KFF Health Tracking Poll - September 2020: Top Issues in 2020 Election, The Role of Misinformation, and Views on A Potential Coronavirus Vaccine

Key Findings:

• The economy has now secured a spot as the top issue in the 2020 election with one-third of registered voters (32%) saying it will be the most important issue in deciding their vote for president, followed by the coronavirus outbreak (20%), criminal justice and policing (16%), and race relations (14%). There is a strong partisan divide, with Republican voters prioritizing the economy followed by criminal justice and policing, and Democratic voters prioritizing coronavirus followed by race relations. The share of voters who say health care will be the most important issue in deciding their vote has dropped 16 percentage points since February (from 26% to 10%), and outside of coronavirus, health care now ranks 5^th as an issue for voters (and ranks 3^rd for Democrats).
• In light of recent protests following the police shooting of Jacob Blake in Kenosha, Wisconsin and President Trump’s focus on violence in cities as a campaign issue, the share of voters who now say violence caused by protestors is a “big problem” in the U.S. has increased 15 percentage points since June (52% compared to 37%). The increase in the share who say violence caused by protesters is a big problem is particularly large among Republican and independent voters as well as among white voters (which is mostly driven by white Republicans rather than Democrats).
• Recently, the Centers for Disease Control and Prevention (CDC) issued a notice to states to start preparing to distribute a coronavirus vaccine by November 1^st, 2 days before the 2020 election. Most adults (81%), including majorities across partisans, do not think a vaccine for coronavirus will be widely available in the U.S. before the presidential election in November.
• Many (62%) are worried that the political pressure from the Trump administration will lead the FDA to rush to approve a coronavirus vaccine without making sure that it is safe and effective – including 85% of Democrats and 61% of independents. Fewer Republicans (35%) express this level of concern. About four in ten adults overall say both the FDA (39%) and the CDC (42%) are paying “too much attention” to politics when it comes to reviewing and approving treatments for coronavirus or issuing guidelines and recommendations.
• The latest KFF Health Tracking Poll finds a shift in the public’s attitudes on the coronavirus outbreak. More than six months into the pandemic, about four in ten (38%) now say “the worst is yet to come” (down nearly half from 74% in early April), while an equal 38% say “the worst is behind us” (up from 13% in April).
• Nearly half of adults hold at least one misconception about coronavirus prevention and treatment, including one in five who say wearing a face mask is harmful to your health and one in four who say hydroxychloroquine is an effective treatment for coronavirus. Three in four Republicans have at least one misconception, compared to 46% of independents and one in four Democrats. At the same time, trust in some official sources of information on coronavirus has declined since April, including a particularly steep drop in Republicans’ trust of Dr. Anthony Fauci and the CDC.

One-Third Of Voters Say Economy Is Most Important Issue For 2020 Election; Health Care Ranks Lower

With less than two months before the 2020 November election, one-third of registered voters (32%) say the economy is going to be the most important issue in deciding their vote for president. About one-fifth of voters say the coronavirus outbreak (20%) is the top issue, while about one in seven say criminal justice and policing (16%) or race relations (14%) are the top issues. Fewer voters choose health care (10%) or immigration (4%) as the most important issue in deciding their vote for president.

The economy is overwhelmingly the top issue for Republican voters with more than half (53%) choosing it as the most important issue in making their decision about who to vote for president, and it is also the top issue for independent voters (29%). Nearly four in ten Democratic voters (36%) say the coronavirus outbreak is the top issue in deciding their vote, followed by race relations (27%). Few Republican voters say the coronavirus outbreak (4%) or race relations (2%) is their top issue in the election.

The latest KFF Health Tracking Poll was conducted soon after the police shooting of Jacob Blake in Kenosha, Wisconsin (fielded August 28-September 3) and amidst the nation struggling with the health and economic effects of the coronavirus pandemic. Besides coronavirus, which ranks second as a voting issue, the issue of health care in general (which dominated the presidential campaign in early 2020), has fallen as a priority for voters and now ranks behind the economy, coronavirus, criminal justice and policing, and race relations. Democrats continue to prioritize the issue of health care more highly than independents or Republicans, ranking it third (tied with the economy, and ranking behind the coronavirus pandemic and race relations).

Swing voters

The economy is also now the top issue for swing voters, the crucial group of voters who say they are “probably” going to vote for either President Trump or former Vice President Biden but haven’t made up their minds yet or say they are still “undecided” about who they are going to vote for (24% of voters are “swing voters”).

