Established to provide another source of Medicaid funding and promote program integrity, the recovery of certain Medicaid costs after an enrollee dies (estate recovery) has been criticized for several reasons, including that it falls primarily on individuals with limited incomes, raises little revenue, and is applied very unevenly across the states. Family members may be unaware of the policy at the time of enrollment and only learn that the family home may be repossessed after the death of a loved one. Such criticisms have led to proposals (Box 1) that would modify or reduce the practice of estate recovery by Democrats, Republicans, and the Medicaid and CHIP Payment and Access Commission (MACPAC).

Estate recovery is a process that primarily affects older Medicaid enrollees who use long-term services and supports (LTSS). To be eligible for Medicaid coverage of LTSS, people must usually demonstrate having limited incomes (typically below $3,000 per month in 2024 for an individual) and financial resources (often below $2,000 for an individual), but some assets, including their home, are excluded from the calculation of financial resources. Many people only qualify after spending their assets on the out-of-pocket costs for LTSS, which may easily exceed $100,000 per year. The 1993 Omnibus Budget Reconciliation Act required state Medicaid programs to recover the costs of certain Medicaid benefits through a process called estate recovery. Specifically, states are required to recover the costs of LTSS and related hospital and prescription drug services for Medicaid enrollees ages 55 and older; and have the option to recover the costs for other services and populations. States may not take the family home if it is occupied by a spouse, child under the age of 21, child who is blind or has a disability, or a sibling with an equity interest in the home, but they may place a lien on real property for individuals who are alive but permanently institutionalized.

This issue brief sheds light on states’ policies towards estate recovery, drawing from KFF’s Survey of Medicaid Financial Eligibility & Enrollment Policies for Seniors & People with Disabilities which was conducted in March 2024 by KFF and Watts Health Policy Consulting. Overall, 49 states and the District of Columbia (hereafter referred to as a state) responded to the survey, though response rates to specific questions varied (Florida was the only state that did not respond).

Key takeaways include:

• Over half of states reported using estate recovery for the costs of populations and services for which federal law does not require estate recovery, with 28 states reporting estate recovery for some individuals under age 55 and 32 states reporting estate recovery for the costs of all Medicaid benefits for individuals ages 55 and older, and an additional 5 states reporting estate recovery for some optional benefits (Figure 1).
• Over half of states (30) reported using estate recovery to recoup the costs of premiums paid to managed care organizations on behalf of Medicaid enrollees.
• Federal law requires states to establish procedures for waiving estate recovery when recovery would cause hardships, but there are no specific procedures required. States reported waiving estate recovery under the following conditions: when the individual meets state-defined hardship requirements (49 states), if the estate is the sole income-producing asset of survivors (35 states), and when the home is of modest value (15 states). (The definition of “modest value” varies by state and may reflect dollar values, market value relative to local property values, or other measures.)

Why was estate recovery established and why is it a source of concern for policymakers?

Estate recovery was established as a tool to promote program integrity and ensure that people contribute to the costs of their health care. People must generally have very limited income and assets to qualify for Medicaid, but the value of the home is not counted towards the initial eligibility determination. Most eligibility pathways for people who use LTSS require people to have incomes under $3,000 each month and only $2,000 of savings for an individual or $3,000 for a couple. Despite stringent financial eligibility levels, some people with moderate incomes during their working years may become eligible for Medicaid during their retirement years if they need LTSS. Most Medicare beneficiaries live on fixed incomes, with half living on incomes below $36,000 per year and half having savings below $103,800 in 2023. The high costs of LTSS, easily exceeding $100,000 per year, may cause people to qualify for Medicaid after exhausting their savings even if they live in a home of some value. Proponents of estate recovery have indicated that it ensures Medicaid funding is used for the most needy, prevents people from relying on Medicaid instead of using their personal resources to pay for LTSS, and allows states to spend more on other Medicaid expenses. States are also required to establish a cost-effectiveness threshold, which determines whether the value of the estate is cost effective relative to the administrative costs of recovery; and is intended to preclude states from pursuing small estates.

Estate recovery is a source of concern to some policymakers because it disproportionately affects low-income families, creates high administrative costs relative to the revenue generated, and may deter eligible people from applying for Medicaid. A 2021 report to Congress by MACPAC summarizes those concerns, which include:

• Medicaid enrollees are generally low-income and estate recovery may perpetuate intergenerational poverty.
• Individuals with greater awareness of estate recovery and resources are often able to leverage legal mechanisms allowing them to bypass Medicaid estate recovery but preserve Medicaid eligibility. Individuals with fewer resources or only a family home often don’t have the income to hire an attorney to help implement such strategies.
• Estate recovery results in administrative costs to states that could exceed the value of the collections.
• Estate recovery raises relatively few revenues: $733 million in 2019, which offset 0.1% of the over $600 billion that Medicaid spent in 2019. Even in states with the highest relative recovery revenues, those revenues offset less than 1.0% of the states’ Medicaid spending.
• Estate recovery may deter some people from applying to Medicaid who are eligible even if they would not be subject to estate recovery. For example, Medicare beneficiaries who are only eligible for Medicaid coverage of Medicare premiums and cost sharing would not be subject to estate recovery, but limited understanding of the program may prevent them from applying.

States’ use of estate recovery varies considerably, with a small number of states accounting for most of the collections. Five states (Massachusetts, New York, Pennsylvania, Ohio, and Wisconsin) with the largest estate recoveries accounted for nearly 40% of all collections in FY 2019, the most recent year for which data are publicly available about all states’ collections. The same report showed survey data for 10 states, with those states reporting varying numbers of estates pursued, estates recovered, and the amounts recovered per state. Alaska pursued the fewest estates of the responding states (under 500 per year). At the other end of the spectrum were Iowa (pursuing over 15,000 estates each year) and New York (pursuing around 30,000 per year). The average amount recovered per estate ranged from around $5,000 or less in Missouri and Wisconsin to $30,000 per year or more in Alaska and Georgia.

When does Medicaid estate recovery apply?

States must conduct estate recovery for some services and enrollees but may choose to apply estate recovery in additional circumstances, which contributes to the variation in how many estates are pursued and the amount states are recovering. Estate recovery is required for enrollees ages 55 and older who use LTSS, including enrollees eligible for Medicaid through the Affordable Care Act’s Medicaid expansion. For people ages 55 and older who use LTSS, states must recover the costs of nursing facility services, home- and community-based services (HCBS), and related hospital and prescription drug services (defined as those services provided during a nursing facility stay or while receiving HCBS). States may elect to recover the costs of all Medicaid-covered services. They may also elect to conduct estate recovery for individuals who are under the age of 55 if they have been determined to be permanently institutionalized.

