KFF Health Tracking Poll: Health Care Issues Emerge as Important Topics on 2024 Campaign Trail, Plus Concerns Loom Large Around Medicaid Unwinding | KFF

Key Takeaways

• With the 2024 presidential election cycle in full swing, voters want to hear the candidates talk about many different issues, and voters identify inflation, including the rising cost of household expenses, as the most important topic for discussion. Notably, the affordability of health care came in a close second with eight in ten voters saying it is “very important” for candidates to discuss on the campaign trail.
• Once a longstanding issue for the Republican Party, former President Trump has recently resurrected the debate around the future of the 2010 Affordable Care Act (ACA). Surveyed prior to this discussion, Democratic voters are more than twice as likely as Republicans voters to say the future of the ACA is a “very important” issue for the candidates to discuss (70% v. 32%). The Democratic Party holds an advantage on which party voters trust to do a better job of handling the ACA with six in ten (59%) voters saying they trust the Democratic Party more, compared to four in ten (39%) who say they trust the Republican Party more. Partisans differ, with nearly all Democratic voters saying they trust the Democratic Party (94%), while three in four (77%) Republican voters say they trust the Republican Party. The Democratic Party holds the advantage among independent voters (61% v. 36%).
• The 2024 election will be the first presidential election since the Dobbs decision. While few voters overall (4%) say abortion is the “most important” issue for 2024 presidential candidates to talk about as they campaign, the Democratic Party holds a strong advantage over the Republican Party on voters’ trust to handle abortion (58% vs. 41%). The Democratic Party hold the advantage on trust on this issue across key voting blocs including women voters overall (61%), women voters ages 18 to 49 (66%), independent women voters (66%), and almost all Democratic women voters (94%).
• While two-thirds of the public now say abortion should be legal in “all” or “most” cases, most voters (57%) say a candidate’s position on abortion is only one of many factors in their vote choice. About a quarter of voters (24%) say they would only vote for a candidate who shares their views on the issue, including larger shares of Democratic voters (33%), including three in ten Democratic women (31%) and one-third of Democratic men (35%) – groups where large majorities say abortions should be legal. Notably, one in four (27%) Republican voters who believe abortion should be illegal in “all” or “most” cases also say they would only vote for a candidate who shares their views on abortion. Among Republican voters who believe abortion should be legal in all or most cases, very few (4%) say they would only vote for a candidate who shares their views on the issue.
• The poll also takes a look at public awareness around two key health policy issues including the unwinding of the Medicaid continuous enrollment provision and the prescription drug provisions included in the 2022 Inflation Reduction Act, revealing that most of the public is unaware of these actions. Medicaid enrollees themselves are among the most likely to say they are aware of the unwinding, but still a majority say they have heard either “nothing” or “only a little” about the unwinding. Among those who are aware, large majorities are worried that this means many adults and children will become uninsured.

Key Issues in the 2024 Election

Less than one year until the 2024 election, there are many issues that voters are eager to hear about from presidential candidates, with two economic issues topping the list: inflation and the affordability of health care. Although inflation is now at a 2-year low, consumers continue to notice high prices. At least eight in ten voters say it is “very important” for the 2024 presidential candidates to talk about inflation (86%) or affordability of health care (80%). These are closely followed by the future of Medicare and Medicaid (75%) and access to mental health care (70%). About two-thirds of voters say it is “very important” for candidates to discuss immigration (65%), gun violence (65%) and prescription drug costs (64%) while on the campaign trail. For about half of voters, it is “very important” that candidates discuss the opioid crisis (53%), abortion (52%), the future of the ACA (49%), and climate change (48%), while fewer say it is “very important” for candidates to discuss aid to foreign countries (44%). On the other hand, fewer than one-fourth (22%) of voters say it is “very important” for candidates to be discussing COVID-19 heading into the 2024 election.

When asked to pick their top issue, four in ten (41%) voters say the “most important” issue for candidates to discuss is inflation, including the rising cost of household expenses. This is about three times the share of voters who say any other issue is the “most important” for candidates to discuss, such as gun violence (14%) or immigration (12%). Fewer voters say the affordability of health care (8%), the future of Medicare and Medicaid (6%), climate change (5%), abortion (4%), access to mental health care (3%), aid to foreign countries (2%), the opioid crisis (1%), prescription drug costs (1%), or the future of the Affordable Care Act are the “most important” topics on the campaign trail.

