2024 Voter Priorities in Health Care: Telling the Policy Story
May 15, 2024
1:00 pm-
2:00 pm
Virtual Event
Event Description
Research shows that health care issues are poised to play an important role in the upcoming 2024 presidential election and national health policy discourse. Expert panelists discussed the latest polling data identifying key health policy concerns that will drive election coverage and campaign discourse. This roundtable explored the intricacies of covering health policy issues that voters identify, like affordability, providing insights into how reporters can employ storytelling and narrative techniques to create dynamic, accurate, and data-informed coverage.
Learning Goals
- Learned how to interpret polling data about health topics in the election in context of methods and history.
- Provided an overview of data on voter priorities in the election, including health care costs.
- Discussed potential implications of anticipated health care policy decisions and debates on the health care system.
- Explored strategies and storytelling techniques that can create engaging narratives and deepen understanding in news coverage on voter opinions on health care priorities.
This event was made possible with support from the National Institute for Health Care Management (NIHCM).
Speakers
Claire Sheahan
President and CEO
Claire is the Chief Executive Officer at the Alliance for Health Policy. She is a dynamic executive with more than 25 years of experience effectively engaging others to catalyze change in health care and health policy.
Claire has served in leadership roles in associations, corporations, consulting and communications firms, including GMMB, the Blue Cross Blue Shield Association, Fleishman Hillard, the Generic Pharmaceutical Association (now AAM), Avalere, Alexion Pharmaceuticals, and others. In these roles, she has managed effective educational and engagement campaigns, introduced new capabilities, products and services, established novel cross-functional teams, and successfully achieved gains in reputational status, growth and audience impact.
In her career, she has worked for organizations across the spectrum in health care ranging from scientific discovery to public health to patient advocacy. These include non-profits like the Robert Wood Johnson Foundation, The Bill and Melinda Gates Foundation, and National Health Council; medical leaders like the American Academy of Family Physicians, the International Society for Stem Cell Research and Mayo Clinic; and companies like Biogen, Cigna, and Siemens Health.
Claire is a graduate of the University of Illinois at Champaign-Urbana, where she served a semester as a research assistant to a member of UK parliament, and a co-founder of the campus sketch comedy troupe. She also holds an MSc. with Distinction from the London School of Economics in Media and Communications, where her dissertation focused on the construct of public opinion within the halls of the U.S. Congress. Claire also served as an adjunct professor at Johns Hopkins University, teaching students in the Communications MA program. She is the mother of two children, a cancer survivor, and serves as a Director on the Fairfax Library Foundation Board.
Liz Hamel
Vice President and Director, Public Opinion and Survey Research, Kaiser Family Foundation (KFF)
Liz Hamel is vice president and director of public opinion and survey research at KFF. She oversees the team that is responsible for the KFF Health Tracking Poll, the COVID-19 Vaccine Monitor, and ongoing survey partnerships with news organizations such as The Washington Post, Los Angeles Times and CNN.
In more than 20 years of public opinion research, she has directed survey projects on a range of topics, including attitudes and experiences regarding COVID-19; views of the ACA, Medicare, Medicaid, and private health insurance; racial and ethnic disparities and discrimination; and health care as an issue in elections.
Hamel serves on the executive council of the American Association for Public Opinion Research and the board of directors of the Roper Center for Public Opinion Research. She holds a bachelor’s degree from Harvard College.
Rachel Cohrs Zhang
Chief Washington Correspondent, STAT
Rachel Cohrs Zhang is the chief Washington correspondent for STAT, reporting on the intersection of politics, business, and health policy. She is also the author of the twice-weekly D.C. Diagnosis newsletter and leads STAT's D.C. bureau. She previously covered health care policy for Modern Healthcare and prescription drug pricing for Inside Health Policy. Rachel earned a degree in journalism from the University of Southern California.
Presentation: 5.15.24 Voter Priorities Slide Deck
Transcript
0:04
Welcome and good afternoon, everyone. My name is Allison Jones. I’m Director of Program Strategy and Management here at the Alliance for Health Policy. We are a non-profit, non partisan organization dedicated to helping policymakers and the public better understand health policy, the root of the nation’s healthcare issues, and the tradeoffs posed by various proposals for change.
0:24
We’re thrilled to be presenting today’s webinar, 2024 Voter Priorities In Healthcare Telling the Policy Story.
0:31
The Alliance has served as a trusted educational resource for the health policy community for more than 30 years, and today’s webinar will explore the role that health care issues will play in the upcoming 2024 presidential election. Discuss the latest polling data and provide insights into how reporters can use storytelling and dynamic news coverage.
0:50
We’re excited to showcase the different viewpoints and perspectives of our fantastic panelists as we look ahead to what to expect during this upcoming year.
0:58
Before we get started, I want to take a moment to thank our event sponsor. Today’s webinar is generously supported by the National Institute for Healthcare Management.
1:08
We are grateful for your support of this program and for all you do to improve health care Advancing diverse perspectives on health.
1:14
I also want to share a few quick logistical notes. Today’s panel has a Q&A session at the end. We encourage you all to be active participants, so please feel free to share questions at anytime. You should see a dashboard on the right side of your web browser, that has a speech bubble icon and a question mark.
1:31
You can use the speech bubble icon to submit questions you have for the panelists at any time.
1:35
We will collect these and address them during the Q&A.
1:38
Throughout the webinar, you can also chat our team about any technical issues you may be experiencing, and we can assist you.
1:44
If we don’t get to your question, please don’t hesitate to reach out to us at events at all health policy dot org, and we’ll do our best to connect you to additional information.
1:53
And don’t forget to follow the lines for our policy on LinkedIn to stay informed about upcoming events like this one. You can also find us on Facebook and YouTube.
2:01
With that, I’m so pleased to introduce our panelists for today’s webinar. Starting with our moderator for today’s event, our President and CEO, Clare Sheehan.