Most states apply estate recovery beyond the federally-required circumstances: 37 states apply estate recovery to services for which it is optional and 28 determine permanent institutional status for individuals under age 55 (Appendix Table). For individuals under age 55, estate recovery most frequently applies to people in nursing facilities and in intermediate care facilities for individuals with intellectual disabilities. Among the states applying estate recovery for optional services, 5 states reported applying it to some optional services and 32 states reported applying it to all Medicaid-covered services, but several states noted that recovery could only occur if LTSS services were also rendered.

For people enrolled in managed care, estate recovery is based on the premium payments states make rather than on the services people use, which means some people are subject to estate recovery despite not using applicable services. When states provide benefits through managed care, states are required to seek recovery for the premiums paid if the enrollee would have been subject to estate recovery under a fee-for-service system. If the state recovers the costs of all Medicaid services, estate recovery must apply to the full Medicaid premium. If the state only recovers the costs of a subset of benefits, estate recovery must apply to the portion of the premium attributable to those benefits.

Over half of states apply estate recovery to the costs of managed care premiums. Among the 27 states with capitated managed care that includes LTSS, 11 states pursue estate recovery for the entire premium for people who use LTSS, and 10 states recover the entire premium for everyone enrolled in the plan. Fewer states (5) pursue only the premium attributable to LTSS used. Pennsylvania reported a unique approach, taking the smaller of the premium or the amount of claim spending on LTSS and related services each month. There is no recovery for months without LTSS spending. Among states with stand-alone LTSS managed care plans, 8 states recover the entire premium but only for people who use LTSS and 5 states recover the entire premium for everyone enrolled in the plan. Indiana’s managed LTSS program began in July 2024 and the state will pursue recovery for the entire capitation and any other amounts paid.

When do states waive estate recovery requirements?

Federal law requires states to waive estate recovery requirements when they impose “undue hardships,” but does not specify what constitutes a hardship, leading to significant variation in when states waive estate recovery. Guidance from the Centers for Medicare and Medicaid Services (CMS) provides three examples of potential hardships which include:

• Estate is sole income-producing asset of survivors such as a family farm;
• Home is of modest value, defined as roughly half the average home value in the county; or
• Other compelling circumstances.

The variable approach to hardship waivers has raised equity concerns because the ease with which they are granted varies across states. In some states, securing a hardship waiver may require an attorney, and the families with the fewest resources are least likely to be able to afford such services. In the 10 states included in MACPAC’s survey, the percentage of hardship applications granted in 2019 ranged from 29% in New York to 95% in Iowa.

In KFF’s survey, nearly all states (49) reported adopting at least one of the three potential hardship exemptions in CMS guidance, with the most common being to waiver the estate if it was the sole income-producing asset of survivors (Appendix Table). Specifically, 35 states reported using the income-producing asset criteria, although Arizona also required that the heir must own a business located on real property that is part of the estate and Georgia limits the hardship to farms with annual income of $25,000 or less. Washington does not waive recovery, only delays, when hardship exists. Criteria for delaying recovery include estates that are the sole income-producing property of survivors, when recovery would deprive the heir of shelter and they cannot afford alternative shelter, and when the survivor is a state-registered domestic partner.

Only 15 states reported waiving estate recovery for homes of modest value but the definition of “modest” was unclear in many cases. Only four states reported dollar thresholds to define “modest,” including: West Virginia $50,000 or less; Texas less than $10,000; Mississippi and North Dakota, less than $5,000. Seven states (California, Louisiana, Michigan, New Mexico, New York, South Carolina, and Virginia) defined modest value as one whose market value is 50% or less than the average or median price of homes in a county. Other states used more varied approaches including the following.

• Two states (Arkansas and Maine) waive estate recovery when it is not cost effective but did not provide another definition for homes of modest value.
• In some cases, states reported exempting portions of the home for all descendants. For example, Louisiana exempts either the first $15,000 or half of the median value of a home within the parish from the homestead and South Carolina exempts 50% or less of the average home price within a county from the home’s value. Such exemptions would also preclude estate recovery for homes under those exemption levels.
• Hawaii and Vermont did not describe general definitions of modest value, but both have exemptions that reflect the value of the home in circumstances when heirs cared for the descendent prior to their death.

Most states (40) described other circumstances that would trigger a hardship exemption. Many of those circumstances related to federal policies such as exempting homes that were occupied by surviving minors and when the estate is the sole income-producing asset of a family business. The most common other exemptions included those for heirs who had provided care in the home for enrollees prior to their death and exemptions that considered the income and resources of the heir. Idaho, Ohio, and Wisconsin waive estate recovery when it would result in the survivor becoming eligible for Medicaid or other public assistance.

Key Takeaways

• The Biden administration recently announced a projected reduction of out-of-pocket costs for seniors as part of the Medicare drug negotiations, yet large majorities of voters have not heard about these savings, with almost half (45%) who say they have heard “nothing at all,” while a quarter have heard “a lot” or “some.” Larger shares of older voters, those ages 65 and older, say they’ve heard “a lot” or “some” about these savings, with a third (32%) who say so, compared to two in ten (22%) of those under age 65. Most voters continue to be unaware of the Medicare drug pricing provisions in the Inflation Reduction Act, or IRA, that was passed by Congress and signed into law by President Biden more than two years ago, though awareness of some of the provisions is higher among older voters – the group most impacted by the provisions.
• While awareness of Medicare drug negotiations continues to lag, KFF finds widespread support for this policy. Majorities of voters support authorizing the federal government to negotiate drug prices, while one in seven (14%) oppose. This provision is supported by nine in ten Democrats and independent voters (92% and 89%, respectively) and three-quarters of Republican voters (77%). It is also supported by 88% of older adults, those ages 65 and over, including majorities across partisans.
• Voters’ views of who is responsible for the legislation as well as the expected savings from the negotiations are largely partisan. Overall, a slight majority (55%) of voters ages 65 and older think Medicare negotiating will lower their own prescription drug costs, but the share who expect to see savings increases to nearly two-thirds (64%) of older Democratic and Democratic-leaning voters. On the other hand, about half (52%) of older Republican and Republican-leaning voters say they don’t expect the negotiations to have any impact on their drug costs. In addition, voters are also more likely to give their own party leaders credit for passing legislation aimed at lowering the price of prescription drugs for people on Medicare, though Republican voters are less enthusiastic about their party leaders’ roles. Larger shares of Democratic voters than Republican voters say President Biden, Vice President Harris, and the Democrats in Congress played a “major” or “minor” role in passing legislation for lowering drug prices for people on Medicare, while Republican voters are more likely than Democratic voters to say the same about Republicans in Congress. A similar share of Republican voters give former President Trump credit for passing the legislation as give credit to President Biden.
• Vice President Harris’ campaign has announced proposals for expanding some of the IRA provisions beyond those with Medicare coverage. Majorities of voters, overall and across partisanship, support these proposed provisions, though smaller shares of Republicans are on board. Three-quarters (77%) of voters support the proposal to expand the $35 cap on out-of-pocket costs for insulin beyond those with Medicare, including majorities of Democratic voters (84%), independent voters (79%), and Republican voters (70%). Seven in ten (69%) voters support the proposal to expand the $2,000 annual limit on out-of-pocket prescription drug costs beyond those with Medicare, including 83% of Democrats, 70% of independents, and 58% of Republicans.

