KFF Health Tracking Poll December 2022: The Public's Health Care Priorities For The New Congress

Key Findings:

• With the rising cost of living at the top of the public’s mind, the latest KFF Health Tracking poll finds that the public wants lawmakers to prioritize the economy and combatting inflation in the upcoming Congressional term. When asked specifically about health care priorities for Congress, passing a law to make health care costs more transparent to patients tops the list, with 60% calling this a top priority. And nearly three years into the pandemic and at a time when government COVID-19 funding may come to an end, three in ten (31%) say Congress should prioritize continuing funding for COVID-19 vaccines and treatment.
• In the wake of the Dobbs decision overturning Roe v. Wade, President Biden pledged that the first bill he would send to the new Congress would be one to protect abortion rights. And though such a bill has little chance of passing in a divided Congress, this month’s KFF Health Tracking poll finds that two in three adults (65%) say passing a law to make abortion legal in all states is important, including four in ten (42%) who say it should be a top priority for Congress. Majorities across key groups say legalizing abortion nationwide should be a top priority for Congress, including Democrats and those who lean toward the party (66%), adults under 30 (58%), women under 50 (58%), and Black adults (55%). However, about one in four (26%) of the public overall and about half (49%) of Republicans and Republican-leaning independents say codifying the right to abortion nationwide is something Congress should not
• Worries about rising prices are widespread among the public and health care costs are no exception. Nine in ten (91%) say they are concerned about increases in health care costs for individuals, including six in ten who say they are very concerned, nearly double the share who say they are very concerned about increases in government insurance programs like Medicare and Medicaid (34%) or about increases in health care costs paid by employers (31%). About half (48%) of the public say they are very worried about increases in health care costs for the nation as a whole.
• Although there is great concern among the public about increases in health care costs, many have false impressions about where most U.S. health care money is spent. When asked where they think most health care spending goes, the most frequent answer given by the public is prescription drugs (36%), followed by hospitals (30%), long-term care (19%), and physician services (11%). Analyses of overall national health spending in 2020 found that the largest share of the U.S. health care dollar is spent on hospitals, while physicians/clinics and prescription drugs account for a smaller share of national health expenditures.
• The costs associated with mental health care are another area where the public wants Congress to take action. Majorities say it should be a top priority for Congress to strengthen mental health parity laws (54%) and to increase funding for access to mental health services (51%). And, nearly eight in ten (79%) adults say that health insurance companies not covering mental health services like they do physical health is a big problem for mental health in the U.S., while a similar share (77%) say the same about the cost of mental health care.
• Four months after the signing of the Inflation Reduction Act (IRA), at least seven in ten say they support each of the health care provisions polled, all of which aim to reduce patient costs. Support is highest for the provisions that aim to reduce costs for people on Medicare, such as capping monthly costs for prescription drugs, insulin, and allowing the government to negotiate for the price of prescription drugs. This includes majorities across partisans, though the majority that supports extending Affordable Care Act subsidies under the ACA is notably smaller among Republicans than among Democrats (54% vs. 90%).

The Public’s Top Priorities For The New Congress: Focusing On The Economy And Reducing Health Care Costs

Just as KFF analysis of APVotecast data found that inflation was the top factor motivating voters in midterm elections, the December KFF Health Tracking Poll finds that the economy and inflation is the public’s top issue for Congress in its upcoming term. More than one in three (37%) adults cite economic concerns when asked in their own words what should be the top priority for Congress in its new session next year, including 28% who mention inflation specifically.

Health care (including health care costs) is the second-most frequently mentioned priority by the public (9%), followed by immigration (8%). Other priorities were mentioned by smaller shares of adults, such as abortion and reproductive (5%), guns, crime and safety (4%), climate change, the environment, and global warming (3%), and democracy and election and voting reform (3%).