2:10
Claire …, is the Chief Executive Officer at the Alliance for Health Policy. She’s a dynamic executive with more than 25 years of experience effectively engaging others to catalyze change in health care and health policy.
2:22
Clara served in leadership roles and associations, corporations, consulting, and communications firms, including GMB, the Blue Cross Blue Shield Association, Fleishman Hillard, the Generic Pharmaceutical Association, …, Alexia, Pharmaceuticals, and others. We’re so grateful to have clear with us today.
2:38
I’m also pleased to introduce our other esteemed panelists, including Liz Hamill, vice president and director of Public opinion. In survey Research. I care that … oversees the team that is responsible for the … health tracking poll, the … Vaccine Monitor and Ongoing survey partnerships with news organizations such as The Washington Post, The Los Angeles Times, and CNN. And more. We also have Rachel Corrie saying Rachel is the chief Washington correspondent for stat reporting at the intersection of politics business and health policy. She’s also the author of the twice Weekly DC Diagnosis newsletter and lease that DC.
3:15
She previously covered health care policy for modern health care and prescription drug pricing for inside health policy. Rachel earned a degree in journalism from the University of Southern California and our heartfelt welcome to our final panelist, Annie Linsky, any of the White House reporter with The Wall Street Journal. And she’s covered politics and policy on the state and national level for 20 years. You can read more about fears, background, and the bios of our other panelists on the Alliance website. And with that, I will turn it over to you all.
3:45
Hello, everyone. Hi, I’m so happy to be here with you today if it looks like I’m in a hotel room. That’s because I am. I’m coming to you from Atlanta, where I’m at the American Association for Public Opinion Research Conference.
3:59
So, before I get started, I just want to say that, you know what, …?
4:03
Our polling focuses broadly on, how health care issues are impacting people, and that includes their opinions about policies, but also their knowledge and awareness and their experiences with health care. And during election seasons, we also look at how healthcare issues are factoring into voters decisions, but we do not really do horse race polling, or likely voter modeling aimed at making projections for who will win the election. So please don’t ask me. Who’s got if, we can go to the next slide, please.
4:38
So many of us, many of you, are probably on this call because you care deeply about health care. And many poll results will confirm that most Americans care deeply about these issues too. But fundamentally the 2024 presidential election is not a healthcare election. You know. First off issues are only one factor among many that voters are considering When they’re making voting decisions. Other things like partisanship and candidate characteristics also come into play. And I think we can all agree that we have two candidates in the Democratic and Republican nominees who evoke strong emotional reactions from voters. And it’s also important to keep in mind that among issues, there are many other issues that voters are more focused on than health care, including things like inflation, immigration, democracy, and the economy.
5:29
But that said, that doesn’t mean that healthcare issues are not important to pay attention to in this election. So, first off, the cost of health care is really a big part of voters concerns. When they talk about inflation in the economy, and they do want to hear from candidates that they’re committed to lowering health care costs for people like them. You know, another way that health care could play in this election is that there are many existing health programs, including Medicare, and Medicaid, and increasingly, the ACA that are popular with voters, and voters may react to messaging that implies cuts or changes to these programs. And then another way that health care could be really important is that issues like abortion. and some other healthcare issues may not be at the top of voters lists, but they really could motivate turnout for specific groups. That could end up being decisive and what’s likely to be a really close election. Next slide, please.
6:24
So, here’s a question from our February poll, asking registered voters, how important it is for candidates to talk about a list of issues. And one important thing to note about this question is that we chose this list, and gave this to voters. We may have gotten different responses if we had asked people to name issues off the top of their heads. But among this list, you see that issues like inflation, the future of democracy, and immigration are all near the top of the list. But also note the placement number two on this list, 80% of voters saying it’s very important for the candidates to talk about the affordability of healthcare. Now, well, for many of us, healthcare as a wonky policy issue for voters, it really, as a pocketbook issue. It’s a big part of their concerns about the economy and about inflation.
7:14
So healthcare costs are also an issue that cuts across partisanship in terms of importance. So some other issues, if you see on this list, are more partisan. So, for example, Republicans are much more likely to say they want to hear candidates talk about. About immigration. Democrats are more likely to say they want to hear candidates talk about abortion, but large shares of voters across the board said that they want to hear candidates talk about the affordability of healthcare. Next slide, please.
7:44
So this slide shows you one reason why health care affordability gets elevated to the top of that list that voters want to hear about from candidates. When we asked people how worried they are about affording certain things, including things like groceries, their rent or mortgage, gas, and transportation, you see here that large shares are worried about each of each of these things. So if we look at the blue parts of the bars in this chart, that’s the share that says they’re very or somewhat worried. But if you notice, what’s at the top of that financial worry list, it’s unexpected medical bills and the cost of health care services. And so that’s something that, that worries people even more than affording other basic things like transportation, food, and housing. Next slide, please.
8:33
So we obviously can’t talk about health policy without talking about the Affordable Care Act. And I could give 10 different webinars on all the polling we’ve done about the ACA over the years. So I’ll just touch on a few points about where we stand now, regarding public opinion and the ACA. First, we do find now that the ACA as a whole is more popular than it was when it initially passed. Really, since the failed repeal efforts in 20 17, we’ve seen that a majority of the public has a favorable view of the law. So it’s about 60% that view the law favorably now. It’s not quite at the same level of popularity as more established health programs, and entitlement programs, like Social Security, Medicare, and Medicaid, but it’s much more popular now than it was when it passed. And in particular, many provisions of the ACA are even more popular than the law itself. 1 notable 1 are the protections for people with preexisting conditions.
9:33
It was mainly the threat of remove, moving these protections that that contributed to the previous repeal effort failing. On the other hand, you know, we do find that most people don’t believe that the ACA lower healthcare costs for people like them. And when you connect that, to the fact that the number one priority among health care issues for voters is health care costs. We don’t see a connection between that, and the ACA in voters’ minds. And then even though the law has become more popular, we do still see substantial partisan division over the law. Favor ability has increased among Republicans, but it’s still only about a third of Republicans, that view of the law favorably. And two thirds have an unfavorable view.