About one-third (35%) of swing voters say the economy is their top issue, followed by criminal justice and policing (17%), the coronavirus outbreak (15%), and race relations (14%). About one in ten swing voters (11%) say health care is their top issue while few swing voters (2%) choose immigration is their top issue.

Recent events May Be shifting Voters’ priorities

The recent police shootings of unarmed black Americans and subsequent protests have resonated with voters with both criminal justice and policing and race relations ranking among the top election issues, depending on party identification. About one-fourth of Democratic voters (27%) say race relations is going to be the most important issue in deciding their vote for president while a similar share of Republicans (23%) say criminal justice and policing will be the top issue in to their vote.

In addition, large majorities of voters view racism, police violence, and violence caused by protestors as at least “somewhat of a problem” in the U.S. About six in ten (58%) say racism is a “big problem” while about four in ten say the same about police violence against the public (43%). Over the past three months, there has been a 15 percentage point increase in the share of voters who say violence caused by protestors is a “big problem,” 52% compared to 37% in June. This comes as national attention has focused on protests and acts of violence in cities like Kenosha, Wisconsin and Portland, Oregon, and as President Trump has made tamping down violence in cities a central issue in his campaign.

The partisan divisions in perceptions of these problems, especially views about the violence caused by protestors, have also shifted since June. While a large majority of Democratic voters and six in ten independent voters continue to say racism is “big problem” in the U.S. today, compared to 33% of Republican voters; now eight in ten Republican voters (81%) and half of independent voters (52%) say violence caused by protestors is “big problem,” compared to 62% of Republican voters and 35% of independent voters back in June. One-fourth of Democratic voters say this is a “big problem” – relatively unchanged since June (21%).

Table 1: Increasing Partisan Divide On How Big Of A Problem Racism, Protestor Violence Is In U.S.
Percent of voters who say each of the following is a “big problem” in the U.S. today:	Party ID
	Democratic voters	Independent voters	Republican voters
KFF Health Tracking Poll – September 2020
Racism	84%	58%	33%
Police violence against the public	67	39	20
Violence caused by protesters	25	52	81
KFF Health Tracking Poll – June 2020
Racism	82	57	25
Police violence against the public	63	38	13
Violence caused by protesters	21	35	62
Percentage point change (June-September)
Racism	+2	+1	+8
Police violence against the public	+4	+1	+7
Violence caused by protesters	+4	+17	+19

This shift is notable among all white voters with now similar shares of white voters saying that violence caused by protestors (56%) and racism (53%) are each a “big problem” in the U.S. today. The share of white voters who say violence caused by protestors is a “big problem” is up 17 percentage points since June, mostly driven by the views of white Republicans and independents and less of a change among white Democratic voters. About four in ten (37%) white voters say police violence against the public is a big problem.

Health Care As A Voting Issue

In the early months of 2020 and during the height of the Democratic primary contest, health care was consistently rated as one of the top issues for voters and was the top issue for Democratic primary voters in all of the seventeen Democratic contests analyzed by KFF researchers. But the latest KFF poll finds voters’ priorities have shifted during the last six months with the coronavirus outbreak, the closing of businesses due to the spread of the virus and subsequent recession, the police shootings of unarmed Black Americans, and violence occurring around protests. When asked what about health care is important to their vote, voters offer responses related to increasing access to health insurance coverage (18%) such as universal coverage, the cost of health care (15%) including issues around affordability and the cost of prescription drugs, the coronavirus outbreak (8%), and Medicare or senior concerns (7%).

A health care issue that no longer seems to be resonating with voters, especially Republican voters, is the 2010 Affordable Care Act (ACA). The latest KFF Health Tracking Poll finds 5% of Republican voters offering responses related to opposing or getting rid of the ACA as a top health care issue (compared to 29% of Republican voters who said the same prior to the 2016 presidential election).

A recent analysis of the Republican National Convention found only one mention of the ACA during the 2020 convention, compared to 13 mentions in 2016 and 23 mentions in 2012. The future of the ACA is still in question as the U.S. Supreme Court case will hear arguments for Texas v. California, the court case challenging the law’s constitutionality, one week following the November election.

Overall views towards the 2010 health reform law remain similar to July, with half of the public (49%) continuing to hold favorable views of the ACA while 42% view the law unfavorably (up slightly from 36%). The increase in the share with an unfavorable view was mostly driven by independents (41% now view it unfavorably compared to 35% in July) while a majority of Democrats continue to favor the law and most Republicans continue to hold unfavorable views with 79% saying they have an unfavorable opinion, showing that it is still unpopular among Republicans even if it is no longer a top issue in the 2020 election. KFF has been tracking views of the ACA since April 2010.

