The independent source for health policy research, polling, and news.
In this JAMA Health Forum column, KFF’s Executive Vice President for Health Policy Larry Levitt discusses waning awareness of the Affordable Care Act’s provisions protecting people with pre-existing conditions and examines the Republican Study Committee’s budget proposal, which proposes to repeal the provisions.
In 2024, Affordable Care Act (ACA) Marketplace enrollment hit a new record high, reaching over 21 million people, almost double the 11 million people enrolled in 2020. This growth can be largely attributed to enhanced subsidies made available by the American Rescue Plan Act (ARPA) in 2021 and renewed under the 2022 Inflation Reduction Act (IRA). These enhanced subsidies significantly reduced premium payments across the board for ACA Marketplace enrollees – including providing 100% premium subsidies for the lowest-income enrollees – and made some middle-income people who had previously been priced out of coverage newly eligible for financial assistance.
Although the Inflation Reduction Act’s enhanced subsidies are available nationwide, some states have seen faster growth than others. In 15 states, ACA Marketplace enrollment has more than doubled since 2020 (Figure 2). One of these states is Texas, where ACA enrollment has more than tripled since 2020. Meanwhile, 3 states’ Marketplaces have seen enrollment fall since 2020.
The five states with the fastest growth in Marketplace enrollment since 2020 – Texas (212%), Mississippi (190%), Georgia (181%), Tennessee (177%), and South Carolina (167%) – have certain characteristics in common: They all started off with high uninsured rates before the enhanced subsidies rolled out, they have not expanded Medicaid under the ACA, and they all use the Healthcare.gov enrollment platform.
It is difficult to disentangle the effect of each of these factors (uninsured rate, Medicaid expansion, and enrollment platform), as they are correlated and closely connected to one another. Nonetheless, the data suggest that a large number of uninsured people in these southern states with high uninsured rates wanted health insurance coverage, and the recently enhanced subsidies have made it possible for them to afford that coverage. However, these subsidies are temporary and will expire at the end of 2025 if not renewed by Congress.
When considering the varying growth rates of Marketplace enrollment across states in recent years, it is important to keep in mind that states had different starting points before the enhanced subsidies in the ARPA and IRA were rolled out. The nonelderly uninsured rate in 2019 ranged from less than 5% in Massachusetts, the District of Columbia, and Hawaii to over 15% in Mississippi, Georgia, Florida, and Oklahoma, and over 20% in Texas. Generally speaking, states with higher uninsured rates in 2019 saw faster growth in ACA Marketplace enrollment from 2020 to 2024, while those with the lowest uninsured rates saw their market sizes generally grow less or even shrink a bit. On average, states that started out with nonelderly uninsured rates below 10 percent in 2019 saw an average of 31% growth in ACA Marketplace enrollment, while states with uninsured rates of 10 percent or more saw an average growth of 136% from 2020 to 2024.
Another closely related factor that could explain why some states are seeing faster growth in their ACA markets is Medicaid expansion. On average, non-expansion states have seen their ACA Marketplaces grow by 152% since 2020, compared to 47% average growth in expansion states.
The Inflation Reduction Act subsidies bring premiums for ACA Marketplace silver plans down to as low as $0 per month for people with incomes between 100% and 150% of poverty. Meanwhile, in states that have expanded Medicaid, people with incomes up to 138% of poverty are eligible for Medicaid and are therefore ineligible to purchase ACA Marketplace plans. There are therefore relatively fewer people in Medicaid expansion states who would qualify for one of these “free” silver plans on the ACA Marketplaces. This could explain, in part, why there has been faster Marketplace growth in several non-expansion states. (With North Carolina recently expanding Medicaid, there are now 10 states, primarily in the South, that have chosen not to expand the program).
The unwinding of the pandemic-era Medicaid continuous enrollment policy, which led to millions of people losing Medicaid in 2023 after having their coverage maintained during the pandemic, likely contributed to the steeper increase in Marketplace enrollment during the 2024 open enrollment period. As states unwind the Medicaid continuous enrollment policy, these $0 premium, low-deductible ACA Marketplace plans may make the transition from Medicaid to Marketplace coverage easier, especially for people with incomes just above the poverty level in non-expansion states.
Growth in ACA Marketplace enrollment in recent years also correlates with enrollment platforms. The 23 states with the fastest growth in ACA Marketplace enrollment from 2020-2024 all use the Healthcare.gov enrollment platform. States using Healthcare.gov saw a weighted average growth of 126% in ACA Marketplace enrollment from 2020 to 2024, compared to 22% growth in states using state-run enrollment websites. All 10 states that have not expanded Medicaid use the Healthcare.gov platform.
Another difference is that only Healthcare.gov states have Enhanced Direct Enrollment, which allows health plans and insurance brokers to directly enroll and provide customer service to enrollees throughout the year without the consumer needing to visit the Marketplace website (Healthcare.gov). In recent years, brokers have played a growing role in assisting Marketplace consumers.
However, states that use their own enrollment websites also had different starting points in 2020, ahead of the enhanced subsidies passing in 2021. Some state-based Marketplaces were already using state funds to offer additional health insurance subsidies beyond those offered by the federal government. Additionally, several states with their own Marketplaces had long embraced the ACA and have directed state resources toward outreach and marketing efforts for a decade. By contrast, states that rely on Healthcare.gov had significant cuts to outreach and marketing budgets during the Trump administration, with those investments renewed in 2021 under the Biden Administration.
The states with the fastest recent growth in ACA Marketplace signups also had among the highest uninsured rates previously, as enhanced subsidies helped to make coverage more affordable for many consumers, particularly in southern states that did not expand their Medicaid programs to cover low-income adults, a new KFF analysis finds. The enhanced premium subsidies were first provided in the American Rescue Plan Act in 2021 and then extended through 2025 in the Inflation Reduction Act.
Marketplace enrollment has more than doubled in 15 states since 2020, including in Texas, where signups more than tripled (growing by 212%). On average, states that started out with nonelderly uninsured rates below 10% in 2019 saw an average of 31% growth in ACA Marketplace enrollment, while states with uninsured rates of 10% or more saw an average growth of 136% from 2020 to 2024.None of the five states with the largest growth in recent ACA marketplace enrollment – Texas, Mississippi, Georgia, Tennessee, and South Carolina – have expanded Medicaid.