Most Voters Continue to Be Unaware of IRA Provisions to Reduce Prescription Drug Prices

Most voters continue to be unaware of the Medicare drug pricing provisions in the Inflation Reduction Act, or IRA, that was passed by Congress and signed into law by President Biden more than two years ago, though awareness of some of the provisions is higher among older voters – the group most impacted by the provisions.

Four in ten voters are now aware there is a federal law in place that caps the cost of insulin for people with Medicare at $35 per month, while another third (35%) are aware of the law that requires the federal government to negotiate the price of some prescription drugs for people with Medicare. A quarter of voters (27%) are aware of the federal law that places a limit on out-of-pocket prescription drug costs for people with Medicare, and one in eight (12%) are aware that there is a law in place that penalizes drug companies for increasing prices faster than the rate of inflation for people with Medicare.

Larger shares of voters ages 65 and older are aware of some of these drug pricing provisions of the IRA. For example, six in ten (61%) voters ages 65 and older are aware of the law that caps the cost of insulin for people with Medicare and about a third (34%) of older voters are aware of the provision that places an out-of-pocket limit on prescription drug costs. Similar shares of older voters compared to younger voters are aware of the provision that requires the government to negotiate the price of some prescription drugs and that penalizes drug companies for increasing prices faster than the rate of inflation for people with Medicare.

While awareness of the Medicare drug pricing provisions increased, especially among older voters, from November 2023 to May 2024, awareness has remained steady over the past several months.

Voters Remain Unaware of Impact of Medicare Drug Negotiations, Older Adults Are Unclear if It Will Reduce Their Prescription Costs

The Biden administration recently announced that the lower prices negotiated for some prescription drugs would have saved the federal government $6 billion in 2023 with an estimated $1.5 billion reduction in out-of-pocket costs for older adults when lower prices take effect in 2026. Large majorities of voters have not heard about these projected savings, with almost half (45%) who say they have heard “nothing at all” about the negotiations, while a quarter (25%) have heard “a lot” or “some.” Another three in ten (30%) have heard “a little” about the negotiations.

Larger shares of older voters, those ages 65 and over, say they’ve heard “a lot” or “some” about these savings, with a third (32%) who say so, compared to one in five (22%) of those under age 65.

Similarly, larger shares of Democratic and independent voters have heard about the projected savings, with about a third (34%) of Democrats and a quarter (27%) of independents who have heard at least “some,” compared to about one in six (16%) Republican voters.

Overall, almost nine in ten (85%) voters support authorizing the federal government to negotiate drug prices, while one in seven (14%) oppose. This provision is supported by 92% of Democratic voters, 89% of independent voters, and 77% of Republican voters. While support for the law is lower among Republicans, most Republican voters support it.

In addition to supporting the federal government negotiations, a slight majority (55%) of voters ages 65 and older think Medicare negotiations will lower their own prescription drug costs, while four in ten (43%) older voters think negotiating won’t have any impact on their prescription drug costs. Expectations that Medicare negotiations won’t lower drug costs seem to be partisan, with two-thirds (64%) of older Democratic and Democratic-leaning voters thinking it will lower their drug costs, while about half (52%) of older Republican and Republican-leaning voters thinking it won’t have any impact on their drug costs.

The Inflation Reduction Act was enacted under President Biden without any Republican support in Congress. Six in ten voters say President Biden had a “major” or “minor” role in passing the recent law aimed at lowering drug prices for people on Medicare, including four in ten (37%) who say he had a “major” role. Similar shares of voters say the same about Democrats in Congress, with six in ten (60%) who say they played a “major” or “minor” role. Another four in ten (42%) voters say Vice President Harris played a role. Credit for the recent law could be key as she picks up these issues on her own platform for president.

Almost half (46%) of voters think that Republicans in Congress played a role in passing the recent law, with a small share saying they played a “major” role (14%). About a quarter of voters credit former President Trump for the passage of the law aimed at lowering drug prices for those on Medicare, with a quarter (28%) who say he played a “major” or “minor” role, while 41% say he had no role in passing the recent law. Between a quarter and a third of voters aren’t sure how big of a role these groups played in the health care legislation.

Partisans are more likely to give their own party leaders credit for passing legislation aimed at lowering the price of prescription drugs for people on Medicare, though Republican voters are less enthusiastic about their party leaders’ roles. Larger shares of Democratic voters than Republican voters say President Biden, Vice President Harris, and the Democrats in Congress played a “major” or “minor” role in passing legislation for lowering drug prices for people on Medicare. While Republican voters are more likely than Democratic voters to say former President Trump and the Republicans in Congress played a role, only about a quarter of Republican voters said either (23% and 24%, respectively) played a “major role.” In fact, a similar share of Republican voters give former President Trump credit for passing the legislation as give credit to President Biden.

Overall, eight in ten (81%) Democratic voters say Biden played a role in passing the legislation, four in ten (39%) of Republican voters say the same about Trump. Another eight in ten Democratic voters say Democrats in Congress played a “major” or “minor” role in passing the legislation, while over half (54%) of Republicans say the same about Republicans in Congress.