10:20
So you know, the bottom line is that voters in particular lead Democratic voters want to hear candidates talk about the ACA, about preserving the ACA, but they’re really not looking for detailed policy proposals on the ACA at this point. Next slide, please.
10:38
So here’s just an illustration of one of our recent questions. On the ACA, we asked about the next steps that people would like to see the president and Congress take when it comes to the Affordable Care Act. And you see that about half of voters overall want to see the ACA expanded. But again, you can see the partisan divisions on this. If you look at republicans who are in the bottom line, majorities of them would prefer to repeal the law entirely, or scale back what the law does.
11:08
So on the next slide, please.
11:12
Another issue that we really can’t ignore if we’re talking about health care issues in this election is the issue of abortion. So, abortion doesn’t rise to the top of the issue List for voters. Overall, however, it could play a big role in motivating turnout around certain groups of voters, particularly in states where abortion is on the ballot.
11:34
And we found in our March Tracking poll that voters who say abortion is the most important issue to their vote are mainly made up of voters who are supportive of abortion rights. And that’s a change from previous elections prior to the overturning of Roe V Wade, when most single issue abortion voters, were those who are looking to place more restrictions on abortion access. So this is an issue where national polling is a little bit less useful. But polls of specific groups that are motivated by this issue, including younger women, or pulling in specific states, can tell you more. That said, I think it’s worth noting. The data that I’m showing on the slide here, which is that at least half of voters overall, including larger shares of democratic voters, believe that the elections for president, congress, and their state, legislator, will have a major impact on access to abortion in the country or in their state.
12:27
Next slide, please.
12:30
So, finally, I’m just going to show a few findings from our new poll that was just released this morning. The timing that included a focus on the major health and entitlement programs. So first thing to note is that Social Security, Medicare, and Medicaid are incredibly popular programs. So voters will be listening to hear candidates talk about strengthening or preserving these programs for the future.
12:54
As you can see here, majorities of voters are also worried about whether these programs will be able to provide the same level of benefits in the future as they do today, and then also include includes subsidies for those enrolled in insurance through the ACA marketplaces. Now, I don’t expect our leading presidential candidates to get engaged in a major policy debate over the future of these programs, but we are likely to hear them talked about in the course of the campaign.
13:21
Next slide.
13:25
Another thing is that President Biden considers the passage of the Inflation Reduction Act, including the Medicare Drug Pricing Precision provisions, one of the …
13:34
signature Achievements of his presidency so far. But we find in our polling that if information hasn’t trickled down to most voters yet. So on the left here, you see, among voters overall, fewer than four in ten are aware of some of these signature provisions, including the drug price negotiation, provision, the cap on insulin. And so, so, we see that among among voters overall, there is not high awareness of those provisions. If you look in the middle, though, and on the right, you see that older voters and democratic voters are more likely to recognize that these provisions exist. And we’ve seen some seem seen some increase in that awareness in recent months. And so, this suggests that Biden’s campaigning on the IRA is breaking through with some of these groups among his base. Next slide, please.
14:31
OK, so, that’s it for the data that I’m going to share, But I do want to wrap up with just a few tips for reporting on election polls. First, pulse attempting to predict who’s going to win the election can really only tell you so much about what’s going on with voters. So, it’s a really good idea to look for findings that go beyond the horse race, and the question of who’s going to win. But also understand that policy preferences, as measured by poles, are not necessarily predictive of election outcomes. Another thing that’s really important to pay attention to is what Pulse can tell you about key sub groups of voters. And not only how issues may my housemate, how issues may factor, and they’re both vote choice, but also how they factor in their motivation to turnout.
15:16
Another point is that polls can really also help you understand people’s experiences and gaps in voter knowledge. And, you know, those kind of data can can provide really good context for a story. They can also help you identify areas where stories can help inform. And then finally I would be remiss if I didn’t make this plug coming to you from the April conference, which is full of Survey Nerds. Pay Attention Tech Survey, methodology. When polls come across your desk, and if you don’t feel equipped to judge the quality of polls on your own, make a survey friend who can help you. And with that, I am I will pass it off to Claire, who I think is going to moderate our discussion.
16:02
Absolutely.
16:03
I am just very excited list that you could join us today, and that our other panelists could join, as well. So I’ll invite Liz and break those.
16:14
Rachel and Annie, all three of you if you can press the tiny little button on goto Meeting and join the, Join our, our panel here.
16:26
Um, so I really learned a lot, Liz, from reading through your survey research.
16:33
Thanks so much, Rachel and Annie, I’m so excited that you’re joining us as well. Allison mentioned that. I’ve worked in communications over the last 20 years, So I have a lot of experience with both looking at survey data, and also working with members of the media.
16:50
And I think this question of how does the conversation around the election, and how people think about policies, and how this story gets told, is a really interesting point, right? Because, you know, at the Alliance for Health Policy, we work with folks who are working every single day on the line items, what goes into policy, and when they sort of see it on the big stage of the general election, it can look very different.
17:18
So, I’m, I’m excited to have the conversation, not just how voters perceive these issues, but also then how do they translate into the discussion when it becomes a policy discussion.
17:29
So, with that, Liz, I think you mentioned that, you know, this is not a healthcare election, and I’d love to hear a little bit more from you about what makes something a health care election and where they are.
17:44
Other elections that you can think of that fall into that category, or meet that criteria.
17:49
I’d love to hear a bit more.
17:53
Yeah, I mean, I think there are certainly different ways to define a health care election if we think about what is defining how voters are thinking about the candidates in this election.
