With the presidential election coming up in November 2004, an examination of recent public opinion data as well as historical trends can give some insight into the potential role health care might play as an election issue. When it comes to the relative importance of different issues in deciding their vote, health care has been one of the top five issues chosen by voters in four of the last six elections, and it was the second most frequently chosen issue in both the presidential election in 2000 and the congressional election in 2002, ranking behind the economy/jobs both times. Although the economy and jobs almost always outrank health care as voting issues, it is important to note that these issues are very closely tied, since most people get health insurance through an employer, and many are concerned about being able to afford health care for themselves and their families. While in polls, the importance of health care and the economy are measured separately, it may make more sense to consider health care one dimension of economic concerns.
Historically, people in different demographic groups have given different rankings to health care as a voting priority. In recent elections, Democrats, seniors, and people without health insurance have been more likely than their counterparts to say that health care was one of the top issues determining their vote. Importantly, however, those who care about health care as an issue often pay attention to different priorities within health care. For instance, seniors are much more likely to say that Medicare and prescription drug costs are top issues determining their votes, while younger adults are more likely to say they vote based on health care issues such as accessing to health care and insurance.
Furthermore, it is important to recognize the variation in voting behaviors of the different demographic groups. For instance, seniors are much more likely to vote than younger adults, and they will continue to make up a growing share of the electorate as the Baby Boom generation reaches retirement age. Also, surveys show that the uninsured are less likely than their insured counterparts to report being registered to vote, and to say that they participate in elections.
In examining how health care as an issue might play out in any given election, it is also important to remember that candidates’ stands on the issues are only one part of what determines how people vote. In a survey following the presidential election in 2000, more than one-third of voters (37%) said the candidates’ stands on issues were the most important factor when they decided who to vote for, while others said character and moral values (27%), leadership abilities (14%), and the candidates’ experience (12%) were the most important factor. In addition, perceptions of the major political parties are a factor that many people consider in deciding who to vote for. Historically, the Democrats have had an edge over the Republicans in terms of the percent of people who say they trust each party to do a better job dealing with health care.
Although the next presidential election is close to a year away, polls conducted in January provide an early indication that health care may again play an important role as an issue in the 2004 election, though secondary to the economy. In January 2004, health care ranked second in terms of the percent of people saying it will be the top issue determining their vote for president in November (19%), still far behind the economy and jobs (36%), but ahead of terrorism (14%), Iraq (11%), education (10%), and taxes (4%) as a voting issue. However, if there are dramatic changes in world events, it is very possible that these priorities could change over the coming months. Another early indication of the role health care may play in the upcoming election is the fact that health care/Medicare was named as the most important issue determining their vote by nearly three in ten voters in the entrance poll at the Iowa Democratic caucuses and in the exit poll in the New Hampshire Democratic primary, and it was named by about one in five voters in exit polls in South Carolina, Oklahoma, Missouri, Delaware, and Arizona. Health care/Medicare ranked second as a voting issue (behind the economy and jobs) in each one of these states, except for New Hampshire, where it ranked first, just ahead of the economy.
Finally, examinations of past elections can help shed light on the role health care may play in 2004, including the congressional elections in 2002 and 1998, and the presidential elections in 2000 and 1992.
