It’s not a health election, but health problems can still add up KFF

You will often hear that this is not a healthcare election. And it isn’t. It’s an election primarily about former President Trump and President Biden. There is no great debate about national health reform to encourage the attention of voters.

On the other hand, it is again expected to be a very close election and abortion will and should be in the spotlight, and potentially other health issues.

Close elections are a game of inches where a slight shift in turnout or a shift in a swing voting pool in a few states can make all the difference. That’s why health care may still matter in this election. A combination of various health issues, which are relevant to different swing voting groups, could add up in the right battleground states and have enough impact to matter in the election. Here’s a general roadmap of the various ways this can happen.

Obviously, the election also has huge implications for health policy. This is almost a bifurcation of the health care election. Biden can be expected to continue to build on public programs like the Affordable Care Act (ACA), Medicaid and Medicare, and protect reproductive rights. While Trump has a somewhat erratic approach to health policy at times punishing drug companies and high drug prices, for example, a Trump administration could be expected to generally move in the opposite direction, including on abortion. (See Trump vs. Biden on Health Care and What Would Another Trump Presidency Look Like for Health Care?)

Above all, key battleground states will be important to the outcome of the presidential election. They are believed to be Arizona, Nevada, Georgia, Wisconsin, Pennsylvania and Michigan. As is well known, the margin of victory in most of these states was very small in 2020. In the six swing states, 312,861 votes made the difference. The margin was 10,457 in Arizona; 20,682 in Wisconsin; and the famous, 11,779 in Georgia. Even a little traction for a health issue could play a role with margins like these. The same goes for other issues, such as the Israel-Hamas war in Michigan or immigration in some states.

A number of health issues could also matter in these states, and in every state in congressional races. First on the list is abortion and reproductive rights, which could increase turnout in what, at this point, appears to be a lukewarm Democratic base, or potentially sway enough swing vote groups to the Democratic side to make a difference in some battlefields. Nothing focuses voters on an issue like a state ballot initiative, and a state constitutional amendment is possible in Arizona and may have an outside chance in Nevada.

According to recent KFF polls, about a quarter of voters at large say they will only vote for a candidate who shares their views on abortion with Democrats who have an edge with voters on the issue. Less than 5 percent of Republican women say they are dedicated abortion rights voters, meaning they are pro-reproductive and say they will only vote for a candidate who shares that view. But again, even small numbers can matter if the difference in a swing state is as little as 10,000 votes. More importantly, few voters are single-issue voters, and what is unclear is how many Republican and independent women share concerns about Dobbs with other concerns they may have about Trump that could mean a vote for Biden or keep them at home. In the GOP primaries so far, nearly 6 in 10 Haley voters say they would not vote for Trump, though it’s too early to tell what they will do in November.

A collection of other health issues could also sway some other voters, including threats to the ACA, Medicaid expansion, drug costs and other affordability issues. One question is whether Trump’s renewed threats to the ACA were just a primary tactic to shake up a base that is still largely anti-ACA, or whether it will have legs. If he continues to talk about repealing the ACA through the general election, he won’t get any new votes (he already has those voters), but he could elevate the issue and give Democrats a juicier target, possibly rallying some grassroots Democratic voters or influencing -some of them Independents on the sidelines.

Regardless, our most recent follow-up survey showed that concerns about health care affordability are at the core of, not separate from, the public’s economic concerns. Voters want candidates to talk more about affordability, including 89% of voters who have trouble paying their health care bills. Historically, health issues have generally favored Democrats. To appeal to voters’ concerns about health care affordability, Biden will no doubt talk about efforts to make coverage more affordable under the ACA, control drug costs through price negotiations, and annual caps on the Medicare pocket and reduce the costs of insulin policies that are comprehensible to voters even if they directly benefit relatively narrow constituencies.

Finally, health might matter because health issues are relevant to different swing voting groups: women, Republican women, suburban women, and younger voters on some issues, such as gun violence or opioids. Our most recent follow-up survey showed that women were even more concerned. about health care affordability and drug costs than men, perhaps unsurprisingly since they have so much responsibility for making family health decisions.

That health issues have an impact on elections is not self-executing. It depends a lot on what the candidates are talking about, what’s hot in a state, and which grassroots and advocacy groups fail to elevate health issues. This isn’t a healthcare election, but as Donald Rumsfeld might say if he were still around, it isn’t, either.

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