The Role Of Health Care In The 2020 Election

Throughout 2020, KFF tracked the role health care played in voters’ decisions in the U.S. presidential election, both during the Democratic primary contests in Spring of 2020 and the general election, concluding in November 2020.  The data below is KFF analysis of state-level data from AP VoteCast, a survey of voters in both the Democratic primaries (including caucus-goers) and the general election. Both the general election and primary election surveys were conducted for seven days, concluding as the polls closed in each state.

The Role Of Health Care During the 2020 Presidential General Election

Since the Democratic primaries in late February and early March 2020, when health care was the top issue for Democratic primary-goers, life in the United States has changed dramatically. Eight months into the coronavirus pandemic, voters in the general election were divided between prioritizing the public health crisis of the coronavirus outbreak and the economic recession caused by the virus. These issues together with police killings of unarmed Black people in the U.S. and subsequent racial justice protests have caused traditional health care policy issues to take a backseat during the 2020 general election. At the same time, the passing of Supreme Court Justice Ginsburg and the appointment of Justice Barrett prior to the election highlighted the ongoing legal battle over the Affordable Care Act. Using the interactive below, you can find out which presidential candidate won the most votes in each state, the top issue for voters in each state, voters’ views on the federal government’s handling of the coronavirus pandemic, and views of the ACA. The interactive also shows the share of voters within states that have not expanded Medicaid that want to see their state expand, where available.


The Role Of Health Care During The Democratic Primaries

Prior to the coronavirus pandemic in the U.S., health care was the dominant issue in the 2020 Democratic presidential primary contest. Using the interactive below, you can see that health care was the top issue for  Democratic primary voters and caucus-goers in the 17 states where there is KFF analysis of state-level data from AP VoteCast. The interactive also shows the share of Democratic voters who said health care is the most important issue facing the country, the share who favor a single-payer health plan—similar to the one being proposed by front-runner Sen. Sanders—and those who favor a proposal for a public option—the more moderate expansion of access proposal by former Vice President Biden. For more polling insights and public opinion on different approaches to expanding access to health care, see more here.


Methodology of AP VoteCast

AP VoteCast is a survey of American voters conducted by NORC at the University of Chicago. Interviews begin six days before the day of the primary election or caucus in each state, and seven days before the general election, and are conducted until polls close in the state. Interviews are conducted both online and by telephone (landline and cell) in English and Spanish. All states include a probability-based sample of voters drawn from Catalist LLC’s registered voter database and matched to a registered voter database maintained by L2, which provides additional phone numbers for voter records. For some states, the probability sample is supplemented with online interviews with self-identified registered voters selected from non-probability online panels managed by Lucid or Dynata

Weighting involved multiple stages and are done separately for the probability sample and the nonprobability sample (when applicable). First, the probability-base sample is weighted to adjust for disproportional nonresponse. Then these weights are adjusted to population totals of registered voters in each state using a combination of the 2018 CPS Voter Supplement, the 2018 Census Bureau’s ACS, and the Catalist voter file. For the nonprobability sample, the respondents receive a calibration weight to ensure the nonprobability sample is similar to the probability-based sample on key demographic variables such as ideology. All respondents are then weighted to improve estimates for sub-state geographic regions using a small area model. Finally, the survey results are weighted to the actual vote count following the completion of the election.

Numbers of interviews in each state and margins of sampling error (adjusted for design effects) are shown in the table below. For subgroups, the margin of sampling is higher.

More details about the AP VoteCast methodology can be found here.

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