18:02
I don’t think anyone, would, would think that, that healthcare is at the top of the list, given that, the two candidates that we have. You know, if we think back, there have been, there have been previous elections that have happened in the midst of a bigger national health reform debate before the ACA was passed. Particularly, Democratic primaries. Right? If we think about the 2008 Democratic primary, and then even the 2008 general election, we were having a much bigger national focus on health reform debate. Or if we think about the 2016 Democratic primary, we think about Bernie Sanders and Medicare for all right. There have been elections in the past, where I think we’ve had a more, a more robust discussion from the candidates about different directions on healthcare. And that’s not to say that there are not huge differences in the ways that that President Biden or former President Trump would approach healthcare. There are certainly huge stakes for healthcare in this election. But I think in terms of the voter perspective, I would say that that, that it’s not a health care election from that perspective.
19:07
Then Annie or Rachel do you have thoughts on that?
19:13
I can jump in here. You know, I think, I think first of all, as your presentation was wonderful, I really enjoyed listening to it and very selfishly.
19:23
And I, you know I am I think it’s right with these two candidates.
19:28
Healthcare’s is not it’s not one of the major theme, necessarily, but what do you think about presidential Elections in particular?
19:37
I think it’s so important to remember that Election this. You know, the electorate is split, you know nearly almost 50 50 and elections are won by turning out the base, turning out your base, turning out your voters and getting, you know, Persuading a very small sliver of independent voters to go your direction.
19:58
So, the issues that voters writ large are interested in are not necessarily what the candidates will or should be talking about. And I think that is when you go back to abortion. There’s an issue that does too magical things for Democrats. Right, It, it, it, it gets their base really enthusiastic, their bases has shown a willingness to go out and vote on that issue. So it turns out they’re based in an election where the candidate himself is not, particularly, you know, charismatic, and it does not have that is not attracting the sort of enthusiasm that you normally would see. So, abortion is helping with that.
20:37
But abortion also helps with persuasion for democrats. There are some suburban women, who are republicans, who are really uncomfortable with where the Republican party is taking the country on this issue. And so, in for that, for that reason, it does have some magical qualities that do put abortion.
20:58
You know, make abortion issue that while the most of the country is probably not so interested in, it does hit two really key things for Democrats, and I will also say, I think that your data, the data on, um, prescription drugs and older voters was fascinating.
21:14
That’s a key part of Biden’s accomplishments is that he has been able to, For very small number of drugs, for a small number of people, negotiate a lower price for prescription drugs. And he has not been getting credit for that. But, you know, the data is showing that, That is changing. That’s an enormous, There’s a very, very good news for his campaign, because that is a key accomplishment. So, those are, those are the two takeaways that I read, and I will also say older voters, is what are the areas where the president does particularly Well. If you look at is coalition, there’s a lot of attention on areas where its, fraying, you know, black voters, Young voters, Hispanic voters, but wanted to really sort of bright spots for him in the polling is older voters. And so, I just think there’s a, there’s something pretty fascinating going on right there.
22:09
So interesting, I thought of that. Rachel, do you have thoughts on what makes the health care election?
22:14
Sure. Yeah, front, even just thinking from a policy perspective, about 2020, You know, during every debate, we would almost roll our eyes and be like, All right, here we go. They’re gonna fight about the public option, and Medicare for all again. And neither of those things have come to pass. And I think kind of the lack of a competitive primary on either side here has really mitigated the need for candidates to put forward inventive, or new policy ideas. Like kinda know where each of these candidates stands. There. You know, percolating. Their ideas are well-known and I think both of them have things they would have liked to accomplish. That didn’t quite get done. And so it feels like there who are arguing, but I continuation, of the things that they’ve already proposed instead of proposing new ideas.
23:03
That’s so interesting, because that’s almost like a structural reason, that the conversation isn’t going into more depth on the policy side. And that’s not something that I had thought of before.
23:15
That makes it harder than right to cover it as a story, because it doesn’t seem relevant because there’s no difference.
23:21
Right, like, you’re not looking at different approaches on the DNR side.
23:26
So, there’s no, there’s nothing at stake, because that makes is that would make sense. I think there are stakes or difference between the two candidates, but in terms of differentiating from their prior positions in a competitive primary, they have to seem different from their opponents. and so they have to give voters something be excited about are inspired by, or that they feel would make their lives better. And they just have to be less imaginative here because the it kind of when to kinda that stark contrast so quickly between Democrats and Republicans, where there are, clearly differences there are clearly stakes. But both F, two former presidents are current and former president, both of them have laid out their agenda kind of through their actions.
24:13
That makes sense, You’ve said it better than I did, yeah, there’s more nuance, right?
24:16
And in the policy discussion, when you, when you have that earlier round?
24:23
Great.
24:23
So one thing I noticed in the data is that, um, you know, the affordability responses. It struck me that 3 and 4 adults say that they’re very worried or somewhat worried about unexpected medical bills in the cost of health care services, which Lindsay pulled out.
24:41
Um, and that’s higher than gasoline or transportation costs or electricity and heat.
24:46
And the reason that struck me as somebody who’s paying a lot of attention to media over the years, is that gasoline prices, when they are higher on that list, really dominate the conversation. So I have a question for our journalist friends.
25:00
Which is, what do you think makes this different when health care is that top of that list? How come that is covered a little bit differently than when it’s gas prices?
25:11
I think it’s just the health care prices are just so opaque. I mean, like, gas prices like could not be more transparent. Like you drive by them every day.
25:19
They’re, like, flashing and giant lights, you know, exactly how much to the penny. You know, one competing gas station is against the next, and then you will also know, golly it’s at $4 a gallon. This is ridiculous, whereas Health Care, I mean, you’re never gonna know. You know, you don’t know how much, if anything, is going to cost until you get a bill and then argue with your, your healthcare provider about that. They’ll let you know somebody who just got a very surprisingly big bill. So, you know, I think that, like, if there was that kind of transparency and healthcare pricing, you’d see those stories and instances where there have been. Like, when you saw that piece of insulin really rise a few years ago, there was just this, all of a sudden, it did become a really big issue, and it’s because it was just easily, more easily digestible. And it didn’t have it wasn’t like these prices that are like layered into, like, multiple, either.
26:14
They’re just coded and cocoons of apps, vacation.