Half Of Voters Say Biden Has Better Approach On Most Health Care Issues

At least half of voters think former Vice President Biden has a better approach than President Trump to handle a variety of different health care issues including making decisions about women’s reproductive health choices and services (55%), determining the future of the ACA (54%), maintaining protections for people with pre-existing health conditions (52%), and ensuring access to health care and insurance (52%). On all of these health care issues, a larger share of voters say Biden has the better approach than say the same about President Trump. Voters are more divided on which candidate has the best approach lowering the cost of health care for individuals and protecting people from surprise medical bills with nearly half of voters saying they think Biden has the better approach compared to four in ten who say President Trump does.

When it comes to overseeing the development and distribution of a COVID-19 vaccine, voters are more closely divided with Biden having a slight, but not statistically significant, advantage. About half (49%) of voters say Biden has the better approach for the COVID-19 vaccine while 44% say President Trump does. Voters are also divided on who has the better approach to lowering prescription drug costs, an issue that President Trump has been focusing on throughout his presidency.

As expected, views on which candidate has the better approach largely fall down party lines with vast majorities of Democratic voters saying Biden has the better approach (93%) and nine in ten Republican voters (91%) saying President Trump has the better approach. Independent voters are equally divided with about four in ten saying each candidate has the better approach to the development and distribution of a vaccine.

Few Expect A Coronavirus Vaccine Before The November Election

On September 2^nd, the Centers for Disease Control and Prevention alerted states that they should be ready to distribute a coronavirus vaccine by November 1^st, two days before the 2020 election. The latest KFF Tracking Poll finds most adults (81%) – including majorities of Democrats (90%), independents (84%), and Republicans (75%) –  do not think a vaccine for coronavirus will be widely available in the U.S. before the presidential election in November. Moreover, if a coronavirus vaccine was indeed approved by the FDA before the election and was made available and free to everyone who wanted it, just four in ten adults (42%) say they would want to get vaccinated while a slight majority (54%) say they would not want to get vaccinated under those circumstances. Notably half of Democrats (50%) say they would get vaccinated if a vaccine were available before the election while majorities of independents (56%) and Republicans (60%) say they would not get the vaccine.

A majority of the public (62%) is worried that the political pressure from the Trump Administration will lead the FDA to rush to approve a coronavirus vaccine without making sure that it is safe and effective. A third of adults (33%) say they are “very worried” the FDA will rush to approve a vaccine while a further 29% say they are “somewhat worried.” Across partisans, 85% of Democrats and six in ten independents (61%) say they are worried the FDA will rush to approve a vaccine, while fewer Republicans (35%) express this level of concern. Notably, women are more likely than men to say they are worried the FDA will rush to approve a vaccine (70% vs. 55%).

Public’s Views On Coronavirus Outbreak May Be Shifting

More than six months into a pandemic that has killed more than 180,000 Americans, the public is divided on whether the worst is behind us or yet to come. This comes on the heels of a Republican National Convention in which President Trump was lauded for his handling of COVID-19 and with conflicting information about the availability of a vaccine this fall. About four in ten (38% each) say “the worst is behind us” or “the worst is yet to come.” The share of adults who think the worst is yet to come has decreased by 22 percentage points since July.

Across partisans, a majority of Republicans (56%) say the worst of the coronavirus outbreak is behind us (up from 31% in July). While a majority of Democrats (58%) say the worst is yet to come, the share who expect the worst still lays ahead has decreased by 21 percentage points since July.

In addition, President Trump is now receiving slightly better marks on his handling of the coronavirus, with the share of the public who approve of his handling of the outbreak in the U.S. up 9 percentage points since July 2020. A slight majority (55%) still disapprove of his handling of the current coronavirus outbreak (down from 62% in July).

The Public Is Divided In Who They Trust For Coronavirus Information, Some Misconceptions Exist

CDC and Fauci Are Most Trusted Information Sources, But Trust In Both Has Become Increasingly Partisan

About two in three adults say they have at least a fair amount of trust in Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases (68%), and in the U.S. Centers for Disease Control and Prevention (CDC) (67%) to provide reliable information on coronavirus. About half say they trust Dr. Deborah Birx, the Coronavirus Response Coordinator for the White House Coronavirus Task Force (53%) as a reliable source of information. Half of the public say they trust Joe Biden to provide reliable information on coronavirus while about four in ten say the same about President Trump (52% vs. 40%).