States that have not expanded their Medicaid programs under the ACA have seen their Marketplaces grow by 152% on average since 2020, compared to 47% average growth in expansion states. This reflects, in part, that many low-income people who would be eligible for Medicaid if they lived in expansion states are instead able to sign up for Marketplace coverage in non-expansion states without having to pay a premium. Growth in ACA Marketplace enrollment in recent years also correlates with the type of enrollment platform, with states using Healthcare.gov seeing ACA Marketplace enrollment growing by 126% on average from 2020 to 2024, compared to 22% growth in states using state-run enrollment websites. This difference in growth could be explained in part by states’ differing starting points. States that use their own platforms are more likely to have made earlier and more consistent investments in outreach and marketing, and some had state-funded subsidies before the federal government’s enhanced subsidies. Additionally, states using Healthcare.gov have an option for brokers to enroll Marketplace customers directly without visiting the exchange website, which could have helped boost enrollment in states using the federal platform.
A long-awaited new rule recently finalized by the Biden Administration gives LGBTQ+ people more protections against discrimination when seeking health care and coverage from a range of programs and organizations, including Medicaid, Medicare, Health Insurance Marketplaces, many health insurance plans, and most hospitals and providers. The rule has been subject to a wave of litigation across the Obama, Trump, and Biden Administrations and the Biden Administration’s new rule reinstates protections eliminated by the Trump Administration.
In a new brief, KFF examines the rule and highlights two areas of interest— nondiscrimination protections for pregnancy related decisions, including abortion, and nondiscrimination protections for transgender people, including those related to gender affirming care. The brief also provides a side-by-side comparison of the Obama (2016), Trump (2020), and Biden Administration (2024) rules.
The revised regulations implement Section 1557 of the Affordable Care Act, which prohibits discrimination based on race, color, national origin, age, disability, or sex in covered health programs or activities. The Biden Administration’s interpretation of the ACA’s sex protections also offers protections based on sexual orientation and gender identity, among other considerations.
Beyond those for LGBTQ+ people, the rule also provides a range of other nondiscrimination protections, including those related to abortion; people with disabilities; people with limited English proficiency; and use of telehealth and patient care decision support tools, including clinical algorithms and AI. The rule also extends to include Medicare Part B for the first time.
Note: This resource was originally posted on February 22, 2024, and was updated May 15, 2024, to include newer polling data on the public’s views of the ACA.
Public opinion of the Affordable Care Act (ACA) has been largely divided along partisan lines since the law was passed in 2010. Following Republican efforts to repeal the ACA in the summer of 2017, KFF Health Tracking Polls show an uptick in overall favorability towards the law, and since then, a larger share has held a favorable than an unfavorable view. The May 2024 Health Tracking Poll shows that about six in ten U.S. adults (62%) hold a favorable opinion of the ACA while about four in ten (37%) hold a negative opinion of the law. Views of the ACA are still largely driven by partisanship; nearly nine in ten Democrats (87%) along with two-thirds of independents (65%) view the law favorably, while two-thirds of Republicans (66%) hold unfavorable views. Explore more demographic breakdowns using KFF’s interactive: The Public’s Views on the ACA.
The ACA has been the subject of both legal challenges and Congressional actions aimed at overturning the 2010 health care law. However, many of the specific provisions included in the law are popular and the public would like them to remain.
For example, the 2020 California v. Texas case challenged the legality of the individual mandate and brought special attention to the law’s protections for people with pre-existing medical conditions. These provisions prohibit insurance companies from denying coverage based on a person’s medical history (known as guaranteed issue) and prohibit insurance companies from charging those with pre-existing conditions more for coverage (known as community rating). As of February 2024, two-thirds of the public say it is “very important” for the guaranteed issue (67%) and community rating (65%) provisions to remain law, including majorities of Democrats and independents. About half of Republicans say each of these protections for people with pre-existing conditions are “very important.” Historically, majorities also say it is very important for many of the other ACA provisions to be kept in place, even if the Supreme Court ruled the ACA unconstitutional and no longer the law of the land.
Though majorities say it is very important for guaranteed issue to remain law, knowledge that this provision is part of the ACA has dropped over the past 14 years. As of February 2024, about four in ten (39%) adults are aware that the ACA prohibits insurance companies from denying coverage based on a person’s medical history, compared to seven in ten adults in June 2010, shortly after the ACA’s inception.
One reason why majorities across partisans may support the ACA’s protections for people with pre-existing medical conditions is that large shares of the public, regardless of age, gender, racial or ethnic identity, and income report having someone with a pre-existing condition in their household. A KFF analysis estimates that 27% of adults ages 18-64 have a pre-existing condition that would have led to a denial of insurance in the individual market prior to the implementation of the ACA. An even larger share of the public believes they or someone in their family may belong in this category. According to the KFF polling data from 2020, about half of the public say they or someone in their household suffers from a pre-existing medical condition, such as asthma, diabetes, or high blood pressure.1
KFF polling from March 2022 shows about a quarter of the public says the ACA has helped them and their family in some way, while one in five say the law has hurt them. About half of those who say the ACA helped them say allowing someone in their family to get or keep their health coverage has been the main way the health care law has helped them (48%, or 12% of total adults). Three in ten say the law has made it easier for them to get the health care they need (7% of total) and one in five say it has lowered the cost of their health care or health insurance (5% of total).
The February 2024 Health Tracking Poll also reveals four in ten (39%) adults say the ACA has made it easier for people like them to get health insurance, while about one in four (23%) say it has made it more difficult. However this perception varies by partisanship, as Democrats are almost three times as likely as Republicans (60% v. 22%) to say the ACA has helped them in this way.
Among the one in five U.S. adults who say the ACA has hurt them and their families, most say the law has increased costs of health care or health insurance (59%, 12% of total). Smaller shares say it has made it more difficult to access care (22%, 5% of total), or caused someone in their family to lose coverage (11%, 2% of total). The high costs of health care in this country continue to be a major burden for many families.
This brief provides an overview of the Biden Administration 2024 final rule implementing Section 1557 of the ACA, which is home to the law’s major nondiscrimination provisions. While Section 1557’s protections took effect when the ACA was enacted in 2010, much of its reach has been determined by implementation guidance issued across different Presidential administrations, often reflecting conflicting views. The final rule reinstates and expands upon many of the 2016 regulations from the Obama Administration and is a reversal from much of the 2020 Trump Administration rule. We provide a brief background on 1557 rulemaking and identify key differences between this rule and the 2020 rule. We also highlight two areas of growing interest impacted by the rule – nondiscrimination protections for pregnancy related decisions, past, present and future, including abortion, and for transgender people. Despite the issuance of the final rule, debates about 1557’s protections, and ensuing litigation, continue and will be particularly dependent on the outcome of the 2024 Presidential election.
