Health care has faded into the background of the election campaign as Donald Trump himself has become the issue on the Republican side and the debate between Hillary Clinton and Bernie Sanders over health care has shifted to other topics. Health wasn’t even listed among the “most important issues” Republican voters could select from in the exit poll of Tuesday’s Wisconsin primary. But that doesn’t mean health is a total non-factor in the primaries; it is a more salient issue for some voting groups than others. And a broad constellation of health issues, not only the Affordable Care Act, are likely to have traction in the general election, particularly among women.
Health has traditionally been more of a priority for Democrats. The chart above shows that, although Republican candidates are all-in for repealing Obamacare, health care is a bigger voting issue for Democrats. Health ranked first as an “extremely important” voting issue for Democrats and fourth for Republicans in the Kaiser Family Foundation’s Health Tracking Poll in March. This doesn’t mean that health will be the No. 1 or No. 4 factor when Democrats and Republicans vote in November. As the chart also shows, issue priorities are closely bunched, and my experience has been that voters cast ballots in presidential elections on the basis of their overall views of the candidates rather than candidates’ specific positions on issues.
When people say health care is an extremely important voting issue, they aren’t always thinking of the ACA. Among Republicans who say health is “extremely important” to their vote, about equal shares are thinking about the ACA as are thinking about issues such as access to care and health-care costs. Nor are Democrats always intending to support the ACA when they cite health as a voting issue. They are more likely to cite improving access or addressing costs generally as their reason for naming health a top voting issue.
Some demographics appear to care more about health as a voting issue than other groups do. Among registered voters, 35% of women who are independents say health will be “extremely important” to their vote, compared with 26% of men who are independents. Among Republicans the gender gap is a little wider, with 44% of women and 28% of men saying health care is extremely important to their vote.
It’s likely that the gender gap on health as a voting issue will carry over to the general election, with women forming the bloc of voters who feel strongest about health-care issues. Rising out-of-pocket costs and drug prices, reproductive health issues, opioid abuse, and other health concerns will join the ACA to form what is becoming a more multifaceted health agenda. And if big differences emerge between the Democratic and Republican candidates on Medicare, that always has the potential to drown out other health issues and activate senior voters.