26:19
So, I think that, once it’s more clear than it, it is an easier thing to have as part of the public conversation.
26:28
Yeah. I agree. I think any covered kind of why it’s covered less. I think it just struck me as interesting, because voters, the respondents, chose overall concerns about health care costs over prescription drug costs. And I think that has been very much a populist kind of trend that we’ve been seeing in public opinion polling. That hasn’t really reflected in the policy space as much. It’s not popular to go after hospitals. They’re huge employers. They’re really politically powerful. They spent so much money lobbying.
26:57
But we have seen this groundswell of concern from consumers about getting large medical bills, about being surprised. And we know that bills from doctors and hospitals are more likely to be part of consumers, medical debt when they’re carrying medical debt.
27:17
And so, I think that the sticker shock at the pharmacy is still a problem, obviously, given the list as polling, But I thought it was kind of interesting to see how that public opinion could be shifting, but we may not see as much criticism of providers. Just given the nature of politics and health policy. And where we are today.
27:41
Just hop is complicated and there are lots of players I think it also has interesting connections to the other side about Social Security and Medicare and Medicaid, right?
27:52
Oh, so, Liz, my question is, have, you know, If this is a pocketbook issue, um, Then, how does that translate with voters to a specific party preference?
28:09
You know, it’s interesting when it comes to the pocketbook issue of healthcare because we know historically, Democrats tend to have an advantage over Republicans, on on healthcare in general as an issue. But when we start drilling down and asking which party or which candidate you trust more on specific parts of healthcare, on lowering costs, there’s a smaller advantage or no advantage for Democrats. You know, partly because Republicans tend to be trusted more on economic issues. So I would say, you know, on the issue of health care costs, specifically, there’s not really a clear advantage for a specific party.
28:50
There’s also, I think, a sense we asked a question in our most recent survey about how likely you think it is that either Biden or Trump’s policies would bring down prescription drug costs if they were elected and partisans answered it completely differently. But, among independent voters, there were sort of, not a lot of confidence that either one of them would do, much to lower costs.
29:14
It’s interesting to talk about costs, I mean, this, it just strikes me, that’s a concern or support for these existing programs, You know, Social Security, Medicare, and Medicaid. And you mentioned, even now, the ACA.
29:26
It seems, it seems like, it seemed to me, as somebody who has looked at a lot of data, I think, you know, this, there is this concern, or worry, right? And so concern and worry about something being changed or taken away, right? So there’s preservation of the status quo, in general, right? And then there’s also, you know, concern or worry. And then you tie that to the one medical bill.
29:48
No Data that shows that people are worried that that mites put them in financial straits so that they’re concerned about that.
29:58
I’m just wondering, know, that if folks are, you know, folks, are you concerned about these things?
30:06
Does this differ, Liz, from previous elections in terms, He talks a little bit about the ACA, but, but in that support for Social Security, Medicare and Medicaid, it, sort of support, but it’s also this worry peet’s, right.
30:19
Like, it’s not going to be there for me, and I’m wondering if that, has shifted at all?
30:24
I would say, we had that, those have been things that voters have been concerned about for a long time. I mean, I’m not going back to, you know, I think each of those programs, when they were passed, maybe took some time to become very popular. Just like with the ACA, But, but I don’t think it’s knew that there is concern. Or worry about, those programs being available in the future.
30:48
You know, another thing that I, I, I didn’t show, though, is that, you know, I mean, President Trump has talked about, you know, there’s fraud and waste, we need to clean up. And if you ask voters, do you think there’s fraud and waste in these programs? A lot of them also agree with, with that talking point.
31:04
So, yeah, so, so, you know, I think that this is something that is a continual concern, but whether that translates into a robust debate about actual policy changes to these programs, I don’t see that as being very likely.
31:25
Yeah, and there’s not usually people in polls that are for fraud, waste or abuse as we fight. Majority issue were against it.
31:35
That’s great.
31:36
So, are there other we talked about abortion as I’m motivating?
31:41
Force for voters to turnout.
31:43
Are there other healthcare issues, that kind of impact turnout, maybe not as dramatically or historically documented.
31:50
But is there any that come to mind?
31:54
That’s a handy if you want to take that one. I think on this election.
32:00
No.
32:03
I really think that is going to be the major when we think about health care and what you’re going to hear out of candidates mouths.
32:09
Now, I mean, the, like, targeting has become, ad targeting, has become so excited that I was meeting with somebody recently, who told me that there’s a way to, like, specifically target individuals who have changed from paying for, like, a non generic brand name drug to a generic drug.
32:34
And so, an ad could potentially target you.
32:39
Claire?
32:41
I saw recently change your drug prescription. Do you know that?
32:45
It’s because President Biden’s law was passed that enabled the X, Y, and Z Like Then I’m not sure that he would do it in such a creepy way like that.
32:57
Training job for you, Annie, I know. But, that, to me, I think what that speaks to, is that, well, maybe the candidate isn’t going to be seeing it. But if you are, you know, your phone, and you’re looking at your Facebook page, or your Instagram, you may actually start seeing very targeted ads that do good at health care costs. And that can specifically know, you know, in the back of the ad makers mind, they know that you have changed drugs, that you are cost sensitive, and that you are therefore potentially receptive to this message. So, I think that’s a place that you’ll see it.
33:34
The other thing that, know, you’ve seen a little bit from this White House, has been policy changes that are in the healthcare space, and they’re a little bit around the edges. A big one that we’ve hit a lot of attention to the Wall Street Journal was on the rule on menthol banning menthol cigarettes. Yeah. This is a, this is something that the White House decided not to take it take action on, sort of punching this idea of banning menthol cigarettes off until after the election.
34:05
And that is because the people who smoke these predominantly smoke, these, these cigarettes happened to be part of Joe Biden’s Base.
34:15
It’s black Black Voters, Black Men and the the The Campaign Against it was was Searing the Biden Campaign.