On April 27, 2024, the Biden Administration’s Department of Health and Human Services (HHS) finalized long-awaited revised regulations implementing Section 1557 of the Affordable Care Act (ACA). Section 1557 prohibits discrimination on the basis of race, color, national origin, age, disability, or sex and applies to health programs and activities receiving federal financial assistance (referred to as covered entities). In broad terms, it prevents covered entities from discriminating against certain protected groups in providing health care services, insurance coverage and program participation. The rule has staggered effective dates starting on July 5, 2024. In broad terms, 1557 provides nondiscrimination health care protections to individuals in protected groups, including prohibiting denial of benefits, coverage, program participation, and otherwise unequal treatment based on these factors
The administration also released a FAQ and press release. Section 1557 houses the law’s major nondiscrimination provisions by incorporating protections from existing civil rights laws. These laws include Title VI of the Civil Rights Act of 1964 (race, color, and national origin), Title IX of the Education Amendments of 1972 (sex), the Age Discrimination Act of 1975, and Section 504 of the Rehabilitation Act of 1973 (disability). Notably, Section 1557 is the first federal civil rights law to prohibit discrimination on the basis of sex in health care.
Section 1557’s protections took effect when the ACA was enacted on March 23, 2010, but much of the law’s reach has been determined by implementation guidance issued by different Presidential administrations, reflecting different interpretations and priorities. Across the Obama, Trump, and Biden administrations, the 1557 implementing regulations have volleyed back and forth in their interpretations, particularly related to the scope of entities covered by the law and the law’s ability to provide nondiscrimination protections based on sexual orientation and gender identity and pregnancy related conditions. These debates, and ensuing litigation, are likely to continue, and will be particularly dependent on the outcome of the 2024 Presidential election.
Most of the implementing regulations in the new rule are effective 60 days (July 5, 2024) after publication in the Federal Register (May 6. 2024). Some provisions impacting health insurance plan design won’t become effective until the plan year beginning after January 1, 2025, and other provisions where entities might need additional time to amend current practices also have later effective dates. (The rule and the FAQ provide a table of these dates.)
The FAQ accompanying the rule states it was necessary to issue this guidance “to restore and strengthen civil rights protections for individuals consistent with…the statutory text,” noting that the 2020 Trump Administration rule “covers fewer programs and services and limited nondiscrimination protections for individuals.”
Section 1557 has been subject to a wave of litigation across administrations. Litigation has both centered on rulemaking and on the statue itself. In some cases (e.g. Franciscan Alliance v. Azar), courts have found narrowly in favor of plaintiffs who have asserted that the requirement to cover or provide certain services, such as those related to termination of pregnancy or gender affirming care, violated their sincerely held religious beliefs and thus religious freedom protections. In other cases, courts have found that Section 1557 protects access to these same services, such as by requiring state Medicaid programs to cover gender affirming care (e.g. Flack v. Wisconsin). Courts have also weighed in on the legality of aspects of rulemaking (e.g. Whitman-Walker Clinic v. HHS) and litigation has already been filed in the state of Florida by the attorney general and a Catholic hospital group challenging the new rule (see State of Florida et al v. HHS et al.) In addition, litigation related to other civil rights protections (Bostock v Clayton County, Georgia) has implications for Section 1557 and, in particular, this regulation’s interpretation of nondiscrimination based on sex. (Box 1)
Box 1: Impact of Bostock v Clayton County, Georgia on Section 1557
In June 2020, just three days after the Trump Administration rule was finalized, the Supreme Court ruled in Bostock v Clayton County, Georgia that in the context of employment, discrimination based on sex encompasses sexual orientation and gender identity. The Bostock ruling does not directly apply to 1557 because it was based on interpretation of sex protections under Title VII and the 1557 sex protections are pulled in through Title IX. However, courts have historically looked to Title VII in interpreting Title IX, including in cases where plaintiffs challenged the Trump-era rule. As such, prior to issuing the new regulation, the Biden Administration issued guidance in May 2021 stating it would interpret and enforce 1557’s sex nondiscrimination provisions to include protections on the basis of sexual orientation and gender identity in light of and consistent with Bostock.
The final rule closely mirrors a proposed rule issued by the Biden administration in July of 2022 and is, in many ways, a reversal of the final rule issued by the Trump Administration in June of 2020, which itself was a significant departure from the Obama Administration regulations issued in 2016. This final rule reinstates and expands upon much of those 2016 regulations. Compared to the previous rules, key changes in the Biden Administration final rule include:
Box 2: Abortion – Protections from Sex Discrimination Includes Pregnancy Termination
The ACA protects providers and programs based on their willingness to provide, pay for, cover, or refer for abortion or to provide or participate in such trainings. The new final Section 1557 rule includes protections for patients on discrimination on the basis of having had actual or perceived abortions. OCR explains that a covered provider’s decision not to provide an abortion is not a violation of Section 1557 unless the provider chooses not to provide abortion for a particular individual based on a protected ground such as race. Some commenters “expressed concern that Dobbs created tension between health providers, and patients, increasing distrust in providers and that it has created chaos in the health care system. They state this has increased the risk that patients will experience discriminatory care and suffer delays in lifesaving treatment as a direct result of legal and medical uncertainty. These commenters said that discrimination in care propagates more distrust, which is a significant barrier for individuals seeking care and is precisely what section 1557 was designed to protect against.” OCR responded to these concerns noting that it is considering revisions to the HIPAA Privacy Rule to strengthen privacy protections for individuals’ protected health information related to reproductive health care.
Box 3: Care and Access for Transgender People – Protections from Sex Discrimination Include Gender Identity
Section 1557’s regulatory treatment of sexual orientation and gender identity has changed considerably over time. The 2016 Obama Administration rule interpreted sex nondiscrimination protections to include gender identity and sex stereotyping (among other identities) but not sexual orientation. At that time, HHS stated it would “evaluate complaints alleging sex discrimination … sexual orientation” on a case-by-case basis and anticipated that case law would evolve as to clarify whether sexual orientation could be covered. The Trump Administration did not define sex in the regulatory text but in the preamble suggested it would interpret sex to mean only biological sex assigned at birth. The Biden Administration interpreted sex to include sexual orientation and gender identity (among other identities), reaffirming its earlier guidance which took the same approach, in light of Bostock (see Box 1). It also extends these protections to include intersex people for the first time.
As noted above, the new rule also reinstates explicit prohibitions on discrimination based on gender identity and sexual orientation in regulations outside of Section 1557 that had been put in by the Obama Administration but eliminated through the Trump Administration’s 1557 rule.
***
In addition, the rule, in text and preamble, spells out specific protections for transgender people and access to gender affirming care including that entities cannot refuse gender affirming care services that would be provided to an individual for other purposes, if the limitation is based on sex or gender and that the categorical exclusions of gender affirming care is prohibited. It does not prohibit nondiscriminatory denial of services with the preamble noting “OCR has a general practice of deferring to a clinician’s judgment about whether a particular service is medically appropriate for an individual, or whether the clinician has the appropriate expertise.” OCR states any investigations will not focus on clinical judgment per se but rather whether that judgment reflects unlawful bias, The rule also does not prevent a covered entity from availing itself of religious freedom and creates new pathways for asserting such protections. (Additional details in Table 1.)