While the economy is the most frequently mentioned topic regardless of partisanship, Republicans and those who lean toward the party are twice as likely to name economic concerns as a top Congressional priority than are Democrats and Democratic leaners (50% vs. 26%). Beyond the economy and inflation, partisans differ somewhat in what they think Congress should prioritize in its new term. Among Democrats and those who lean toward the party, health care and health care affordability is the second most frequently mentioned topic (13%), while immigration is the second most frequently raised issue among Republicans and those who lean Republican (12%). A number of other priorities are named by at least 5% of Democrats, including abortion and reproductive rights; guns, crime and safety; democracy and election and voting reform; and climate change. Much smaller shares of Republicans mention each of these priorities.

HEALTH CARE PRIORITIES FOR THE NEW CONGRESS

When asked specifically about health care priorities that Congress could take on next term, the public sees many as important for Congress to tackle. While recent regulations have sought to improve both price transparency and mental health care access, both of these issues are at the top of the public’s priority list for Congress. A large majority (95%) of the public say it is important for Congress to pass a law to make health care costs more transparent to patients, including 60% who call this a top priority.

On mental health, large shares say Congress should prioritize strengthening requirements to make health insurance plans cover mental health as they do physical health (91% important, including 54% top priority), as well as increasing funding for access to mental health services (92% important, 51% top priority). Another mental health priority, increasing funding to expand treatment programs for opioid addiction, is seen as important by about eight in ten adults (79%), but fewer (30%) say it should be a top priority for Congress.

Two policies related to women’s health are also seen as important areas for Congressional action by majorities of the public. About two-thirds (65%) say it is important for Congress to pass a law to make abortion legal in all states, including 42% who call this a top priority. Three-quarters (75%) also say it’s important for Congress to pass a law that requires states to continue coverage for 12 months after childbirth for pregnant people on Medicaid, including 35% who say this should be a top priority.

The Biden Administration recently announced that barring further Congressional action, the government will no longer fund the purchase of COVID-19 vaccines, which would likely increase spending on vaccines by billions of dollars a year according to an analysis by KFF. While seven in ten say continuing funding for COVID-19 vaccines is important for Congress to do, it ranks lower on the public’s priority list, with three in ten (31%) saying it should be a top priority.

Rounding out the list of health care priorities for the new Congress, seven in ten adults say it’s important for Congress to pass a law providing expanded access to telehealth services, though just two in ten call this a top priority. The relatively lower ranking of this issue may reflect the decline in the use of telehealth for outpatient visits, which peaked at 13% between March and August of 2020 according to KFF analysis.

On nearly all of these issues, women, Democrats, and those with lower incomes are more likely to see each of these as priorities for Congress.

Majorities across key demographics say PROTECTING ABORTION ACCESS is IMPORTANT for new congress

As KFF analysis of AP VoteCast data has shown, the overturn of Roe v. Wade this summer  played an outsize role in shaping the minds of many voters in the recent midterm election. Now, looking ahead to the new Congressional term, about two-thirds (65%) of the public say passing a law to make abortion legal in all states is an important thing for Congress to do in its new term, including 42% who say it should be a top priority.

On this topic, 50% of women say it should be a top priority compared to one third (33%) of men. And Democrats and those who lean toward the party are about four times more likely than Republicans and those who lean Republican (66% vs. 17%) to say Congress should prioritize legalizing abortion nationwide. Notably, 26% of the public overall, including about half (49%) of Republicans and Republican leaners say that legalizing abortion is something Congress should not do.

About half of voters age 18-29 and women voters ages 18-49 said in November’s KFF/AP VoteCast poll that the Supreme Court overturning Roe v. Wade had a major impact on their decision about whether to vote in the midterm election, and a similar share said it also had a major impact on which candidates they supported in the election. This month’s KFF Health Tracking Poll finds majorities among these groups say legalizing abortion nationwide should be a top for the new Congress. Nearly six in ten adults under 30 (58%) and women under 50 (58%) say passing a law to legalize abortion in all states is a top priority, while similar shares of Black adults (55%) say the same.