Partisan voters differ slightly on what issues they want the presidential candidates to discuss on the campaign trail. For Democratic voters, nine in ten say it is “very important” that candidates talk about affordability of health care (90%) and gun violence (89%), followed by about eight in ten who say inflation (81%) and access to mental health care (78%) are “very important.” The list of issues that are important to Republicans differs slightly, with nearly all Republican voters (96%) saying it is “very important” that inflation is discussed, eight in ten (82%) saying immigration is “very important,” and about seven in ten wanting to hear about the affordability of health care (71%) or the future of Medicare and Medicaid (70%).

Further down the list for partisans, some of the most polarized issues are climate change, with Democratic voters 51 percentage points more likely than Republicans to say this is a “very important” issue for candidates to talk about (73% v. 22%). Nearly three-fourths (72%) of Democratic voters say that abortion is a “very important” issue for candidates to discuss, compared to about four in ten (38%) Republican voters who say the same (a 34 percentage point difference). The future of the Affordable Care Act, an issue that was once a key health care issue for Republican voters, is now ranked as a “very important” issue for larger shares of Democratic voters (70%) than Republican voters (32%). This survey was fielded before former President Donald Trump reignited the issue by announcing that he plans to replace the 2010 health care law.

Yet, across partisans and among other key voting groups, inflation emerges among the top issues when voters are asked for their “most important” issue for candidates to discuss. For Democratic voters, Black voters, and voters ages 65 and older, similar shares rank gun violence and inflation as the most important issue. The future of Medicare and Medicaid emerges in the top five issues for adults over age 50, including 13% of adults ages 65 and older, and abortion makes its way into the top five issues for Democratic voters and younger voters.

In the figure below, use the drop-down menu to explore the top five “most important” issues among key subgroups:

When voters are asked which political party they trust to handle each of the issues presented, the Republican Party has a slight edge on inflation and the Democratic Party has the edge on health care related issues, climate change, abortion, and gun violence. Just over half (54%) of voters say they trust the Republican Party to do a better job to address inflation including the rising cost of household expenses, compared to 45% of voters who say they trust the Democratic Party more on this issue. The Republican Party also holds the advantage among voters on immigration (57% v. 41%) and aid to foreign countries (55% v. 41%).

The Democratic Party, however, has the edge on handing health care related issues such as access to mental health care (61% v. 37%), affordability of health care (59% v. 39%), the future of the ACA (59% v. 39%), the future of Medicare and Medicaid (59% v. 40%), abortion (58% v. 41%), and prescription drug costs (57% v. 42%). Nearly two-thirds of voters also say they trust the Democratic Party (63%) over the Republican Party (35%) to address climate change, and more than half (54%) say they trust the Democratic Party over the Republican Party (44%) to do a better job addressing gun violence.

Voters are split on which party they trust to do a better job handling the opioid crisis with half saying they trust the Democratic Party (50%) and a similar share saying they trust the Republican Party (48%).

To explore how key groups rank their top five “most important” issues they want candidates to discuss, and which political party they trust on each of those issues, use the toggles on the figure below:

Abortion in the 2024 Election

After the Dobbs decision overturned Roe v. Wade in June 2022, decisions about abortion access are now left up to the states. In October 2023, a few state elections that included abortion-related ballot measures gave some insight into how voters react when presented directly with ballot questions related to abortion rights.

Overall, most voters say they think abortion should be legal in either “all cases” (29%) or “most cases” (36%), while one in four voters say it should be illegal in most (26%) cases and just one in ten (9%) say it should be illegal in all cases. A majority of Democratic voters, independent voters, women, men, and voters across age, racial, and ethnic groups say that abortion should be legal in all or most cases. A majority of Republican voters (60%)—including 55% of Republican women—say that abortion should be illegal in all or most cases. Currently, abortion is banned in 14 states in the U.S., and limited in an additional 11 states.

Overall, while most voters say that abortion is an important issue they would like 2024 presidential candidates to discuss, few (4%) voters say it is rises to the most important issue to discuss during this campaign. Most Democratic voters (72%), including seven in ten Democratic women, say that abortion is a very important issue for candidates to discuss, as do seven in ten (68%) Black voters and more than half (55%) of Hispanic voters. Yet, it rises to the most important issue for discussion for just one in ten (11%) of Democratic voters, and fewer than five percent of Black or Hispanic voters.

When it comes to which party voters trust to do a better job handling the issue of abortion, majorities across race, ethnicity, and gender say they trust the Democratic Party, as do majorities of Democrats and independents. Republican voters are much more likely to say they trust the Republican Party to handle the issue of abortion (80%), though four in ten (40%) Republican voters who say abortion should be legal in all or most cases say they trust the Democratic Party more on this issue. For these voters, just one-fourth say abortion is a very important issue to them.