Voters Support Expanding on IRA Provisions

Vice President Harris’ campaign has announced that, if elected, her administration hopes to expand some of the drug pricing legislation beyond just those with Medicare, allowing others to benefit from the cap on monthly out-of-pocket costs for those with insulin and the annual limit on out-of-pocket prescription drug costs. Former President Trump has remained silent on some of these issues, though his administration implemented a program under which Medicare plans voluntarily lowered insulin copays to $35 per month. Majorities of voters, overall and across partisanship, support these proposed provisions, though smaller shares of Republicans are on board. Three-quarters (77%) of voters support the proposal to expand the $35 cap on out-of-pocket costs for insulin beyond those with Medicare, including majorities of Democratic voters (84%), independent voters (79%), and Republican voters (70%). Seven in ten (69%) voters support the proposal to expand the $2,000 annual limit on out-of-pocket prescription drug costs beyond those with Medicare, including 83% of Democrats, 70% of independents, and 58% of Republicans.

This KFF Health Tracking Poll/Health Misinformation Tracking Poll was designed and analyzed by public opinion researchers at KFF. The survey was conducted August 26-September 4, 2024, online and by telephone among a nationally representative sample of 1,312 U.S. adults in English (1,244) and in Spanish (68). The sample includes 1,028 adults (n=53 in Spanish) reached through the SSRS Opinion Panel either online (n=1,018) or over the phone (n=18). The SSRS Opinion Panel is a nationally representative probability-based panel where panel members are recruited randomly in one of two ways: (a) Through invitations mailed to respondents randomly sampled from an Address-Based Sample (ABS) provided by Marketing Systems Groups (MSG) through the U.S. Postal Service’s Computerized Delivery Sequence (CDS); (b) from a dual-frame random digit dial (RDD) sample provided by MSG. For the online panel component, invitations were sent to panel members by email followed by up to three reminder emails.

Another 284 (n=15 in Spanish) interviews were conducted from a random digit dial telephone sample of prepaid cell phone numbers obtained through MSG. Phone numbers used for the prepaid cell phone component were randomly generated from a cell phone sampling frame with disproportionate stratification aimed at reaching Hispanic and non-Hispanic Black respondents. Stratification was based on incidence of the race/ethnicity groups within each frame.

Respondents in the phone samples received a $15 incentive via a check received by mail, and web respondents received a $5 electronic gift card incentive (some harder-to-reach groups received a $10 electronic gift card). In order to ensure data quality, cases were removed if they failed two or more quality checks: (1) attention check questions in the online version of the questionnaire, (2) had over 30% item non-response, or (3) had a length less than one quarter of the mean length by mode. Based on this criterion, no cases were removed.

The combined cell phone and panel samples were weighted to match the sample’s demographics to the national U.S. adult population using data from the Census Bureau’s 2022 Current Population Survey (CPS), September 2021 Volunteering and Civic Life Supplement data from the CPS, and the 2024 KFF Benchmarking Survey with ABS and prepaid cell phone samples. The demographic variables included in weighting for the general population sample are gender, age, education, race/ethnicity, region, civic engagement, frequency of internet use, political party identification by race/ethnicity, and education. The sample of registered voters was weighted separately to match the U.S. registered voter population using the same parameters above derived from the 2024 KFF Benchmarking Survey. Both weights account for differences in the probability of selection for each sample type (prepaid cell phone and panel). This includes adjustment for the sample design and geographic stratification of the cell phone sample, within household probability of selection, and the design of the panel-recruitment procedure.

The margin of sampling error including the design effect for the full sample is plus or minus 4 percentage points and is plus or minus 4 percentage points for registered voters. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available by request. Sampling error is only one of many potential sources of error and there may be other unmeasured error in this or any other public opinion poll. KFF public opinion and survey research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research.

Note: The third bullet in the key findings was updated on Sept. 17, 2024, to correct a typographical error, where former President Trump had been misidentified as President Biden.

Key Takeaways

• Four in ten voters (38%) choose the economy and inflation as the most important issue determining their vote this fall from a list of national issues, including several health care issues. As the economy looms large in the 2024 election, voters from both parties want their candidates to talk about health care costs. When voters are asked to offer in their own words what health care issue they most want to hear the candidates talk about, about four in ten voters across partisanship mention issues related to the cost of health care. Democratic and Democratic-leaning independent voters say they would like Vice President Harris to talk about general health care costs (20%), prescription drug costs (15%), and the cost of insurance or reducing their monthly premiums (6%). About one in seven offered abortion as the one health care issue they want to hear about from Harris and 13% mentioned universal health care – an issue that was largely debated during the 2020 Democratic primaries. Similarly, nearly half (45%) of Republican voters and Republican-leaning independent voters say they would most like to hear former President Trump talk about health care costs. This is followed by one in eight (12%) who say they want to hear him talk about Medicare, Medicaid, or Social Security.
• Abortion continues to motivate a small group of voters, mainly Democratic and Democratic-leaning independent women voters of reproductive age (ages 18-49). About a fifth of this voting bloc say abortion is their most important voting issue and half say they will only vote for a candidate who shares their views on abortion. Overall, this group of voters wants abortion to be legal and the vast majority (90%) say they want a federal law restoring a nationwide right to abortion similar to what was protected by Roe v. Wade. The share of Democratic-leaning women of reproductive age who say they think the presidential election will have a major impact on abortion access has increased 31 percentage points in the past six months (90% v. 59%), a time in which Vice President Harris became the Democratic presidential nominee and began highlighting the issue in her campaign.
• A majority of all voters now say they trust the Democratic nominee more to handle the issue of abortion compared to former President Trump (53% v. 34%), widening a much smaller advantage that President Biden had over Trump earlier this year (38% v. 29%), a sign of Harris’s relative strength with Democratic voters on this issue.
• Voters largely prefer a federal law restoring a nationwide right to abortion, similar to what was protected by Roe v. Wade (61%), rather than leaving it up to the states to decide whether abortion is legal or not (39%). Majorities of both Democratic voters (87%) and independent voters (68%) would prefer a federal law restoring the nationwide right to an abortion, the policy position of the Democratic presidential candidate V.P. Harris, while seven in ten Republican voters would prefer leaving abortion laws up to the states, the position advocated by former President Trump. Notably, while the vast majority of Democratic and Democratic-leaning women voters of reproductive age support restoring a federal law for a nationwide right to abortion, this policy proposal is also preferred by half of Republican women voters of reproductive age.