34:24
It was sort of, you know, there was a very effective lobbying group that sent out mailers to black voters in South Carolina, which is not swing state but this is sort of telling them what they could do in Georgia, which is a swing state that said, you know, Joe Biden wants to take away your cigarettes. And like, that’s not a great message for the president even if you want to debate what the policy is. And I think they, you know, there’s some people who have strong feelings of the policy. But so you’re seeing the White House making some healthcare tweaks, you know, ahead of the election, you know, with an eye to voting. And, then I really that, in this case, to, like, avoiding an attack ad, rather than sort of us are proactive. This is a great policy that we’ve done.
35:11
Any thoughts, Rachel?
35:13
Oh, I just, my thought was mainly going back to, I think, liz’s slides on how, the White House has made some progress on awareness of the Inflation Reduction Act, and the drug pricing powers. I mean, from a reporter’s perspective, the White House has started making.
35:33
In terms of news value, a little mountains out of molehills here, I mean, even when there’s some tiny, it’s like, development that was written in statute, not a surprise to anyone, You know, not necessarily an unexpected development. They have press conferences. They have had, you know, events at the White House.
35:52
They’ve really just a made a concerted effort to highlight every chance they can, that this law exists, and just make sure that the health care part doesn’t get lost in the larger kind of policy developments that were included in the Inflation Reduction Act, which, by its name, you wouldn’t necessarily think, is about health care. So, I think we’ve definitely seen a concerted effort, and it’s very interesting to the data that it’s starting to pay off for them. And I think you’ve also seen administration officials, HHS. Secretary Secretary Javier, Sarah, fanned out across the country, doing events in local communities, trying to raise awareness here.
36:35
Great.
36:36
That’s that is interesting.
36:39
I mean, I think, you know, it’s, it’s a giving and receiving, right, in terms of these, these, these messages, and what gets through us, sometimes kind of a mystery. The, the other question I wanted to make sure we talked about, because it kind of framed it up at the beginning.
36:54
It’s kinda the relationship between the voter identified issues, how they’re relevant in the election, how people vote, and then how it impacts policy, right?
37:05
Like, so, we’re looking at that little chain, or, you know, which might break in some places or maybe it’s, you know, maybe it’s a different shape.
37:15
So, I’d like to start with Liz. and can you talk a little bit about the relationship between voter policy preferences we see in polls and then voter choices like how they actually vote.
37:28
Yeah, and I think when we talk about voter choices, we really also need to include the choice to actually vote, because it’s not just deciding between the candidates, it’s deciding, am I going to actually go to the polls. Where am I going to actually go to the mailbox? And that is why we talk a lot about voter motivation. You know, I think policy preferences are a small part of what voters consider when making those decisions. But it can really matter if we talk about you know, my our CEO, Drew Altman, likes to talk about the tidal action as a game of inches. So it’s not about everybody making these policy decisions, but it could be that one why, you know, a few voters who really care about a specific policy could make a big difference.
38:13
But you know, I think another thing we really have to keep in mind is that voters don’t have the same understanding of policy that all of us do. So for example, if we talk about the ACA, ACA protections for people with preexisting conditions are very popular. But we’ve done polling Murray find that fewer than four in ten people actually connect those protections to the ACA itself. And so talking about taking away the ACA, you know, unless it’s explicitly connected to preexisting conditions and an ad is not going to make that connection, in voters’ minds, only a third of the public knows that the uninsured rate has decreased since the ACA was passed.
38:50
Only a third, when we asked them knew, there was a record number of sign-ups for the ACA marketplaces in the most recent enrollment period. And, so, so, I think when you’re thinking about policy preferences with voters you have to, you have to take into account the level of understanding. and awareness. that the average voter has the average voter. Who is trying to put food on their families to give all, and has a lot of other things to think about, so, it’s not their top priority.
39:20
Everyone. That’s great.
39:22
And then, Andy, I would ask you, What do you see as relationship between like pulling on issues, like the healthcare issues identified here, and, and how an election actually plays out, or what the results might be, since you’ve covered quite a few.
39:40
I mean, it’s really tricky. I think that list is really wise in how she laid out, how you want to look at these.
39:47
These polling is particularly issue polling. It can be so much more useful than a horse race poll, which I know gets all the headlines, and kind of people commit them to memory. But I think that, you know what, What? You know what? This is this poll.
40:03
It shows, is like the kind of broader forces and kind of plate tectonics that are beneath that those horse race poles. So you know, I think that like it, especially this far away from an election.
40:15
You know these are you know, these are just much more helpful documents, and there’s much more helpful data to be sifting through and thinking about because it does help you understand and connect, like, OK, why is the White House all of a sudden doing press conferences like Rachel pointed out. So wisely, why is the White House all of a sudden doing press conferences on this?
40:36
Like, like, this little, tiny change, or is this? This very minor thing is getting, you know, attention from the White House, and I think that’s where you see, the connective tissue is.
40:48
The White House is seeing that those, those broader forces and reacting to it, and trying very hard to be in sync with the limited public it. So, I think it just, that this kind of data is just so, so helpful, and just helping to understand why the conversation is going, where, where it’s going.
41:08
Great.
41:09
So it’s helpful in like, framing and creating that sort of general standing. As you know, I mean, I think, you know, to Rachel’s point like that, the you see that, OK, and the White House is going to do five events this week. And all of them are really, really minor, but they are all surrounding you know prescription drug costs.
41:27
And you can see, OK, that that is being responsive to this much larger pool of voters who are saying that costs are among their biggest concerns.
41:39
And I would add to that, that, you know, we’ve talked a lot, and of course it’s about health care and, know, this not being a health care election this year, but it is an economical action.
41:49
And you will see, you know, I was talking to a wise person recently, who was saying that, you know, they had what they felt was a very good week. You know, Trump was in court every single day.
42:01
The White House felt very good about just their day to day moments. But, you know, really bad, bad inflation data came out. It’s not this big.
