The 2020 election was supposed to be all about health care. Then 2020 happened. We check the latest polling on voters’ attitudes on health care this election season.

Click here for more of our coverage of health care and the 2020 election.

How the Role of Health Care in the 2020 Election Has Changed

A lot has happened since we first talked to Kaiser Family Foundation pollster Ashley Kirzinger in early February about the role health care was likely to play in the 2020 election. Ashley and her colleagues have been gauging voters’ attitudes throughout the year, and their latest polls show that much has changed.

1. Health Care No Longer Voters’ Top Issue

More than a quarter of voters at the start of the year ranked health care as their top issue. But after months of pandemic, economic hardship and protests for racial justice and against police violence, only 10% of voters still feel that way.

“Health care only has emerged as a top issue in elections when there aren’t other major crises in America,” Ashley says. “And unfortunately, in 2020, I feel like every day we have a new crisis.”

However, health care is still coming up on the campaign trail. According to analysis by the Wesleyan Media Project, about one-third of Biden ads and one-fourth of Trump ads are about health care.

2. Access Unseats Costs as Top Health Care Concern

Health care costs were the top health care concern of voters back in February at 24%, followed closely by increasing access at 22%. But with the coronavirus becoming a major concern and threatening health care access for millions who have lost their jobs, access has leapfrogged costs, although both have dropped as concerns over COVID-19 have grown.

“It makes complete sense in terms of how the coronavirus is affecting daily life in the U.S.,” Ashley says of the switch. “And we’re also seeing people putting off routine care, so they may not have as many or as high of health care costs as they did prior to the pandemic.”

3. ACA, Pre-Existing Conditions Back in the Spotlight

With the death of Supreme Court Justice Ruth Bader Ginsburg and the court set to hear arguments on the constitutionality of the Affordable Care Act a week after the election, the landmark health care law and especially its protections for people with pre-existing conditions are front and center again.

Democrats are hoping the possibility of a Trump appointee helping strike down the law could galvanize support, but it’s unclear from early polling whether that will be the case. But majorities of voters — including all-important swing voters — trust Joe Biden more on the ACA and protecting pre-existing conditions.

“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,” Ashley says.


Episode Transcript and Resources

Episode Transcript

Note: This transcript has been created with a combination of machine ears and human eyes. There may be small differences between this document and the audio version, which is one of many reasons we encourage you to listen to the episode!

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.

Episode Resources

Previous Episodes Featuring Ashley Kirzinger:

Other Select Research and Reporting:

Episode Credit

Guest:

  • Ashley Kirzinger, Associate Director of Public Opinion and Survey Research, Kaiser Family Foundation

Music composed by Ty Citerman, with additional music from Blue Dot Sessions

This episode was produced and mixed by Ryan Levi.

Ryan is the managing editor for Tradeoffs, helping lead the newsroom’s editorial strategy and guide its coverage on its flagship podcast, digital articles, newsletters and live events. Ryan spent six...