How Voters Are Prioritizing Health Care Issues in 2024

The economy and inflation continue to dominate the list of issues that voters are focusing on during this year’s presidential election with four in ten voters (38%) saying it is the most important issue determining their vote in the 2024 presidential race. Following the economy is threats to democracy (22%), immigration and border security (12%), then several individual health care issues including abortion (7%), Medicare and Social Security (7%), and health care costs, including prescription drug costs (5%). Altogether, health care issues are seen as the most important issue by about one in five voters (19%). Gun policy (3%) and the war between Israel and Hamas in Gaza (2%) rank the lowest among the issues included in the list provided to voters.

While substantial shares of voters across partisanship say the economy and inflation is their most important voting issue including more than half (54%) of Republican voters, the ranking of other issues are more partisan. For example, Republican voters are much more likely to prioritize immigration as a voting issue with nearly a quarter (23%) saying it is the most important issue to their vote compared to one in ten independent voters (9%) and few Democratic voters (4%). On the other hand, threats to democracy is the top voting issue for Democratic voters with four in ten (38%) saying it is their most important issue, compared to one in five independent voters (22%) and 5% of Republican voters who say the same.

Voters Want to Hear Candidates Talk About Lowering Health Care Costs

An indication of how the economy and health care consistently overlap for voters, economic concerns also rear up when voters are asked what health care issue they most want to hear the candidates talk about. Across partisans, the recurring theme is costs. Responses related to health care costs are offered by four in ten (42%) Democratic and Democratic-leaning independent voters when asked to say in their own words what is the one health care issue they would most like Vice President Harris to talk about. This includes voters who mentioned general health care costs (20%), prescription drug costs (15%), and the cost of insurance or reducing their monthly premiums (6%). About one in seven offered abortion as the one health care issue they want Harris to talk about and 13% mentioned universal health care – an issue that was largely debated during the 2020 Democratic primaries.

Similarly, nearly half (45%) of Republican voters and Republican-leaning independent voters say they would most like to hear former President Trump talk about health care costs. This is followed by one in eight voters who say they want to hear him talk about Medicare, Medicaid, or Social Security.

Health Care Issues, Including Abortion, Resonate Highest With Certain Voters

Overall, the individual health care issues included in the list loom larger for Democratic voters, as they are more than twice as likely as Republican voters to select abortion, Medicare and Social Security, or health care costs as their most important voting issue (25% v. 11%). One in five independent voters also chose a health care issue as their most important voting issue. In addition, women voters are about twice as likely as men to choose a health care issue as their most important voting issue this fall (25% vs. 12%). Democratic voters and women voters have long been more likely to prioritize health care issues than their counterparts, except for Republican voters’ focus on repealing the ACA, but this election cycle is slightly different. In the first presidential election since the Supreme Court Dobbs decision that overturned Roe v. Wade, abortion is now a top voting issue for about one in ten Democratic voters and a similar share of overall women voters.

Overall, most voters (58%) say a candidate’s position on abortion is just one of many factors that might affect their vote this year while about a quarter of voters say they will only vote for a candidate who shares their views on abortion. About one in five (18%) voters say abortion isn’t an important factor in their vote choice.

Democratic voters are more likely to say they will only vote for a candidate who shares their view on abortion (31%), but still most say it is just one of many factors (61%). The same is true among all women of reproductive age, with one in three saying they would only vote for a candidate who shares their view on abortion.

Abortion Is an Important Voting Issue for Democratic Women of Reproductive Age

While abortion may not resonate as a top voting issue for all voters, for a key group of voters – Democratic women voters of reproductive age – abortion is among the most important voting issues.

Abortion ranks as a top voting issue for Democratic and Democratic-leaning women of reproductive age (between the ages of 18 and 49), with 21% saying it is their most important issue, ranking alongside the economy (23%) and threats to democracy (25%) as their top voting issue.

Half of Democratic women of reproductive age, the group that is most likely to prioritize abortion as a voting issue, say they will only vote for a candidate who shares their view on abortion (48%), a position they hold more often than any other group. A similar share (48%) say abortion is one of many important factors, while few say abortion is not an important factor in their vote choice (4%). This group is largely in support of abortion access with nine in ten (93%) Democratic women of reproductive age saying they think abortion should be legal in all or most cases.

Vice President Harris Has Strong Advantage on Abortion, Former President Trump Leads on Economy and Immigration

Former President Trump has a clear advantage over Vice President Harris on who voters trust to do a better job dealing with two key issues: economy and inflation (52% vs. 37%) and immigration and border security (54% vs. 36%). On the other hand, Vice President Harris has nearly a similar advantage on the issue of abortion (53% vs. 34%). A KFF Tracking Poll conducted earlier this year when President Biden was still the Democratic nominee found that Biden had a smaller advantage over Trump on abortion (38% v. 29%), a sign of Harris’s relative strength with Democratic voters on this issue.

Neither candidate has a majority of voters saying they trust them more to do a better job on any of the other key voting issues asked about including Medicare and Social Security or health care costs. However, V.P. Harris does have the advantage on the issue of health care costs. Former President Trump garners more trust on the issue of the war between Israel and Hamas in Gaza, but a substantial share of voters say they trust neither candidate to do a better job of handling this issue.

Both presidential candidates are trying to garner support from independent voters and these voters give former President Trump the advantage on their top voting issue – the economy and inflation. About half of independent voters (52%) say they trust former President Trump to do a better job dealing with the economy and inflation, while a third (32%) of independent voters say they trust V.P. Harris to do a better job. V.P. Harris holds a much smaller advantage on their second most important voting issue – threats to democracy (46% vs. 37%). Across the three health care issues, V.P. Harris has a strong advantage over former President Trump among independent voters including a 36-point advantage on the issue of abortion. On the other hand, former President Trump holds a 20-point advantage on the issue of immigration and border security.

Most Voters Expect Presidential Election to Have Major Impact on Abortion Policy

Nine in ten (89%) voters say this year’s elections for president will have an impact on abortion access in the U.S., including six in ten (61%) voters who say it will have a “major impact.” One in ten (11%) voters think the election will not have any impact on access to abortion in the U.S.

