We had the first glimpse of how the congressional debate in Washington over the federal shutdown and extending the enhanced premium tax credits for people who purchase coverage on the ACA marketplaces may be impacting voters’ decisions in upcoming elections last night. Looking at the 2025 Voter Poll results from Virginia and New Jersey, the economy remains the top issue for voters (48% of voters in Virginia said it was the most important issue facing the state as did 32% of New Jersey voters), health care came in behind economic issues with about one in five voters saying it was their most important issue. And this group of voters went disproportionately for the Democratic candidates. For example, in Virginia, the Democratic candidate for Governor won 81% of voters who said health care was the most important issue facing the state. The only group that the Republican candidate did as well with was the 11% of voters who said immigration was their top issue. In New Jersey, Democratic gubernatorial candidate Mikie Sherrill won 92% of health care voters. Notably, both Democratic candidates for Governor also won a majority of voters who said the economy was their most important issue – a group that President Trump won handedly back in 2024. After Tuesday’s elections, it is becoming increasingly difficult to disentangle concerns about the economy and concerns about health care as costs become the most pressing health care issue for voters, as CEO Drew Altman and I have both argued in the past.
There are many caveats and cautions before predicting how this off-year election and the current debate and government shutdown will play out a year from now including the fact that these election results are limited to two states and elections are often more about specific candidates than actually about issues. In addition, if there is a deal on the ACA tax credits, it will no longer serve as a talking point for candidates. However, the results do underscore the advantage that Democratic candidates still have on health care issues. And as economic issues and health care concerns become even more intertwined, as seen in the debate over the ACA tax credits in Washington, voters may give the upper hand to Democratic candidates in the voting booth. The 2025 election results highlight the growing importance of addressing health care costs in both policy debates and electoral choices.