While majorities across partisans continue to trust the CDC, there are large partisan differences on trust in other sources, with Democrats more likely to trust Joe Biden and Dr. Anthony Fauci, and Republicans more likely to trust President Trump and Dr. Deborah Birx.

Notably, the share of adults who trust the CDC to provide reliable information has decreased by 16 percentage points since April. Similarly, the share of adults who say they trust Dr. Anthony Fauci has declined by 10 percentage points since April. Trust in the CDC has decreased from April across partisans, though the decrease has been among Republicans in particularly steep, with 60% now saying they trust the CDC, down 30 percentage points from April when 90% said they trusted the CDC to provide reliable information. Likewise, there has been a steep decline in trust of Dr. Anthony Fauci among Republicans. While the share of Democrats who say they trust Dr. Fauci has increased slightly since April (86%, up from 80%), among Republicans, the share who trust Dr. Fauci has decreased by 29 percentage points (48%, down from 77%).

Public mostly knows key facts about coronavirus, though some MISCONCEPTIONS remain

A large majority of the public (87%) is aware that there is no FDA-approved vaccine to prevent coronavirus and that it is possible for children under 18 to transmit coronavirus to other people (88%). Similarly, eight in ten (80%) know that there is no cure for coronavirus and that wearing a face mask helps to limit the spread of coronavirus (81%). Three in four adults (77%) know that wearing a face mask is not harmful to your health, though notably, one in five adults say wearing a face mask is harmful. While 55% of adults say hydroxychloroquine is not an effective treatment for COVID-19, one in four (24%) say it is an effective treatment. Nearly half of adults (48%) hold at least one misconception about coronavirus prevention and treatment, giving an incorrect answer to at least one of these questions.

There are some notable partisan differences on some key coronavirus facts. While majorities across partisans say wearing a facemask is not harmful to your health, Republicans (36%) are more likely than Democrats (7%) and independents (17%) to say wearing a face mask is harmful. Similarly, while majorities across partisans say wearing a face mask helps to limit the spread of coronavirus, Republicans (32%) are more likely than Democrats (3%) and independents (17%) to say masks do not help to limit the spread. Perhaps reflecting the difference among partisans in who they trust for reliable information, the largest partisan gap is on hydroxychloroquine, which President Trump has touted as a treatment for coronavirus. Most Democrats (78%) and independents (57%) say it is not an effective treatment for COVID-19. However, half of Republicans (51%) say it is an effective treatment.

In August, the U.S. Food and Drug Administration (FDA) issued an emergency use authorization for convalescent plasma in the treatment of COVID-19. In a press conference with President Trump, FDA commissioner Stephen Hahn misstated the benefits of convalescent plasma and has since clarified his remarks. A slight majority of the public (55%) has heard about convalescent plasma receiving emergency authorization from the FDA. Among those who have heard about this new treatment for COVID-19, about three in four (74%) say more studies are needed to determine how effective it is. Majorities across partisans say more studies are needed to determine the effectiveness of convalescent plasma for treating people who are sick from coronavirus.

Commissioner Hahn’s misstatement in his press conference with President Trump and his subsequent clarification has highlighted the issue of potential political pressure impacting the work of organizations such as the FDA and the CDC. The public is divided on whether the FDA pays enough attention to science when approving treatments for coronavirus with 43% saying it pays about the right amount of attention to science while 46% say it does not pay enough attention. The public is similarly divided on whether the CDC pays enough attention to science when issuing guidelines and recommendations related to coronavirus with 43% saying it pays about the right amount of attention and 46% saying it does not pay enough attention to science.

However, when asked about the amount of attention these two organizations pay to politics, pluralities say they pay too much attention. About four in ten (39%) say the FDA pays too much attention to politics when reviewing and approving treatments for coronavirus, while a similar share say the CDC pays too much attention to politics when issuing guidelines and recommendations related to coronavirus.

Majorities of Democrats say that under the Trump Administration, the FDA and the CDC pay too much attention to politics. About four in ten independents say these organizations pay too much attention to politics. Among Republicans, about one in five (19%) say that under the Trump Administration, the FDA pays too much attention to politics when approving treatments for coronavirus while about a third (35%) say the CDC pays too much attention to politics when issuing guidelines and recommendations related to coronavirus.