***
Some commenters had specific concerns regarding the rule’s application to “State laws that prohibit access to gender-affirming care…” OCR responded that “some States may have laws…that are contrary to the final rule’s nondiscrimination protections, and…section 1557 preempts those laws.” The conflict between state and federal law in this case is unresolved and the Florida Attorney General, along with a Catholic medical group, has filed suit alleging that the rule requires providers to provide gender affirming care and violates protections.
Table 2 summarizes the major provisions of HHS’s new final rule and provides a side-by-side comparison to the Obama (2016) and Trump (2020) administration rules.
A new KFF poll finds that many older voters are unaware of the provision in the Inflation Reduction Act that for the first time requires the federal government to negotiate the price of some prescription drugs in the Medicare program, a key campaign issue for President Joe Biden.
The 48% of voters ages 65 and older who are aware of the landmark change represents a 12 percentage point increase from November, the poll shows.
Fifty-two percent of older voters are aware of another provision in the IRA, signed into law by Biden in 2022, that has received attention, capping the out-of-pocket cost of insulin for people on Medicare at $35 per month. And 40% are aware of another less widely discussed but significant provision that places an annual limit on out-of-pocket costs for people on Medicare, up from 27% in November.
The poll probed voters’ views of major health policy issues and how they line up with the presidential candidates’ approaches, both in office and on the campaign trail.
“It is commonly believed this is not a health care election because there is no national health reform debate,” said KFF President and CEO Drew Altman. “But in a close election voter concerns about a variety of health care issues, including abortion, prescription drugs and health care costs, could add up and make a difference in key states.”
The poll also finds that large majorities of voters overall, and across political identification, support extending to all adults with health insurance several of the IRA’s Medicare drug provisions – echoing what Biden has proposed. That includes the monthly insulin cost cap, favored by 88% of Democratic voters and 89% of Republican voters, and the annual drug spending limit, backed by 85% of Democrats and 87% of Republicans. Three-quarters of voters (75%) want to expand the number of Medicare drugs covered by price negotiations, including 79% of Democrats and 68% of Republicans.
Trust on health issues
On health care issues overall, partisans predictably put more trust in their own party’s candidate, but the poll shows that Biden has a clear trust advantage over former President Donald Trump with independent voters, a key voting group, on many areas of health care.
The poll finds that independent voters tilt toward Biden over Trump when it comes to whom voters trust more to determine the future of the ACA (49% v. 23%); ensure access to affordable health insurance (47% v. 22%); maintain protections for people with pre-existing health conditions (47% v. 23%); and determine the future of Medicare (44% v. 23%) and Medicaid (44% v. 24%).
On the issue of health care costs, which rises to the top of many voters’ concerns, Biden has a somewhat smaller advantage over Trump with independent voters (39% v. 26%) — although about a third (34%) of independent voters say they trust neither candidate on this issue.
At the same time, among all voters – not specifically independents — most are pessimistic about what either candidate would accomplish in addressing the issue of prescription drug costs. Fewer than half of voters say it is “very” or “somewhat” likely that Biden’s policies would lower prescription drug costs for people on Medicare (47%) or for everyone (43%) if he were re-elected. About four in ten voters say the same about Trump (41% for people with Medicare, 40% for everyone).
Abortion policy
The poll examined voter support for two broad approaches to abortion policy, among the most contentious issues in the election. Most voters (62%) support guaranteeing a federal right to abortion, as advocated by Biden. Fewer (42%) support leaving it up to individual states to decide the legality of abortion, as advocated by Trump.
While partisans divide, the share of Democratic voters who support a federal guarantee (89%) is larger than the share of Republican voters who support leaving the matter up to the states (60%). About six in ten (62%) independent voters favor a federal right to abortion. (For a deeper look at abortion in the election, see KFF’s March 2024 Health Tracking Poll.)
Future of the ACA
Although a majority of voters have favorable views of the ACA, attitudes towards the law continue to be marked by partisanship, with Democrats expressing more favorable views of the ACA than Republicans.
Nevertheless, the poll shows majority support (72%) for extending enhanced federal financial assistance for people who purchase ACA marketplace coverage. That includes large majorities of Democratic (90%) and independent voters (73%) and a smaller majority of Republican voters (57%). The enhanced subsidies are scheduled to expire at the end of 2025.
A large majority of voters say they think Trump – who tried to repeal the ACA when he was president – would either try to repeal the ACA (50%) or scale back what the law does (30%) if he is re-elected. Republican voters are less likely than Democratic voters to say Trump would attempt to repeal the entire ACA (37% v. 67%). Previous KFF polling has found that few voters think Trump has a plan to replace the ACA.
Future of Medicare, Medicaid, and Social Security
Majorities of voters are worried that, in the future, people covered by Medicare, Social Security, and Medicaid won’t be able to get the same level of benefits that are available today, with at least three in four saying they are at least somewhat worried about this when it comes to Social Security (83%), Medicare (78%), and Medicaid (73%). A recent report by the Medicare and Social Security trustees projects both programs will have insufficient funds to pay full benefits in about a decade.
When it comes to determining the future of these programs, voters overall are mixed in terms of which candidate they trust more, but older voters give a clear advantage to Biden. For example, about half of voters ages 65 and older say they trust Biden more to determine the future of Social Security (49%), Medicare (49%), and Medicaid (50%), while about a third of older voters say they trust Trump more on each.
Regarding Medicaid, the poll finds most voters across gender, age, and racial and ethnic groups are opposed to the idea of capping the federal government’s contribution to the states in paying for the program. However, while large shares of Democratic voters (87%) and independent voters (74%) say they want Medicaid to continue as it is today, Republican voters are evenly divided, with 50% preferring Medicaid to stay as it is today and 49% saying the federal government should limit how much it pays states and give them greater flexibility to administer their Medicaid programs.
Designed and analyzed by public opinion researchers at KFF. The survey was conducted April 23-May 1, 2024, online and by telephone among a nationally representative sample of 1,243 registered voters in English and in Spanish. The margin of sampling error is plus or minus 4 percentage points for registered voters. For results based on other subgroups, the margin of sampling error may be higher.