Democratic voters are more than twice as likely as Republican voters (84% vs. 40%) to say the election will have a major impact on abortion access. Three-fourths (72%) of women voters of reproductive age, those most directly impacted by abortion policy in the U.S., say the presidential election will have a major impact on abortion access, rising to nine in ten Democratic and Democratic-leaning independent women voters ages 18-49. On the other hand, four in ten (43%) Republican and Republican-leaning independent women voters of reproductive age say the same.

A larger share of voters now say that this election will have a “major” impact on abortion access than the share who said so in March of this year when President Biden was still on the ballot, perhaps reflecting the current president’s uneasiness with the issue. Currently, six in ten (61%) voters think this election will have a “major” impact, compared to about half (51%) in March. Some of the largest changes have been among independent voters and Democratic voters, with 84% of Democratic voters now saying the presidential election will have a major impact on abortion access, up from 71% in March. Similarly, 58% of independent voters say the same, a 14-percentage point increase from 44% in March. The share of Republican voters who say the election will have a major impact has remain unchanged.

Democratic and Democratic-leaning independent women voters of reproductive age (ages 18-49) are also now placing a higher emphasis on this election’s impact on abortion access. In the most recent tracking poll, nine in ten Democratic women under age 50 now say this year’s presidential election will have a major impact on abortion access in the U.S., compared to just 59% who said the same in March of this year.

Six In Ten Voters Want Roe Protections Restored

Six in ten (61%) voters would prefer a federal law restoring a nationwide right to abortion, similar to what was protected by Roe v. Wade, while four in ten (39%) would prefer to leave it up to the states to decide whether abortion is legal or not in each state.

Majorities of both Democratic voters and independent voters would prefer a federal law restoring a nationwide right to abortion, with nearly nine in ten (87%) Democratic voters and two-thirds (68%) of independent voters who say so. Seven in ten Republican voters would prefer leaving abortion laws up to the states.

Nine in ten Democratic and Democratic-leaning women voters who are of reproductive age support restoring a federal law for a nationwide right to abortion, while Republican women voters of reproductive age are more divided with similar shares saying they would prefer a federal law restoring a nationwide right to abortion (49%) or leaving it up to the states (51%).

Nearly seven in ten voters who live in states where abortion is legal and available support a federal law restoring a nationwide right to abortion (68%), as do a majority of voters living in states where abortion is banned or limited (54%).

This is especially important as ten states are set to have voters cast ballots on abortion-related measures in the 2024 election. In those states, 62% of voters say they would prefer to have a federal law restoring a nationwide right to abortion similar to what was protected by Roe.

As the presidential campaigns continue, a majority of voters say it is important for the 2024 presidential candidates to talk about abortion (84%), access to birth control (79%), and in vitro fertilization, or IVF, (57%) on the campaign trail.

At least three-quarters of Democratic voters say it is either “very important” or “somewhat important” for the candidates to talk about each of these issues, as do a majority of independent voters. A majority of Republican voters agree, albeit to a lesser degree, that it is important for the presidential candidates to discuss abortion and birth control access, but less than half say the same about IVF.

At least nine in ten Democratic and Democratic-leaning women of reproductive age say it is important for the candidates to discuss abortion (97%) and access to birth control (95%) on the campaign trail, and three quarters (76%) say it is important for the candidates to talk about IVF.

This KFF Health Tracking Poll/Health Misinformation Tracking Poll was designed and analyzed by public opinion researchers at KFF. The survey was conducted August 26-September 4, 2024, online and by telephone among a nationally representative sample of 1,312 U.S. adults in English (1,244) and in Spanish (68). The sample includes 1,028 adults (n=53 in Spanish) reached through the SSRS Opinion Panel either online (n=1,018) or over the phone (n=18). The SSRS Opinion Panel is a nationally representative probability-based panel where panel members are recruited randomly in one of two ways: (a) Through invitations mailed to respondents randomly sampled from an Address-Based Sample (ABS) provided by Marketing Systems Groups (MSG) through the U.S. Postal Service’s Computerized Delivery Sequence (CDS); (b) from a dual-frame random digit dial (RDD) sample provided by MSG. For the online panel component, invitations were sent to panel members by email followed by up to three reminder emails.

Another 284 (n=15 in Spanish) interviews were conducted from a random digit dial telephone sample of prepaid cell phone numbers obtained through MSG. Phone numbers used for the prepaid cell phone component were randomly generated from a cell phone sampling frame with disproportionate stratification aimed at reaching Hispanic and non-Hispanic Black respondents. Stratification was based on incidence of the race/ethnicity groups within each frame.

Respondents in the phone samples received a $15 incentive via a check received by mail, and web respondents received a $5 electronic gift card incentive (some harder-to-reach groups received a $10 electronic gift card). In order to ensure data quality, cases were removed if they failed two or more quality checks: (1) attention check questions in the online version of the questionnaire, (2) had over 30% item non-response, or (3) had a length less than one quarter of the mean length by mode. Based on this criterion, no cases were removed.

The combined cell phone and panel samples were weighted to match the sample’s demographics to the national U.S. adult population using data from the Census Bureau’s 2022 Current Population Survey (CPS), September 2021 Volunteering and Civic Life Supplement data from the CPS, and the 2024 KFF Benchmarking Survey with ABS and prepaid cell phone samples. The demographic variables included in weighting for the general population sample are gender, age, education, race/ethnicity, region, civic engagement, frequency of internet use, political party identification by race/ethnicity, and education. The sample of registered voters was weighted separately to match the U.S. registered voter population using the same parameters above derived from the 2024 KFF Benchmarking Survey. Both weights account for differences in the probability of selection for each sample type (prepaid cell phone and panel). This includes adjustment for the sample design and geographic stratification of the cell phone sample, within household probability of selection, and the design of the panel-recruitment procedure.

The margin of sampling error including the design effect for the full sample is plus or minus 4 percentage points and is plus or minus 4 percentage points for registered voters. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available by request. Sampling error is only one of many potential sources of error and there may be other unmeasured error in this or any other public opinion poll. KFF public opinion and survey research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research.

Introduction

This report, based on analysis of KFF’s 2023 Racism, Discrimination, and Health Survey, focuses on the experiences of people who have been previously incarcerated and examines their social and economic circumstances as well as their physical and mental health and access to health care. The findings aim to fill in a gap in publicly available data on the experiences of people who were previously incarcerated. The goal is to provide increased understanding of the health and other basic needs of people who were previously incarcerated, rather than identifying the role incarceration plays in driving these and other outcomes.

