Dan Gorenstein: The 2020 race was supposed to be all about health care.

News clip montage

Then, 2020 happened. 

Today we check in with Kaiser Family Foundation pollster Ashley Kirzinger on the role health care is playing this election.

From the Annenberg Studio at the University of Pennsylvania, I’m Dan Gorenstein, and this is Tradeoffs.

DG: Ashley Kirzinger, it is the third time we’ve had you on the program, I’m very happy to say. The first was back in February, just after the Iowa caucuses. I still remember sitting with you in Washington, D.C., and this is what you told us.

Ashley Kirzinger: Voters are telling us right now that health care is their top issue in the election.

DG: So a lot has happened since then. An unbelievable amount, actually. And you’ve been polling the whole time. Is health care still the top issue for voters?

AK: So in our latest tracking poll, which we released earlier this month and before the passing of Supreme Court Justice Ginsburg, we found that health care has dropped from the top issue, now being ranked fifth in importance among voters. It’s behind the economy, the coronavirus outbreak, criminal justice and policing, and race relations. But this doesn’t mean that we’re not still hearing about health care on the campaign trail. The Wesleyan Media Project, which collects data on all campaign advertisements throughout every election cycle, has found that one third of Biden advertisements are actually about health care.

Biden ad: We need a president who will protect our health care. And that’s Joe Biden.

AK: As are one fourth of Trump campaign ads. 

Trump ad: President Trump is expanding health care and access and bringing down costs. 

AK: Health care policy is also one of the top issues featured in all pro-Democratic Senate ads. So voters are less likely to tell us that health care is their top issue to their vote. But it’s still playing a role in the 2020 election.

DG: And staying on this track for a second, we asked you back in February, what about health care was the most pressing for voters? And this is what you said there.

AK: It really is about their health care costs. It’s those out-of-pocket costs, whether it’s their deductibles or their co-pays.

DG: Has COVID-19 actually changed priorities at all? Does cost continue to be the big issue?

AK: Back in February, 24% of voters told us that health care costs was their top health care issue. That has now dropped to 15%. So now we’re seeing a larger share of voters saying improving access to health care in the face of a global pandemic is their top health care issue rather than just health care costs.

DG: Overall, Ashley, are you surprised that health care has been jumped by all these other issues, issues around policing and racial justice, the economy and the pandemic?

AK: It makes complete sense to me that health care is no longer top of mind for voters. So health care only has emerged as a top issue in elections when there aren’t other major crises in America. And unfortunately, in 2020, I feel like every day we have a new crisis.

DG: Speaking of crises, there’s now the issue of replacing Ruth Bader Ginsburg. 

News clip: Tonight NBC News has learned President Trump has decided to select federal judge Amy Coney Barrett to succeed Ruth Bader Ginsburg.

DG: Former Vice President Joe Biden and Democrats are framing this vacancy as a battle over health care, in particular the future of the Affordable Care Act. 

Biden: This is about whether or not the ACA will exist. This is about whether or not pre-existing conditions will continue to be covered.

DG: Do you think that’s going to be an effective strategy for Democrats, Ashley?

AK: If we think back to 2018, it was really effective for Democrats to be running as the party that was going to protect the Affordable Care Act and pre-existing conditions. And so I think the increased attention on the ACA Supreme Court case allows Democrats to talk about health care in a way that they are very comfortable with and in a way that voters give them the advantage. 

DG: And to that point, and perhaps it’s early to try to answer this question, Ashley, but are there any polls since the passing of Ruth Bader Ginsburg that suggest that it could drive turnout?

AK: So there was a recent poll by ABC News and Washington Post that found that 64% of Biden voters said that the court vacancy made it more important that he win the election compared to only about a third of Trump voters. I imagine this just another one of many reasons why Biden voters would say it’s important for President Trump to lose reelection.

DG: With the ACA potentially in real jeopardy, what do we know about who voters trust to protect people with pre-existing conditions?

AK: As you can probably expect, a majority of Democratic voters say that they trust Biden and a majority of Republicans, 84% of Republicans say that they trust President Trump to do a better job. But when we look at voters overall, especially swing voters, those that haven’t made up their minds, 54% say they trust Biden, compared to only 24% of swing voters who say they trust Trump on this issue.

DG: Why are pre-existing conditions so important to so many people? Like the Affordable Care Act is political. But protections for people with pre-existing conditions, which the Affordable Care Act provides, is not political. Can you explain that to us?

AK: First, it’s important to note that the connection between the ACA and these protections is less…

DG: People don’t get it.

AK: Yeah, people don’t understand that they’re getting these protections because of the ACA. And so we’ve actually seen a decrease in awareness that the ACA is the legislation that maintains these protections for people with pre-existing conditions over time. And then 57% of Americans say either they or someone in their household has a pre-existing condition. So it makes sense that it’s not viewed through the same partisan lens because it affects such large shares of Democrats, independents and Republicans.

DG: Final question, Ashley. Let’s assume that the Affordable Care Act is not struck down and voters over the final weeks continue to prioritize all these other topics over health care. What will that potentially mean for health policy under the next administration, regardless of who is elected?

AK: Major health care legislation in this country is not an easy task. And the last two presidents that took it on, their party was defeated in the midterm elections two years later. And we also know that if health care reform doesn’t occur early in a presidency, the likelihood of it getting done is very small. So if health care, as you say, continues to be a second tier issue, ranked fifth, there will be very little pressure on either candidate to actually take on the issue of health care costs. I think that means that in four years, we will probably still be having very similar conversations about health care costs in this country.

DG: Ashley Kirzinger, thanks so much for taking the time to talk to us on Tradeoffs. 

AK: It’s always a pleasure.

DG: If you’re listening to this on the day it drops, Tuesday, Sept. 29, we’ll be hearing tonight directly from the candidates about the Supreme Court, the coronavirus and more in the first presidential debate.

I’ll be live tweeting and would love for you to follow along and ask questions throughout. You can find me @dmgorenstein and the show is @tradeoffspod.

I’m Dan Gorenstein, and this is Tradeoffs.