Former President Donald Trump and President Joe Biden are now the presumptive nominees for the Republican and Democratic parties, and their respective records as president and their campaign platforms suggest very different visions for the future of U.S. health care. This new KFF Health Tracking Poll looks at voters’ views of some of the country’s major health and entitlement programs and how these views line up with the candidates’ approaches to these issues based on their track records, policy positions, and statements on the campaign trail. While previous polls show that many other issues outrank health care on voters’ minds this election cycle (and issues are only one part of how voters make decisions), these findings help illustrate how voters may react to talking points about health care that the candidates may make during the course of the campaign.
When it comes to trust of the presumptive 2024 presidential candidates, larger shares of voters trust President Joe Biden than former President Donald Trump on several key health care policy issues, but neither candidate has a clear lead when it comes to addressing high health care costs, with similar shares of voters saying they trust Biden (38%) and Trump (36%).
Not surprisingly, voters are split along party lines in their trust of the presumptive candidates on health care issues, with Democrats largely trusting Biden over Trump and Republicans trusting Trump over Biden. Still, even among partisans, substantial shares say they trust “neither” candidate on some health care issues. For example, about one in five Democratic voters and Republican voters say they trust “neither” candidate to address high health care costs.
Independent voters are more likely to say they trust Biden more than Trump in each are of health care, including addressing care costs. Biden has a notable trust lead among independent voters when it comes to determining the future of the ACA (49% v. 23%), ensuring access to affordable health insurance (47% v. 22%), and maintaining protections for people with pre-existing health conditions (47% v. 23%) and a substantial lead on determining the future of Medicare (44% v. 23%) and Medicaid (44% v. 24%). When it comes to addressing high health care costs, independent voters give the edge to Biden, with four in ten (39%) saying they trust him more compared to a quarter (26%) for Trump. However, a third (34%) of independent voters say they don’t trust either candidate.
Lowering prescription drug prices has been a frequent talking point of both President Biden and former President Trump. While Trump kept drug prices on the political agenda during his time as president, his administration ultimately did little to contain them. President Biden has touted passage of the Inflation Reduction Act (IRA), including its provisions aimed at lowering prescription drug prices for people with Medicare, as one of the signature achievements of his administration.
Most voters overall are unaware of the Medicare drug pricing provisions in the IRA, but awareness is higher among older voters and among Biden’s base of voters who identify as Democrats. Overall, about a third of voters correctly say there is a federal law in place that requires the federal government to negotiate the price of some prescription drugs for people with Medicare (36%) or one that caps the cost of insulin for people with Medicare (35%), while about a quarter (27%) know there is a law that limits annual out-of-pocket prescription drug costs for people with Medicare and one in seven (14%) know there is a law that penalizes drug companies for increasing prices for Medicare faster than the rate of inflation.
Awareness of these provisions is higher among voters ages 65 and older – a group that is mostly covered by Medicare and tends to vote at higher rates than younger adults. About half (52%) of older voters are aware of the IRA’s $35 cap on insulin for people with Medicare and a similar share (48%) correctly identify that there is a law that requires the federal government to negotiate the price of prescription drugs for Medicare enrollees.
Across partisans, fewer than half of Democrats, independents, and Republican voters are aware of any of these health care provisions. However, Democratic voters are more likely than Republican voters to correctly say there is a law that caps the cost of insulin for people with Medicare at $35 per month (46% v. 28%) or requires the federal government to negotiate the price of some prescription drugs for people with Medicare (43% v. 32%).
Voter awareness of the IRA’s $35 insulin cap for people with Medicare has increased by about seven percentage points since November 2023 when about a quarter (28%) of voters were aware of this provision of the IRA. Awareness of the IRA’s other Medicare drug pricing provisions has not changed significantly among all voters since November, but there have been increases in awareness of some provisions among Democratic voters and older voters, suggesting that Biden’s campaigning on the successes of the IRA may be breaking through with some groups.
Among Democratic voters, between November 2023 and May 2024 there was a 12 percentage point increase in the share correctly identify the cap on insulin (from 34% to 46%) and an 8 percentage point uptick in awareness of the law placing limits on out-of-pocket prescription drug costs for people with Medicare (from 24% to 32%). Similarly, among voters ages 65 and older, the share who are aware there is a federal law that limits annual out-of-pocket prescription drug costs for people with Medicare increased from 27% to 40% between November and May, the share who are aware of the negotiation provision increased from 36% to 48%, and the share who are aware there is a law that penalizes drug companies for increasing prices faster than the rate of inflation for people with Medicare from 9% to 15%.
President Biden has expressed support for several policies that would extend some of the prescription drug provisions of the IRA to cover all adults with private insurance. The KFF Health Tracking Poll finds that large shares of voters support these proposals, including capping monthly out-of-pocket costs for insulin for all adults with health insurance (86%) and placing a limit on out-of-pocket prescription drug costs for all adults with health insurance (84%).
Large majorities across partisans support both drug pricing provisions, including nearly nine in ten Democratic voters (88%) and Republican voters (89%) who support capping out-of-pocket costs for insulin and similar shares who support placing an out-of-pocket limit on prescription drug costs (85% of Democrats and 87% of Republicans).
Voters are also supportive of expanding the Medicare prescription drug price negotiation of the IRA to cover a larger number of drugs. Under the law, negotiated prices will take effect for 10 prescription drugs in 2026, increasing to a total of 60 drugs by 2029. Three-quarters (75%) of voters say the law should be expanded by increasing the number of drugs subject to price negotiation. Another 15% think the law should be kept as is, while one in ten (10%) voters want the law to be repealed.
Among the biggest proponents for expansion of the drug price negotiation aspect of Medicare are those ages 65 and older (80% want the law to be expanded) and Democratic (79%) and independent (80%) voters. However, a majority of Republicans (68%) also agree that the law should be expanded.
While most voters are supportive of the proposals President Biden has made for addressing prescription drug costs, most are pessimistic about what either candidate would accomplish in this area if elected, with fewer than half saying it is “very” or “somewhat” likely that Biden’s policies would lower prescription drug costs for people on Medicare (47%) or for everyone (43%) if he were re-elected. About four in ten voters say the same about former President Trump (41% for people with Medicare, 40% for everyone).
Not surprisingly, majorities of partisans say they think it is likely their party’s respective candidate will lower drug costs if elected, while few say the same about the other party’s candidate. Among independent voters, about half think it is likely that Biden’s policies would lower prescription drug costs for people with Medicare (52%) or for everyone (48%), while slightly fewer say the same about Trump (39% and 37%, respectively).
The March KFF Health Tracking Poll provided an extensive look at voters’ views of abortion and the role it may play in the upcoming election. In this poll we examine voter support for two approaches to abortion policy for which President Biden and former President Trump have voiced support. President Biden has expressed support for a federal right to abortion while former President Donald Trump has stated that abortion policies should be left to the states. When it comes to abortion policy – a key voting issue for Democratic and younger voters in this election – a majority of voters (62%) support guaranteeing a federal right to abortion while fewer (42%) support leaving it up to individual states to decide the legality of abortion1 .