The analysis shows that people with previous experience with incarceration have significant health needs and limited access to resources, including health care, and experience more social isolation. Some key findings include:

• Adults with prior incarceration experience report many financial challenges, including half who say they have problems affording basic living expenses. These financial hardships are particularly pronounced among previously incarcerated adults who are lower income (household incomes below $40,000) (66%), women (62%), or Black (57%). Yet, the experiences are not solely explained by the fact that many previously incarcerated adults have lower household incomes than their counterparts. When comparing the experiences among the lowest income individuals in both groups, previously incarcerated adults are more likely than those with similar incomes but no incarceration experience to report difficulty affording expenses.
• Social support networks may be particularly important for people who have interactions with the criminal justice system, yet six in ten (61%) of those with prior incarceration experience say they have just a few or no friends or family living near them to ask for help or support. In addition, a quarter of previously incarcerated individuals say they have felt lonely either “always” or “often” in the past twelve months, almost twice the share among those without previous incarceration experience (13%).
• A substantial share of adults who have been previously incarcerated report “fair” or “poor” physical health and mental health, and the disparity between those with incarceration experience and those without is even more pronounced among women. Overall, a quarter of those who have been incarcerated say their physical health is “fair” or “poor,” increasing to four in ten (39%) among women who have spent a night in jail or prison. One in four (27%) previously incarcerated adults say their mental health is “fair” or “poor,” increasing to almost half (46%) of women who have been previously incarcerated.
• Reflecting their lower income levels, Medicaid covers about a quarter (25%) of previously incarcerated adults compared with 14% of adults without previous incarceration experience. Although Medicaid coverage helps to fill gaps in private coverage for previously incarcerated adults, they also remain more likely than adults without incarceration experience to report being uninsured (13% vs. 8%).
• Despite significant health needs, one in five (22%) adults with previous incarceration experience say they do not have a usual source of care or go to the emergency room when they are sick or need advice about their health. One in three of those with previous incarceration experience say they skipped or postponed health care because of costs in the past year. This includes nearly four in ten (37%) women with prior incarceration experience.
• About three in ten (31%) adults with previous incarceration experience say they have received mental health services from a doctor, counselor, or other mental health professional in the last 3 years. Among those with incarceration experience, women are more than twice as likely as men to say they have received such services (53% vs. 20%), likely reflecting the higher share of women in this group who report mental health challenges. But there are still unmet needs, with almost half of those previously incarcerated who report having fair or poor mental health saying there was a time in the past three years when they needed mental health services or medication but didn’t get them.

Economic and Social Challenges

Many adults with prior incarceration experience report facing financial challenges, including difficulty affording basic needs and paying their monthly bills. These challenges are particularly pronounced among certain groups of adults who previously incarcerated including those with lower incomes, those who are Black adults, and those who are women.

Half of adults who have been previously incarcerated say they or a family member living with them have had problems paying for food, housing, transportation, or other necessities in the past 12 months. The share rises to 57% of Black adults and 62% of women with prior incarceration experience. Overall, adults who have previously been incarcerated are more likely than those who have not to report problems paying for basic needs. While this in part reflects their lower incomes, even among adults with household incomes of less than $40,000, those who have been incarcerated are more likely to report problems paying for basic necessities than those who have not (66% vs. 44%).

Lower-income adults and women with previous experience with being incarcerated report difficulties affording expenses and securing housing.

More than one in four adults who have been previously incarcerated say they have difficulty affording their bills each month rising to more than four in ten (43%) of those who have been previously incarcerated and have household incomes under $40,000. One in five (20%) of those earning similar incomes without incarceration experience say the same.

About one in five adults with previous experience being incarcerated report they have been evicted or denied housing, nearly four times the share of those without incarceration experience (19% v. 5%). This share rises among those with lower incomes, with one in four of those with household incomes under $40,000 saying they have been evicted or denied housing (compared to one in ten of those with similar income levels but without previous incarceration experience).

More than four in ten women with previous experience being incarcerated report difficulty affording their monthly bills and more than a quarter say they have ever been evicted or denied housing. The share of women who report such experiences is higher than the share of men with incarceration experience who report the same.

At least a quarter of previously incarcerated adults across race and ethnicity groups said they had difficulty affording bills each month (25% of Hispanic adults, 28% of White adults, and 32% of Black adults). About three in ten Black adults who were previously incarcerated also reported ever being evicted or denied housing as did one in five Hispanic adults and 16% of White adults.

Difficulty affording monthly bills or getting housing may reflect problems getting or keeping a job. One in four of those who have been previously incarcerated say in the past 12 months they or a family member living with them have had problems getting or keeping a job and 14% say they are currently unemployed.

Social Supports

Social support networks may be particularly important for people who have interactions with the criminal justice system, yet six in ten (61%) of those with prior incarceration experience say they have just a few or no friends or family living near them to ask for help or support. In addition, a quarter of previously incarcerated individuals say they have felt lonely either “always” or “often” in the past twelve months, almost twice the share among those without previous incarceration experience (13%). The share who report feeling lonely at least often increases to 42% of Black women who were previously incarcerated (compared to 20% of Black women with no incarceration experience).

Health and Health Care Access

One in four adults with previous incarceration experience report being in fair or poor physical health, and three in ten report having a disability or condition that prevents them from participating fully in work or other activities, including much higher shares among women than men.

About a quarter of those who have been incarcerated say their physical health is “fair” or “poor.” The share of previously incarcerated adults who report negative physical health increases to four in ten (39%) among women, twice the share of women without such experience who say the same (19%). About one in five men, regardless of their experience being incarcerated, report the same. Similarly, while three in ten of those who have been previously incarcerated report having a physical or mental health condition or disability that keeps them from participating fully in work, school housework or other activities, it rises to four in ten among women who have been previously incarcerated.

Reflecting their lower incomes, adults with prior incarceration experience are disproportionately likely to be covered by Medicaid or uninsured. Medicaid covers a quarter (25%) of previously incarcerated adults compared with 14% of adults without previous incarceration experience. Although Medicaid coverage helps to fill gaps in private coverage for previously incarcerated adults, they remain more likely than other adults to report being uninsured (13% vs. 8%).

Despite their reported health care needs, about one in five (19%) people with experience being incarcerated say they have not gone to a doctor or any other health care provider about their own health in the past 12 months.

