the 3^rd Congressional District of Texas.  But a lot has changed since November 2020.  A few months later, Taylor became one of 35 House Republicans to vote for an independent commission to investigate the January 6^th riot at the US Capitol.  Since then, supporters of the former president have criticized this group of Republicans for their lack of loyalty to Trump.  

While Taylor did not go as far as to vote to impeach the former president last year, his vote in support of the January 6^th commission still leaves him vulnerable to GOP challengers in the March 1 primary.  While Trump has not endorsed any of Taylor’s challengers, the Texas congressman still faces a few tough opponents, including former Collin County Judge Keith Self and Suzanne Harp, the mother of Rep. Madison Cawthorn’s (R-NC) chief of staff.  How Taylor fares in the March 1 primary could portent the fate of other Republican incumbents who’ve drawn the ire of the party’s pro-Trump faction.

How Will Progressives Fare against Centrists in the Democratic Primaries?

In Democratic primaries across the country, voters are deciding over with whether to support centrist incumbents   or support progressives who are more aligned with the party’s liberal policies.    This battle will be played out on March 1 in the Democratic primary for the 28^th Congressional District, which runs from San Antonio to the Rio Grande River.  In 2020, incumbent Rep. Henry Cuellar (D-TX) defeated progressive primary challenger Jessica Cisneros by just four points.

Since the last election, congressional districts in Texas have been redrawn, and the 28^th District is now more left leaning than in the previous decade.  In 2022, Cisneros is once again challenging Cuellar for his seat, and this time, she’s secured endorsements from fellow progressives Rep. Alexandria Ocasio-Cortez (D-NY) and Sen. Bernie Sanders (I-VT).  Adding interest to the race is the fact that Cuellar’s residence and campaign office were raided by the FBI a few weeks ago.

Since the redrawn 28^th District is more favorable to Democrats this time around, Cisneros could, in theory, have an advantage on ideological grounds.  However, Mexican-American voters who dominate the Democratic electorate there aren’t particularly warm to progressive ideas, the 2022 Democratic primary for the 28^th District is looking just as competitive as it was in 2020.

How Will New Voting Laws Affect Turnout?

Since the 2020 election, 19 mostly GOP-controlled states like Georgia and Kansas enacted new laws to restrict voting.  States were able to do this thanks to the Supreme Court’s 2013 ruling in Shelby County v. Holder, which struck down an important provision of the Voting Rights Act.  In Texas, new voting laws include ID requirements and limit voting hours from 6am to 10pm local time.

These new laws might suppress turnout, but the impact is likely to be minimal.  That’s because historically, voter turnout in Texas primary elections is low, as less than 20% of registered voters participate in midterm primaries most years.  Early voting for 2022 in Texas started already on February 14, and results show lower than average turnout so far, although early voting numbers the counties report to the state do not include mail-in ballots.   And traditionally, early voting has not been a good indicator of overall turnout in Texas.   This means we may not know the full impact of new voting laws in Texas until this November’s midterm election.