While few voters identify abortion as the most important issue for candidates to discuss, it does appear that the issue could influence a small group of voters’ decisions during the 2024 election. While most voters (57%) say a candidate’s position on abortion is just one of many important factors, one in four (24%) voters say they would only vote for a candidate who shares their views on abortion. Larger shares of Democratic voters (33%) say they would only vote for a candidate who shares their view on abortion, including three in ten (31%) Democratic women. Overall, about one in five voters (19%) say abortion is not an important factor in their vote choice including about three in ten (29%) Republican women.

Abortion does not seem to be a deciding issue in determining which candidates to support for many Republicans, especially those Republicans who think abortion should be legal in all or most cases. Just 4% of this group say they would only vote for a candidate who shares their views on abortion, while half (53%) of Republicans who say abortion should be legal say “a candidate’s position on abortion is just one of many important factors” and four in ten say abortion is not an important factor in their vote choice. This is compared to the nearly three in ten Republican voters who think that abortion should be illegal in all or most cases who say that they would only vote for a candidate who shares their views on abortion.

Many Voters are Pessimistic Heading into the 2024 Election

Less than one year until the 2024 election, many voters are not feeling confident with the way things are going in the U.S. Eight in ten (81%) voters say that things in this country “have gotten off on the wrong track,” compared to about one in five (18%) who say things are generally going in the right direction. While this finding is consistent with past polling of voters since 2014, the latest KFF poll shows that Democratic voters are less pessimistic than Republican voters, with about one-third of Democratic voters saying things in the U.S. are generally going in the right direction (32%) and just six percent of Republican voters saying the same.

Voters who say that things in the U.S. have gotten off on the wrong track are most interested in hearing about inflation, including the rising cost of household expenses (46%), from 2024 presidential hopefuls. About six in ten (62%) of these pessimistic voters say they trust the Republican party better to address inflation and the rising cost of household expenses, while about four in ten (37%) say they trust the Democratic Party on this issue. Voters who say things in the U.S. are headed in the right direction are most interested in hearing about gun violence (24%) and inflation (21%), and larger shares say they trust the Democratic Party on each of these issues.

Medicaid Unwinding and the Inflation Reduction Act (IRA)

Enacted at the start of the pandemic, the Families First Coronavirus Response Act (FFCRA) required state Medicaid programs to keep people enrolled throughout the COVID-19 public health emergency (PHE). However, the Consolidated Appropriations Act (CAA) ended continuous enrollment on March 31, 2023, and required states to conduct redeterminations for all Medicaid enrollees by the end of May 2024. As of November 27, 2023, more than 11 million people have been disenrolled from Medicaid, and by KFF estimates, up to 24 million people could be disenrolled from Medicaid during this period of unwinding of the continuous enrollment provision. Just over half (53%) of U.S. adults say they have heard at least “a little” about states removing adults and children from Medicaid as the pandemic policies end, while half (47%) have heard nothing at all about this. Adults who are currently on Medicaid are most likely to say they have heard of this (65%).

Many states are working to support their Medicaid enrollees in the active renewal process, but enrollees may face barriers renewing Medicaid enrollment. Among those who have heard at least a little about the issue of Medicaid unwinding, a large majority are very (42%) or somewhat (46%) concerned about more adults and children becoming uninsured because of problems obtaining and renewing their coverage through Medicaid. Adults with household incomes under $40,000 and those currently on Medicaid are the most likely to say they are very concerned.

Inflation Reduction Act

More than a year after being signed into law, few adults are aware of the prescription drug regulations included in the Inflation Reduction Act (IRA). About one-fourth are aware that there are federal laws in place that cap monthly insulin costs at $35 for people with Medicare (26%) or that place a limit on annual out-of-pocket drug costs for people with Medicare (23%), and even fewer adults are aware there is a law in place that penalizes drug companies for increasing prices faster than the rate of inflation for people with Medicare (13%). These shares are relatively unchanged from when KFF first explored this in July 2023. However, slightly larger shares of adults now than in July say they are aware that there is a federal law in place that requires the federal government to negotiate the price of some prescription drugs for people with Medicare (32% v. 25% in July). This may be related to the media coverage of the recent announcement by HHS regarding the first 10 drugs covered under Medicare Part D selected for negotiation.

While adults ages 65 and older are more likely to say they are aware of the Inflation Reduction Act’s cap on the cost of insulin for people with Medicare (44%) than younger adults, majorities are still unaware of these provisions. Few seniors are aware that there is a federal law requiring the federal government to negotiate drug costs (36%), placing an annual limit on out-of-pocket drug costs (25%), or penalizing drug companies for increasing prices faster than the rate of inflation for people with Medicare (8%).