In addition, one in five adults (22%) with previous incarceration experience say they do not have a usual source of care or go to the emergency room when they are sick or need advice about their health. One in three of those with previous incarceration experience say they skipped or postponed health care because of costs in the past year. This includes nearly four in ten (37%) women and nearly a third of men (31%).

In all, 37% previously incarcerated individuals say they skipped or postponed care for any reason and their health got worse because of it, rising to half (52%) of women with previous incarceration experience.

While previously incarcerated individuals are less likely to report using health care compared to those with no incarceration experience, this does not necessarily reflect a lack of concern about their health. One in five previously incarcerated individuals say they experienced worry or stress related to their health almost every day or even more often than that in the past 30 days, including one in ten (10%) who say they experienced it every day.

Mental Health Care

A substantial share of previously incarcerated adults, including even larger shares of women, report difficulties with their mental health and barriers to accessing mental health care.

One in four (27%) previously incarcerated adults say that their mental health is “fair” or “poor,” increasing to almost half (46%) of women who have been previously incarcerated. That includes about a quarter of previously incarcerated adults across and racial and ethnic groups.

In addition, one in four previously incarcerated individuals say they have felt depressed always or often in the past 12 months, increasing to 43% of previously incarcerated women. Nearly one in three say they have felt anxious always or often in the past 12 months, once again increasing to half of previously incarcerated women.

About three in ten (31%) adults with previous incarceration experience say they have received mental health services from a doctor, counselor, or other mental health professional in the last 3 years. Among those with incarceration experience, women are more than twice as likely as men to say they have received such services, likely reflecting the higher share of women in this group who report mental health challenges. In addition, six in ten previously incarcerated adults who report having fair or poor mental health say they have received mental health care services in the past three years.

But there are still unmet needs with about a quarter saying they didn’t receive mental health services or medications they needed in the past three years. The share who report this increases to nearly half (48%) of those previously incarcerated who report having fair or poor mental health and women (37%).

The Survey on Racism, Discrimination, and Health was designed and analyzed by researchers at KFF. The survey was conducted June 6 – August 14, 2023, online and by telephone among a nationally representative sample of 6,292 U.S. adults in English (5,706), Spanish (520), Chinese (37), Korean (16), and Vietnamese (13).

The sample includes 5,073 adults who were reached through an address-based sample (ABS) and completed the survey online (4,529) or over the phone (544). An additional 1,219 adults were reached through a random digit dial telephone (RDD) sample of prepaid (pay-as-you-go) cell phone numbers. Marketing Systems Groups (MSG) provided both the ABS and RDD sample. All fieldwork was managed by SSRS of Glen Mills, PA; sampling design and weighting was done in collaboration with KFF.

Sampling strategy:

The project was designed to reach a large sample of Black adults, Hispanic adults, and Asian adults. To accomplish this, the sampling strategy included increased efforts to reach geographic areas with larger shares of the population having less than a college education and larger shares of households with a Hispanic, Black, and/or Asian resident within the ABS sample, and geographic areas with larger shares of Hispanic and non-Hispanic Black adults within the RDD sample.

The ABS was divided into areas (strata) based on the share of households with a Hispanic, Black, and/or Asian resident, as well as the share of the population with a college degree within each Census block group. To increase the likelihood of reaching the populations of interest, strata with higher incidence of Hispanic, Black, and Asian households, and with lower educational attainment, were oversampled in the ABS design. The RDD sample of prepaid (pay-as-you-go) cell phone numbers was disproportionately stratified to reach Hispanic and non-Hispanic Black respondents based on incidence of these populations at the county level.

Incentives:Respondents received a $10 incentive for their participation, with interviews completed by phone receiving a mailed check and web respondents receiving a $10 electronic gift card incentive to their choice of six companies, a Visa gift card, or a CharityChoice donation.

Community and expert input:Input from organizations and individuals that directly serve or have expertise in issues facing historically underserved or marginalized populations helped shape the questionnaire and reporting. These community representatives were offered a modest honorarium for their time and effort to provide input, attend meetings, and offer their expertise on dissemination of findings.

Translation:After the content of the questionnaire was largely finalized, SSRS conducted a telephone pretest in English and adjustments were made to the questionnaire. Following the English pretest, Cetra Language Solutions translated the survey instrument from English into the four languages outlined above and checked the CATI and web programming to ensure translations were properly overlayed. Additionally, phone interviewing supervisors fluent in each language reviewed the final programmed survey to ensure all translations were accurate and reflected the same meaning as the English version of the survey.

Data quality check:A series of data quality checks were run on the final data. The online questionnaire included two questions designed to establish that respondents were paying attention and cases were monitored for data quality including item non-response, mean length, and straight lining. Cases were removed from the data if they failed two or more of these quality checks. Based on this criterion, 4 cases were removed.

Weighting:The combined cell phone and ABS samples were weighted to match the sample’s demographics to the national U.S. adult population using data from the Census Bureau’s 2021 Current Population Survey (CPS). The combined sample was divided into five groups based on race or ethnicity (White alone, non-Hispanic; Hispanic; Black alone, non-Hispanic; Asian alone, non-Hispanic; and other race or multi-racial, non-Hispanic) and each group was weighted separately. Within each group, the weighting parameters included sex, age, education, nativity, citizenship, census region, urbanicity, and household tenure. For the Hispanic and Asian groups, English language proficiency and country of origin were also included in the weighting adjustment. The general population weight combines the five groups and weights them proportionally to their population size.

A separate weight was created for the American Indian and Alaska Native (AIAN) sample using data from the Census Bureau’s 2022 American Community Survey (ACS). The weighting parameters for this group included sex, education, race and ethnicity, region, nativity, and citizenship. For more information on the AIAN sample including some limitations, adjustments made to make the sample more representative, and considerations for data interpretation, see Appendix 2.

All weights also take into account differences in the probability of selection for each sample type (ABS and prepaid cell phone). This includes adjustment for the sample design and geographic stratification of the samples, and within household probability of selection.

The margin of sampling error including the design effect for the full sample is plus or minus 2 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. Appendix 1 provides more detail on how race and ethnicity was measured in this survey and the coding of the analysis groups. For results based on other subgroups, the margin of sampling error may be higher. All tests of statistical significance account for the design effect due to weighting. Dependent t-tests were used to test for statistical significance across the overlapping groups.

Sample sizes and margins of sampling error for other subgroups are available by request. Sampling error is only one of many potential sources of error and there may be other unmeasured error in this or any other public opinion poll. KFF public opinion and survey research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research.