Inflation and the economy are the top concern of voters heading into the 2024 presidential election cycle, but health care remains among the top worrisome issues nationally.
On Jan. 17, 2024, the Bipartisan Policy Center and The Commonwealth Fund hosted the online forum “Health Care Policy in the Election Year.” Four policy analysts offered their interpretations of recent poll data about voters’ feelings, along with forecasts on what that will mean in November and beyond as the nation votes on the president.
Discussion lasted almost an hour with Robert Blendon, professor emeritus at Harvard University’s T.H. Chan School of Public Health; Jarrett Lewis, partner at Public Opinion Strategies; Chris Jennings, founder of Jennings Policy Strategies; and Sheila Burke, a strategic adviser for Baker Donelson.
Blendon and Lewis began with a presentation on polling data – some of it pessimistic or showing great partisan divisions. Jennings and Burke said they hoped to inject some optimism, while recognizing key issues in health care at the state and national levels.
Personal concerns
People right now are pessimistic about the future and thinking short-term. They have little interest in President Joe Biden’s policies that go into effect in 2026 or 2028, but great interest in what’s happening to their families, Blendon said.
Under health care, about 28% to 30% of voters define abortion as a personal issue, meaning they cannot vote for a candidate who does not share their views, he said. Opioids and fentanyl overdoses are a top concern in health care, surpassing cancer, Blendon said.
In the last five years, the country has moved further apart and become incredibly polarized, with sets of values setting apart the Republican and Democratic parties, Blendon said. For example, Republican voters think the federal government is overspending, contributing to inflation, but Democratic voters think the federal government needs to spend more to solve inflation.
Public health and epidemics long were generally were nonpolitical, but now public trust in public health institutions is rock bottom for Republican voters, while Democratic voters still have confidence in public health. Republican voters don’t want to repeal the Affordable Care Act, but they do want to repeal it, while Democratic voters want to enlarge it, Blendon said.
A pandemic of pessimism
American voters are living in the longest sustained period of pessimism that’s been measured. The last time a plurality or majority of Americans thought things were going in the right direction in the country was in January 2004, Lewis said. Now, 66% of Americans have a pessimistic view of the economy, a figure worse than in the Great Recession, he said.
For health care, voters are “exasperated” by costs. Almost 40% of Americans have skipped or delayed care in the last year because of costs, and more than 40% say they are extremely or very worried that one illness, accident or medical event will pull them into bankruptcy, Lewis said.
Belief in excellent or good health care quality is at 48%, the first time below 50% in 20 year of tracking; historically it was in the 50s or low 60s for percentage points. A full 55% of people disagree with the statement that the U.S. health care system offers good value for the costs, and more than 75% say the U.S. health care system is in a state of crisis or has major problems, Lewis said.
Agreeing to agree
Blendon and Lewis noted two areas of agreement about national issues.
Medicare is the second most popular program among Republican and Democratic voters. The program has financial problems that need addressing, but candidates who speak up about cutting it must confront an “incredibly popular issue,” Blendon said.
There is strong bipartisan agreement on a mental health crisis in the nation, “and something needs to be done in a dramatic way,” Lewis said. The opioid crisis is part of the mental and behavioral health crisis, and both parties agree they must act on that, he said.
Voter motivation
In health care and other issues, voters become motivated when they think something they value is going to be taken away from them. “That’s why abortion has become a very motivating issue,” Jennings said. He predicted it will be “front and center” on the campaign trail this year.
The cost and complexity of health care is a huge issue across the board. The Biden administration has promoted prescription drug price reforms and voters can expect more of that from his campaign, Jennings said.
Former President Donald J. Trump has suggested repealing and replacing Obamacare, so expect Democrats to use that in campaigns to motivate voters, Jennings said.
“There are very, very significant motivating issues that will drive voters and I think in the end of the day, when you really compare the two candidates and their threat of taking away things that people value, Joe Biden will do very well,” he said.
Jennings suggested Medicaid spending could become a target if Washington is split or dominated by Republicans.
Government’s role in health care
Right now, voters deal with personal issues in health care – cost, complexity, inability to navigate the system, time and ability to access care. There are unique issues affecting rural areas, Burke said.
There also is a huge national issue: the distribution of responsibility between the federal government and state government in terms of the provision of services, and quality and access, she said. An example was states choosing not to expand Medicaid services.
Another issue is the increasing maternal death rate and risk of mortality, particularly among communities of color, and that has state-level implications, Burke said. And another issue is the Trump administration raising questions about the role of government in dealing with a public health emergency, with diminishing support for public health activities at the state level, she said.
“I think we can look at health care as just the obvious programs, public health service programs, Medicare, Medicaid. We need to look across the board and the government’s responsibility for lots of elements that have an impact,” Burke said.
The discussion included introductions by Marilyn Serafini, executive director of the Bipartisan Policy Center, and Rachel Nuzum, senior vice president of The Commonwealth Fund, and was moderated by Alice Ollstein, health care reporter for Politico.