About nine in ten (89%) Democratic voters support guaranteeing a federal right to abortion compared to about six in ten independent voters (62%) and one-third of Republican voters (34%). Conversely, about six in ten Republican voters support leaving abortion up to individual states compared to 42% of independent voters and a quarter (26%) of Democratic voters.
Those who plan on voting for Biden in 2024 (90%), Democrats (89%), young voters ages 18-29 (79%), and Black voters (78%) are among the largest groups in support of guaranteeing a federal right to abortion. Majorities of those who plan to vote for Trump in 2024 (63%) and Republican voters (60%), support leaving abortion up to individual states.
Besides issues of prescription drugs prices for Medicare, there are signs that Trump and Biden would approach the future of the nation’s major health and entitlement programs differently if elected. Majorities of voters have a favorable opinion of the major entitlement programs, with at least three in four voters saying they have a “very” or “somewhat” favorable opinion of Medicare (80%), Social Security (78%), and Medicaid (75%). A smaller share of voters – but still a majority — say they have a favorable opinion of the Affordable Care Act (ACA), or Obamacare (60%). While its passage and enactment were embroiled in partisan battles, the public has consistently held a more favorable than unfavorable view of the ACA since 2018.
While Democratic voters are somewhat more likely than Republican voters to express favorable views of Medicare, Medicaid, and Social Security, majorities across partisans are favorable towards each of these programs. Partisan divisions are more notable when it comes to the ACA, with nine in ten Democratic voters (90%) holding favorable views of the ACA compared to a third (32%) Republican voters – a share that has increased since the law was enacted (in April 2020, just 11% of Republican voters had a favorable view of the law).
Medicare, Social Security, Medicaid, and the ACA are also popular with voters across age groups, although voters ages 65 and older are somewhat more likely than younger voters to express favorable opinions of Social Security and Medicare – programs that largely provide benefits to older adults. In turn, younger voters ages 18-29 are more likely than older voters to have a favorable opinion of Medicaid.
When it comes to determining the future of Social Security, Medicare, and Medicaid, neither candidate garners a clear majority of trust among voters on all three items. About four in ten voters overall say they trust President Biden more to determine the future of Medicare and Medicaid, while one-third trust former President Trump more. Voters are more evenly split on the future of Social Security, with 38% who trust Biden more and 36% for Trump.
Older voters, a key voting bloc and the primary beneficiaries of Social Security and Medicare, are more likely to trust Biden when it comes to determining the future of each program. About half of voters ages 65 and older say they trust Biden more to determine the future of Social Security (49%), Medicare (49%), and Medicaid (50%), while about a third of older voters say they trust Trump more on each.
Majorities of voters are worried that, in the future, people covered by Medicare, Social Security, and Medicaid won’t be able to get the same level of benefits that are available today, with at least three in four saying they are at least somewhat worried about this when it comes to Social Security (83%), Medicare (78%), and Medicaid (73%). While large shares of voters across the age spectrum worry about future benefits available under these programs, worries about future benefits under Medicare and Social Security tend to peak among those ages 50-64, the next age group to become eligible for these programs in the coming years. A new report issued by the Medicare and Social Security trustees projects both programs will have insufficient funds to pay full benefits in about a decade.
While former President Trump’s remarks on the future of entitlement programs have been inconsistent, in some appearances he has criticized the Social Security and Medicare programs, stating that he will cut these programs by targeting “waste” and “fraud.” Many voters agree that fraud, waste, and abuse are problems in the nation’s entitlement programs, with over half saying fraud, waste, and abuse are a “major” problem in Medicaid (60%), Medicare (55%), and Social Security (53%). For context, 58% of adults also see fraud, waste, and abuse as a major problem in private health insurance.
Larger shares of Republican voters say fraud, waste, and abuse are a “major” problem in Medicare Medicaid, and Social Security than Democrats, with no differences by partisanship when it comes to concerns about private health insurance.
Former President Trump has not released any detailed statements on his plans for the future of Medicaid if elected, but his budget proposals as president included plans to cap federal Medicaid spending. Asked which comes closer to their view of what Medicaid should look like in the future, seven in ten voters say “Medicaid should largely continue as it is today, with the federal government guaranteeing coverage for low-income people, setting standards for who states cover and what benefits people get, and matching state Medicaid spending as the number of people on the program goes up or down.” About three in ten voters (29%) say “Medicaid should be changed so that instead of matching state Medicaid spending and setting certain requirements for health coverage, the federal government limits how much it gives states to help pay for Medicaid and states have greater flexibility to decide which groups of people to cover without federal guarantees.”
Majorities of voters across gender, age, and racial and ethnic groups agree that Medicaid should largely continue as it is today. However, while large shares of Democratic voters (87%) and independent voters (74%) say they want Medicaid to continue as it is today, Republican voters are evenly divided, with 50% preferring Medicaid to stay as it is today and 49% saying the federal government should limit how much it pays states and give states greater flexibility to administer their Medicaid programs.
Under the ACA, most states have expanded their Medicaid programs to cover more low-income people. For states that expand their Medicaid program, the federal government pays for 90 percent of the costs of this expansion with the state paying the rest.
Two-thirds (63%) of voters who live in a non-expansion state want their state to expand Medicaid to cover more low-income uninsured people, while one-third (36%) would rather keep Medicaid as it is today. Expanding Medicaid is largely split along partisan lines, with nearly nine in ten (86%) of Democrats or Democratic-leaning independent voters who live in a state without Medicaid expansion saying they want to expand Medicaid, compared to six in ten (59%) of Republicans or Republican-leaning independent voters who want to keep Medicaid as it is today.
Although a majority of voters now have favorable views of the ACA, attitudes towards the law overall continue to be marked by partisanship. Three quarters of Republican voters say they would support “repealing and replacing” the ACA, as do about half of independent voters. This poll did not test other options (such as expanding or scaling back the law, which generally produce much lower levels of support for repeal). Previous polling and past repeal efforts have shown that public support for repeal erodes considerably when popular provisions like the protections for people with pre-existing conditions are put at risk, so while these views don’t imply that repealing the ACA is a political reality, they do suggest there is some receptivity among Republican voters to “repeal and replace” as a talking point. Previous KFF polling has found that few voters think Trump has a plan to replace the ACA.
Aside from views on repeal, there is majority support for strengthening one key piece of the ACA: about seven in ten voters (72%) support extending financial assistance for people who purchase health coverage through the ACA marketplace, including large majorities of Democratic (90%) and independent voters (73%) and a smaller majority of Republican voters (57%). Notably, two-thirds (65%) of voters are worried that in the future, people covered by ACA marketplace insurance will not be able to get the same level of benefits that are available today.
