WASHINGTON, DC Education and health care top the list of issues voters say will be on their minds when they cast their ballots in the 2000 election, with education cited as a top issue by 29% of registered voters and health care by 28%, according to a new national survey conducted by researchers at the Kaiser Family Foundation and the Harvard School of Public Health.

A plurality (36%) of registered voters say that the candidates stands on the issues will be the most important factor in deciding which presidential candidate they will vote for, but nearly half of registered voters say the candidates leadership abilities (24%) and character and moral values (24%) will be most important to their vote.

"Health care issues will not decide the 2000 elections, but they could be a critical factor in races that are close," said Drew E. Altman, Ph.D., president of the Kaiser Family Foundation.

Health care will be especially important in capturing the women's vote, because registered voters who pick health care as a top issue are much more likely to be women (61%) than men (39%).

The survey identified two distinct groups of "health care voters." About two-thirds of registered voters who picked health care as a top concern were focused on issues such as health care costs, the uninsured, and patients rights. They tended to be registered voters under 50 years of age. About one-third of registered voters who picked health care as a top issue were focused on Medicare and they were disproportionately older voters.

"For ?health care voters the year 2000 election is not about a single issue," said Robert J. Blendon, professor at the Harvard School of Public Health. "Rather, their vote revolves around candidates stands on getting the uninsured coverage, making Medicare financially sound, providing coverage of prescription drugs for seniors, and protecting consumers rights in HMOs and other managed care plans."

Proposals made by presidential candidates to make use of the federal budget surplus have been a hot issue in the presidential campaign. Overall, registered voters say making the Social Security system financially sound is "a top priority" for the use of the surplus (picked by 63%), followed by increasing spending to improve public schools (57%), and providing prescription drug coverage under Medicare and making Medicare financially sound (tied at 54%). However, there were differences between Democratic and Republican registered voters on the question of using the surplus. Top priorities for using the surplus among Republican registered voters were Social Security (picked by 59%), and cutting taxes (52%). Social Security and improving the public schools tied for first among Democratic registered voters (68%), followed by providing prescription drug coverage for the elderly (63%), and making Medicare financially sound (62%).

Overall, health care is a bigger issue for Democratic than Republican registered voters. For example, there is a 23 percentage point gap between Democratic and Republican registered voters who name providing health insurance to the uninsured as a top priority for using the surplus (56% versus 33%).

Overall, this early in the election campaign, registered voters feelings about which candidates would best handle health care issues seem to reflect the candidates general standing in the polls: Governor George W. Bush is picked by the most people (28%) as the best candidate to handle health care issues, followed by Vice President Al Gore (21%), former Senator Bill Bradley (12%) and Senator John McCain (7%).

Health care has been a major point of debate between the Democratic presidential candidates. Among Democratic registered voters, Vice President Gore leads former Senator Bradley on "who would do the better job handling health care issues" (47% choose Gore, 23% choose Bradley). However, Democratic registered voters are unclear about the differences between the two candidates plans and these rankings of the candidates on health do not appear to represent a verdict on their respective health care proposals. For example, despite the fact that Vice President Gore has criticized Senator Bradley s proposal as too costly, and Senator Bradley has criticized the Gore plan as too modest, more Democratic registered voters say the Gore plan would cover more people than the Bradley plan (31% to 14%), and slightly more say Gore s plan would be more costly (23% to 19%). About half of Democratic registered voters say they don't know enough to say.

"While the press and policy people have focused on the differences between the Gore and Bradley health care proposals, the public has yet to tune in," said Drew Altman.

In general, the survey found that registered voters care a great deal about a number of hotly debated health care issues, but, with the possible exception of patients rights, reach no consensus about solutions to these problems.

• Covering the Uninsured. Forty-three percent (43%) of registered voters favored making "a limited effort to provide health insurance for some of the uninsured which would not require a tax increase," 39% favored "making a major effort to expand health insurance for nearly all uninsured Americans which would require a tax increase," and 12% favor "keeping things the way they are now." "Health care voters" (52%) and Democratic registered voters (51%) are more likely to favor making "a major effort," whereas, Republican registered voters (47%) are most likely to favor making "a limited effort."

• Medicare. The Medicare issue in the election consists of two parts: making the program financially solvent and providing coverage for prescription medicines for seniors. While both registered voters as a whole and "health care voters" consider it important to keep the Medicare program financially solvent, they are split on whether Medicare needs a major restructuring. Nearly half of registered voters (47%) and nearly half of "health care voters" (46%) favor only relatively minor changes, while 44% of registered voters and 45% of "health care voters" say major changes are needed.

• Patients Rights. More consensus emerged on the issue of patients rights, even though, after nearly two years of debate, voters have decided that a Patients Bill of Rights would raise the cost of their premiums. About two-thirds of registered voters (65%) and of "health care voters" (65%) think health insurance premiums for people like them would go up if patient protections were enacted. But only four in ten (37%) think their premiums would go up a lot.

The Kaiser Family Foundation/Harvard School of Public Health National Survey on Health Care and the 2000 Elections was designed and analyzed by researchers at the Kaiser Family Foundation and the Harvard School of Public Health. Fieldwork was conducted by telephone by Princeton Survey Research Associates between December 3 - 13, 1999. The survey included a national random sample of 1,515 adults, including 1,257 registered voters.

The term "health care voter" is used to refer to those registered voters who named health care or Medicare as one of their top two issues in their vote for president. This study reports on results for registered voters only. Registered voters accounted for 81% of all interviews and their responses are nearly identical to those of the total public. The margin of sampling error for the registered voter sample is plus or minus 3 percent. The margin of sampling error may be higher for some of the sub-groups noted in the analysis.

The Kaiser Family Foundation, based in Menlo Park, California, is a nonprofit, independent national health care philanthropy and is not associated with Kaiser Permanente or Kaiser Industries.

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