Another policy affecting women’s access to health care, passing a law that requires states to continue coverage for 12 months after childbirth for pregnant people on Medicaid, is seen as important by three-quarters of the public (75%). Fewer (35%) see this as a top priority for Congress, though the share who say it is a top priority rises to 50% for Democrats and those who lean Democratic and 41% for women. About one in two (51%) adults under 30 say passing a law to continue Medicaid coverage for 12 months postpartum is a top Congressional priority, while only about one in four (23%) adults 50 and older say the same. Majorities of women 18-49 (54%), Black adults (54%), and about half (49%) of Hispanic adults also say expanding postpartum Medicaid coverage should be a top priority for the new Congress. Currently, expansion of Medicaid coverage for 12 months after childbirth is optional for states, and about two thirds of states have implemented or plan to implement such coverage.¹

Concerns About Health Care Costs And National Health Care Expenditures

Just as the economy, inflation, and health care are at the top of the public’s priority list for the new Congress, when asked directly about increases in health care costs the public is concerned.  About nine in ten (91%) say they are concerned about increases in the amount individuals pay for health care, including six in ten (60%) who say they are “very” concerned. About eight in ten (83%) say they are concerned about increases in what the nation as a whole spends on health care, including nearly half (48%) who say they are “very” concerned. The public is somewhat less concerned about increases in spending when it comes to increases in costs borne by the government and employers. Around three in ten say they are “very” concerned about increases in spending on government health insurance programs like Medicare and Medicaid (34%), or the amount employers pay for their employees’ health care (31%).

MANY SAY most health care spending is on prescription drugs, followed by hospitals

While the public is greatly concerned about increases in health care costs, many harbor misconceptions about where most of the U.S. health care dollar is spent. When asked about where they think most of health care spending by government and individuals goes, the most frequent answer given by the public is prescription drugs (36%), followed by hospitals (30%). About one in five adults say long-term care (19%) is where most money is spent, and about one in ten (11%) say physician services.

While it is true that the U.S. spends significantly more on prescription drugs than  other comparatively wealthy nations on average according to the Peterson-KFF Health System Tracker, analyses of overall national health spending found that hospitals represented nearly a third (31%) of spending, while physicians/clinics accounted for one fifth (20%) and prescription drugs a further 8%.

Majorities Cite Lack Of Health Insurance Coverage And Costs As Key Concerns For Mental Health Care In The U.S.

Expense and overall costs also emerge as key issues when it comes to the public’s concerns about mental health in the United States. Similar to the shares found in an in-depth survey of mental health KFF conducted with CNN in July-August of this year, the latest KFF Health Tracking Poll finds that majorities say each of the items polled are big problems when thinking about mental health in the U.S. About eight in ten (79%) adults say that health insurance companies not covering mental health services like they do physical health is a big problem, while a similar share (77%) say the same about the cost of mental health care.

Beyond these expense-related problems, about two in three adults say stigma or shame associated with mental health is a big problem (66%), and a similar share (68%) say it is a big problem that there are not enough health care providers, such as therapists or counselors.

Women and those who report having a mental health condition are more likely to say each of these issues polled are a big problem when it comes to mental health in the U.S. than were men and those who do not report having a mental health condition.

Majorities Support Key Health Care Provisions Of The Inflation Reduction Act

Four months after President Joe Biden signed the Inflation Reduction Act (IRA) into law, most adults (71%) say they have read or heard at least a little about the law, though relatively few (13%) say they have heard “a lot.”

When asked about some specific health care components of the IRA, majorities of the public are in support. More than eight in ten adults support capping monthly-out-of-pocket costs for insulin for people with Medicare (84%) as well as placing a limit on out-of-pocket prescription drug costs for people with Medicare (82%). A similar share (81%) supports authorizing the federal government to negotiate the price of some prescription drugs for people with Medicare. And although the law was passed along party lines with all Democratic representatives in favor and no supporting Republican votes, large majorities across partisans in the public say they are in support of each of these provisions.

In addition to the Medicare provisions of the IRA, there is also strong support for the provision that extends financial subsidies for people who purchase health coverage through the Affordable Care Act marketplace. About seven in ten (72%) adults support this component of the law, though there is a strong partisan divide. The vast majority of Democrats and those who lean toward the party support this measure compared to a smaller majority of their Republican (90% v. 54%).