While former President Trump recently stated he is not running to terminate the ACA, he has routinely criticized the law, saying he will make it “better” and “less expensive” and unsuccessfully pushed to repeal it during his time in office. A large majority of voters think Trump would try to either repeal the ACA (50%) or scale back what the law does (30%) if he is re-elected in 2024. About one in eight voters (12%) say they think he will keep the law as is and just 7% say they think he would try to expand what the law does. Despite the large share of Republican voters saying they would support repealing and replacing the ACA, Republican voters are less likely than Democratic voters to say they think Trump would attempt to repeal the entire ACA if elected in 2024 (37% v. 67%).
This KFF Health Tracking Poll/Health Misinformation Tracking Poll was designed and analyzed by public opinion researchers at KFF. The survey was conducted April 23-May 1, 2024, online and by telephone among a nationally representative sample of 1,479 U.S. adults in English (1,396) and in Spanish (83). The sample includes 1,201 adults (n=65 in Spanish) reached through the SSRS Opinion Panel either online (n=1,176) or over the phone (n=25). 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 278 (n=18 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, two 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 2023 Current Population Survey (CPS), September 2021 Volunteering and Civic Life Supplement data from the CPS, and the 2023 KFF Benchmarking survey with ABS and prepaid cell phone samples. The demographic variables included in weighting for the general population sample are sex, 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 parameters above plus recalled vote in the 2020 presidential election by county quintiles grouped by Trump vote share. 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 3 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.
| Group | N (unweighted) | M.O.S.E. |
| Total | 1,479 | ± 3 percentage points |
| Total registered voters | 1,243 | ± 4 percentage points |
| Republican registered voters | 372 | ± 7 percentage points |
| Democratic registered voters | 417 | ± 6 percentage points |
| Independent registered voters | 323 | ± 7 percentage points |
| Have ever used GLP-1 drugs | ||
| Yes | 189 | ± 9 percentage points |
| No | 1,288 | ± 4 percentage points |
KFF’s latest Health Tracking Poll examines the public’s views and use of an increasingly popular group of drugs that include Ozempic, Wegovy, Mounjaro and others that belong to a class of prescription medications known as GLP-1 agonists3 . GLP-1 drugs have garnered an increasing amount of media attention and some notable celebrity endorsements in the U.S., with much of the focus on their use for weight loss, though many of these drugs are also prescribed to treat diabetes or reduce risk of heart attack or stroke.
A large and increasing share of the public say they have heard about GLP-1 drugs, with about eight in ten (82%) adults saying they have heard at least “a little” and about three in ten (32%) saying they have heard “a lot” about these drugs. The share of the public who report having heard about these drugs has increased since July 2023 when seven in ten adults reported having heard at least “a little” about these drugs and one in five (19%) said they had heard “a lot.”
The share who say they have heard “a lot” about these drugs rises to at least four in ten among those who have ever been told by a doctor that they have diabetes (45%) or heart disease (41%) or have been told by a doctor in the past five years that they are overweight or obese (42%) – the primary conditions these drugs are prescribed for.
Across age groups, awareness of these drugs is highest among older adults. About four in ten adults ages 50 to 64 and 65 and older say they have heard “a lot” about GLP-1 drugs, compared to about one-third of adults ages 30-49 (32%) and one in six adults ages 18-29 (17%). Notably, older adults are more likely than their younger peers to have been told by a doctor that they have diabetes or heart disease.
Adults with annual household incomes of $90,000 or greater are more likely than those with lower household incomes to say they have heard “a lot” about these drugs.
Overall, 12% of adults say they have ever used GLP-1 drugs, including 6% who say they are currently using them. The share who report ever taking these drugs rises to about four in ten (43%) among adults who have been told by a doctor that they have diabetes, a quarter (26%) of adults who have been told they have heart disease, and one in five (22%) adults who have been told by a doctor that they are overweight or obese in the past five years (some of whom also have diabetes or heart disease).
Black adults are somewhat more likely than White adults to report ever taking these drugs (18% v. 10%), while 13% of Hispanic adults say they have taken these drugs. KFF’s analysis of Centers for Disease Control (CDC) data shows that Black and Hispanic adults in the U.S. have a higher rate of obesity than White adults. For additional information on obesity rates and racial disparities, see KFF’s policy watch: What are the Implications of New Anti-Obesity Drugs for Racial Disparities?
Similar shares of adults regardless of gender, income, or health insurance coverage report taking these drugs.
Among the 12% of adults who have ever taken GLP-1 drugs, most report taking them, at least in part, to treat a chronic condition like diabetes or heart disease, with fewer saying they took them only to lose weight. Among those who have taken these drugs, six in ten (62%) say they took them to treat a chronic condition like diabetes or heart disease, including about four in ten (39%) who took them only to treat a chronic condition and one in four (23%) who say they took them to both treat a chronic condition and to lose weight. About four in ten (38%) adults who have taken these drugs report using them only to lose weight.
Among all adults, 7% say they have taken or are taking these drugs to treat a chronic condition such as diabetes or heart disease – either alone (5%) or in combination with intent of losing weight (3%) – while 5% of adults report ever taking these drugs to lose weight but not to treat a chronic condition.
About one in five (19%) adults ages 50-64 say they have ever taken GLP-1 drugs, higher than the shares reported by other age groups. Among adults ages 50-64, 15% say they have taken GLP-1 drugs to treat a chronic condition and 5% say they’ve taken them for weight loss only. Few adults under age 50 report having taken these drugs to treat chronic conditions, but similar shares of 18–29-year-olds (7%) and 30–49-year-olds (6%) report having taken them for weight loss. Among adults ages 65 and over, 8% say they have taken a GLP-1 medication for a chronic condition, while just 1% say they have taken these drugs only to lose weight, which may be a reflection of Medicare’s lack of coverage for prescription drugs used for weight loss. Nearly four in ten (37%) adults ages 65 and older report being told by a doctor they are overweight or obese in the past five years.
Alongside the relatively high cost of GLP-1 drugs in the U.S., there have been recent reports of shortages or limited availability of these drugs occurring as demand increases. Recent news reports have emphasized that some adults are seeking generic or compounded versions of these drugs through sources such as medical spas or compounding pharmacies, which may sell products claiming to be name-brand GLP-1s that have not been vetted by the F.D.A.
About eight in ten (79%) adults who have taken GLP-1 drugs report getting these drugs or a prescription for them from their primary care doctor or a specialist, while fewer report getting them from an online provider or website (11%), a medical spa or aesthetic medical center (10%), or from somewhere else (2%).