42:11
It’s a previous week, Bad inflation data came out, and that just killed their internal polls for the week and so, you know, when, when it’s about health care costs, I think, you know, this very much will be a driving force of this election when, when costs are associated, whether it’s healthcare, housing, you know, mortgage rates, interest rates, but the healthcare simply as a driver of cost. And that is something that voters have been saying, is on their mind and I think, you know, particularly in the swing states, but when you talk to almost any strategist, They will say yes, there’s although there’s the Atmospherics, there’s no issues that Trump has various election various trials. There’s, Biden, there’s an age, but the the kind of force that is that both campaigns are really contending with is just sort of this concern over the economy and costs, and inflation, and health care does, kind of dovetail right in with that.
43:15
And that tracks really well with what Liz shared with us.
43:19
Rachele, my question for you is, what’s, what’s your observations on the relationship between health care election issues, which we’ve talked a lot about, and what actually happens in health policy? So maybe after the dust settled?
43:32
Yeah, I think there’s much less of a relationship than people might expect, because after the election, you know, everyone takes their power, you know, all the positions get filled. And, these issues are only one factor, and a whole vortex of other forces that shape the political and policy process, especially in Congress. And I think, again, going back to Medicare Negotiation, that was a perfect example. I mean, that had just generally as a, as an issue, 90% support from rollers, and it took lawmakers specifically Democratic, lawmakers 20 years to get it across the finish line.
44:11
And, as like toward the end of when the debate over the bill in Congress, Senator Bernie Sanders took to having this pull data that he had printed out and would wave around that reporters when he wanted to kinda make the point that we have to pass this. now. It’s wildly popular, but, you know, that we’ve seen in other cases where sometimes even wildly popular issues like capping co-pays for insulin just kind of get stuck. And right now, Congress’s stuck on capping insulin costs for people with commercial insurance. And so there’s absolutely cases all the time, where, you know, voters might think a policy is a good idea. But that doesn’t necessarily translate to action when lawmakers are. The President actually gets into office.
45:04
Great. That’s. That’s a great example. And.
45:08
So yeah that the voice of the people and then when we get into policy making, maybe there’s a, it’s like a translation there. What we call the sausage process. Yes. Yes. Yes, yes.
45:21
Um, so we are going to now go to Q and A And I’ve gotten a few through the magic of goto Meeting to share with you all.
45:30
And I’m gonna start with you Liz, because you were just talking about awareness and kind of the generally low level of awareness among the general voting population around policies.
45:40
one of our participants asked, you know, how aware are voters is the exploration of after 20 25, the ACA enhanced tax credits, insurance tax credits.
45:54
You know, there’s a question here about prospects for extending them as well. If there’s any research on that, that you have, any knowledge items, I think that would be helpful to share.
46:03
Yeah. I don’t, we have not pulled on an awareness of that. I would guess that people are not very aware. We have asked about, about support for extending them, and majority of people do support extending them, but I will just caution that. that is, you know, when there’s lack of awareness and general support for something that says, yes, we should continue to help people, We’ve been continuing, we’ve been helping that. That would be an unexpected result. one thing we haven’t done with that type of question that we try to do when we have space to say, Well, what are the tradeoffs? Would you support this effort? Meant your taxes would be higher, or, you know, other costs would go up. So I would just caution for interpretation of results, finding support for, for sort of low salience, low knowledge programs. And just kinda keep that in mind.
46:59
So this couple of people asked a version of this question, and I’m not sure if we’re far enough in to have an opinion on this, but there’s a question about it, the Senate or House races. Is there a difference that anybody has noted between how the state level races are conducting or might look at health care?
47:18
Or maybe, perhaps, I could add to that, you know, any, any examples you’ve seen in the past, versus what we’re seeing at the presidential level, anybody have thoughts on that?
47:32
Like how it’s playing out in this state, versus how it might play out in a presidential?
47:36
And I think you had at Georgia example my, well, I mean, my um, My sister, that is a lot of this rhetoric. I mean, a lot of it just comes from the White house.
47:46
You know, a lot of, um, You don’t see a lot of daylight, on, on issues like this.
47:56
Between demigods, at least where I have spent most of my time focusing, I mean, again, you know, going to abortion. I think that is one area where an IVF.
48:05
Those are two kind of healthcare areas where I think the Republicans have had a little bit more difficulty, coalescing around one particular position and have found themselves on their back fee. And kinda looking in real time to how to talk about how to focus on the issue. You know, I think that has something to do with the fact that they’re not, you know, empower and they, there’s less of a, like kinda clear message structure. And there are other factors involved as well, of course. But I think, I think when you look like State to state, it’s gonna kinda come down to, like, there are, some states like Arizona, Florida. Obviously weren’t that have older populations where prescription drugs is going to naturally be more of an issue. And in some of the more likely, the younger states.
48:54
But you’re not really seeing Democrats break with the President on health care issues.
49:04
The way that you do on the Republican side see a little bit more fluidity in in their positions and sort of the kinda like key, you know, key issues of the day, in that regard, that connect to health care.
49:19
Makes sense.
49:21
We have a couple of questions here on the role of private equity.
49:26
And just how that’s been kind of picked up by media, Does anybody have thoughts about whether or not that might sort of weren’t become part of that consciousness around some of this cost conversation.
49:39
Has anybody seen any, have you seen any data on that list?
49:43
No, but I have folks within my organization who would really like me to pull on it. We have not a contract.
49:48
And honestly, I’m, I’m not sure how much of that conversation has has trickled to voters and the general public, which is why we haven’t found space to ask about it in our surveys. But I know it’s a, it’s a topic that a lot of people who are really focused on health policy are paying attention to, but I don’t have any data about the general public.
50:10
That, makes sense.
50:11
I think, that’s another area where, no, I think this is an area. And Rachel, I think you, I have another question for you that I think is going to build on that.
50:20
So, just like, sometimes, you talked about things getting stuck, and sometimes things get stuck in relationship to that complexity, right? Like, the understanding that people just don’t actually know. And sometimes, actually, it moves faster because of that complexity, and people don’t really understand it. And with that in mind, I think we have, we have a question here around, you know, there’s this general concern that we’re seeing around cost, and certainly personal, sort of, security tied to health programs.