In the U.S., list prices for GLP-1 drugs can range from $936 to $1,349 before insurance coverage, rebates or coupons. Most insured adults who have taken GLP-1 drugs say their insurance covered at least part of the cost. Among adults with health insurance who report ever taking these drugs, over half (57%) say their health insurance covered part of the cost of these drugs and they paid the rest, while one in four (24%) say their health insurance covered the full cost. One in five (19%) insured adults who have taken GLP-1s say they paid for the full cost themselves.
Despite the fact that few insured adults say they paid the full cost of these drugs themselves, many report difficulty affording them. About half of adults who have taken GLP-1s say it was difficult to afford the cost of these drugs. Among those who have taken these drugs, about half (54%) – including 53% of those with health insurance – say it was either “somewhat” or “very difficult” to afford to pay for these drugs, including one in five (22%) who say it was “very difficult,” including a similar share of adults with health insurance (23%).
While some Medicare drug plans cover the cost of some GLP-1s such as Ozempic or Wegovy when prescribed to treat diabetes or prevent heart attacks or strokes for adults with heart disease, Medicare is currently prohibited by law from covering drugs when prescribed for weight loss – for more information, see KFF’s issue brief on Medicare coverage of GLP-1s. KFF’s latest Health Tracking Poll finds that most adults think Medicare should cover the cost of these drugs when prescribed for weight loss for people who are overweight, with support remaining largely unchanged after hearing arguments for and against this proposal.
Overall, six in ten adults (61%), including similar shares across age groups, say they think Medicare should cover the cost of these drugs when prescribed for weight loss for people who are overweight, a share that rises to about seven in ten (71%) among those who have ever taken these drugs.
While more than half of adults across partisans say Medicare should cover the cost of these drugs for weight loss, Democrats (66%) are somewhat more likely than Republicans (55%) to say this.
Attitudes on some policy proposals may change when the public hears different arguments in favor or against certain proposals. After asking whether Medicare should cover the cost of GLP-1s when prescribed for weight loss for people who are overweight, the poll presented two different arguments for and against this proposal:
Argument against: Some people say that if Medicare covers the cost of these drugs, it could increase premiums paid by people with Medicare and place financial pressure on the Medicare program and the federal budget.
Argument in favor: Others say that if Medicare covers the cost of these drugs, it could help more people afford these medications and improve health and quality of life for people who are overweight.
After being presented with these arguments, the public’s attitudes remain largely unchanged, with six in ten adults still saying they think Medicare should cover the cost of these drugs when prescribed for weight loss for people who are overweight. Attitudes also remained largely unchanged among adults 65 and older, among those who have taken GLP-1s and those who have not, and among independents and Republicans. Among Democrats, there is a slight increase in the share who say Medicare should cover the cost after hearing these arguments (71% after v. 66% before).
This KFF Health Tracking Poll/Health Misinformation Tracking Poll was designed and analyzed by public opinion researchers at KFF. The survey was conducted April 23-May 1, 2024, online and by telephone among a nationally representative sample of 1,479 U.S. adults in English (1,396) and in Spanish (83). The sample includes 1,201 adults (n=65 in Spanish) reached through the SSRS Opinion Panel either online (n=1,176) or over the phone (n=25). 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 278 (n=18 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, two 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 2023 Current Population Survey (CPS), September 2021 Volunteering and Civic Life Supplement data from the CPS, and the 2023 KFF Benchmarking survey with ABS and prepaid cell phone samples. The demographic variables included in weighting for the general population sample are sex, age, education, race/ethnicity, region, civic engagement, frequency of internet use, political party identification by race/ethnicity, and education. The 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 3 percentage points. 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.
| Group | N (unweighted) | M.O.S.E. |
| Total | 1,479 | ± 3 percentage points |
| Have ever used GLP-1 drugs | ||
| Yes | 189 | ± 9 percentage points |
| No | 1,288 | ± 4 percentage points |
About one in eight adults (12%) say they have taken one of an increasingly popular class of prescription drugs known as GLP-1s that are used for weight loss and to treat diabetes and reduce the risk of heart disease and stroke, a new KFF Health Tracking Poll finds. This includes 6% of adults who say they are currently taking one of these drugs, which include Ozempic, Wegovy and MounjaroThe shares of adults who report ever taking these drugs is highest among people with diabetes (43%), followed by those with heart disease (26%) and those who have obesity or overweight (22%), the poll finds. Among those who report ever taking the drugs, most (61%) say that they took the drugs to treat a chronic condition such as diabetes or heart disease – either alone (39%) or in combination with losing weight (23%). Nearly four in ten (38%) say that they took the drugs solely to lose weight.
List prices for GLP-1 drugs can top $1,000 for a month’s supply prior to insurance coverage, rebates, and discount coupons. About half (54%) of those who report ever taking the drugs say it was difficult to afford them, including one in five (22%) who say it was “very difficult.” Having insurance coverage makes little difference to patients’ perceptions of the drugs’ affordability, with similar shares of those covered by insurance saying the drugs were difficult (53%) or very difficult (23%) to afford.
Most of the Public Favors Medicare Coverage of Weight-Loss Drugs Even After Hearing Competing Arguments
While 9% of older adults ages 65 and older report ever taking the drugs, few (1%) say they did so solely for weight loss – likely reflecting Medicare’s prohibition on the coverage of prescription weight-loss drugs. Medicare covers some of the drugs for diabetes and other conditions.
About six in ten adults (61%) say that Medicare should cover these drugs when prescribed for weight loss for people who are overweight. This includes similar shares across age groups, and more than half of Democrats, independents, and Republicans.The poll also tested the impact of arguments for and against Medicare coverage, with short descriptions explaining that it could increase premiums for people with Medicare and place financial pressure on the Medicare program and the federal budget, but that it could help more people afford the medications and improve the health and quality of life of people who are overweight.Those arguments did little to change the public’s views, with similar shares of the public overall and the various subgroups continuing to favor Medicare coverage.
Other findings include:• About eight in ten (82%) adults say they have heard at least “a little” about these drugs, including about three in ten (32%) who say they have heard “a lot” about them. Awareness is up since July 2023, when about one in five (19%) said they heard a lot about the drugs.• About eight in ten (79%) adults who have taken GLP-1 drugs report getting these drugs or a prescription for them from their primary care doctor or a specialist. Fewer report getting them from an online provider or website (11%), a medical spa or aesthetic medical center (10%), or somewhere else (2%).
Designed and analyzed by public opinion researchers at KFF. The survey was conducted April 23-May 1, 2024, online and by telephone among a nationally representative sample of 1,479 U.S. adults in English and in Spanish. The margin of sampling error is plus or minus 3 percentage points for the full sample. For results based on other subgroups, the margin of sampling error may be higher.