50:47
But, you know, I think you and I have had talked earlier about, you know, the, like, the lower cost, more transparency act, right. And Is there than, Does that translate into more enthusiasm for policies like that, one, in realizing the policymaking?
51:08
So with that, Bill, specifically, you can call a bill, the lower costs, more transparency, act, but if it doesn’t actually lower costs, like, I don’t know, how much, that’s going to move the needle, certainly.
51:20
There are provisions of the House bill that kind of get at the back door kind of behind the curtain machinations of the healthcare system. But it doesn’t quite have the appeal of like $35 insulin co-pay cap. You know what PBM Reform you know, so maybe some voters will know what a PBM’s, you know, if they’re, particularly if they take a lot of medications are familiar with their formularies are what they’re paying at the pharmacy counter.
51:49
But I think there’s not a lot of understanding about a lot of what lawmakers are debating in this specific bill. You know, if we’re talking about site neutral payments for hospitals or, you know, outpatient departments, I mean, this is just over a lot of people’s heads. And, not that it wouldn’t have impact for health care system costs on the backend, but in terms of actual policy change, given that many of the transparency measures are already indicated by regulations, they just haven’t been made in statute, it seems like it’s kind of more of a backend thing. That’s something people can really see or feel in a tangible way.
52:35
Since, I mean, I think we’re all, it’s very interesting in this conversation, there’s a lot of focus on policy being self explanatory, right, or the value of the policy being either clearly articulated or self evident.
52:50
Right?
52:50
That, that seems to be a big part of what sort of travels when you’re up against, I think, was like, social security has been around for a long time, right? So people know, That’s what Social Security as they’ve experienced in their data, that lives, you know.
53:05
So you see that, you know, the, the retention kind of chair is very, very high, and then it goes down from there, is like how long the per second, or, So.
53:16
it just takes a while for people to understand, what the benefit is in real life and some of the other policies, like you’re talking about that, that actually are, or are more, you know, understandable or self evident.
53:30
It becomes easier water to carry on the the policy side as well.
53:36
We had a couple other questions.
53:42
I think we, we’ve talked a little bit, somebody asked, like, are there any lessons learned?
53:48
But why Americans are not aware of pick the IRA piece we talked about, and I I wonder if there’s more there in terms of what does it take?
54:00
No other policy, you know, decisions that we’ve seen in health care that have broken through maybe some that were surprises, Maybe some that weren’t self evident.
54:09
Are there any examples that we can think of where, you know, it captured imagination or really kind of resonated into the conversation that maybe wasn’t intended. So anybody have any thoughts on that because I’m interested in knowing, right, because I think every administration is going to use the bully pulpit to say, we accomplish this, we accomplish that.
54:32
What’s really interesting is, what happens after that, like, does it actually land? Does it resonate? Does it get picked up? Does it get repeated? How does it get received?
54:41
And that is such a complex process, that it’s kind of interesting to think about what does and doesn’t land.
54:48
I don’t know. Go ahead.
54:51
Really tricky is that, And this is, you know, every administration has this problem with every piece of major legislation, like the gap between the rhetoric and what people actually feel and see is just like it so hard. So large, that it, it’s almost impossible to measure it. So big, I mean, if you have the President of the United States going around, talking about, well, we are lowering the cost of prescription drugs for you.
55:18
Then you go to the pharmacy, and you don’t happen to be a senior, or you don’t happen to be using one of the, like handful of drugs, in which there are actually no negotiating the price for, then you’re gonna be like, oh golly, like, I’m, I didn’t notice that.
55:34
And so you’re gonna go from being like, Wow, good job, President to, hey, know, who am I going to believe you? Are, you know, my lying eyes? I mean, I think, like, like these, these programs are complicated, and progress is slow. And Democrats have been talking about Lauren, negotiating to lower the price of prescription drugs for like 20 years.
55:58
And so, like I can understand from the voters perspective, kinda tuning out that message and then particularly, you know, you have to start actually seeing it and this is where I don’t even think it’s a messaging problem. It’s a problem, You know?
56:17
I think if we’re looking for an example of where it turned out differently, right, with the Medicare Part D, You know, I think there were some, some things where where seniors would get a benefit right away, right. And so there was, even though most of it took a long time to implement, there was something that came to them right away. And then that that kind of helped helped that program more quickly become popular. Because a lot of people were really skeptical about it when it passed because of the role of private plans and how confusing it was to choose a plan.
56:51
And so I think that could be an example of where a policy was rolled out with a slightly different outcome, and in the public’s mind or IVF.
57:00
I think, like all of a sudden, you know a judge made a decision that paused IVF. For me, many, many live in and I think, you know, that caused you sort of an instant. like, Oh my gosh. Now we’re all talking about IVF.
57:14
So it’s, I think, there has to, like, when there’s A Our connection in real time, I think that really helps something breakthrough.
57:22
Whereas, if it’s a small change, that will affect a small number of people, quite a few years, from now. Yeah, yeah, that’s going to be a hard sell when people are pretty busy, with many, many, other, more immediate things on their plate.
57:36
Great! Well, I know we’re almost at time.
57:38
And I did want to give Liz the last word, just in terms of are there any cautionary, you know, nuggets that you’d like to share with us in terms of how when we look at polling, to think about how to tell a story, what we what are the do’s and don’ts?
57:52
OK, I really appreciate you giving me like two minutes because I am at the April conference. I mean, I will just say survey methods have gotten exceedingly complicated. But but one thing that we really talk about at a poor ram right now is transparency. If you can’t find the exact questions that were used in a poll and the order, they were asked, in, if you can’t find how the sampling was done, who was interviewed, that, to me, right, there is a red flag that, you know, you, you just don’t know enough about the methods to even ask somebody how to evaluate it.
58:28
And then, I would say that a poor does have some great resources on their website, … dot org, on election pulling resources, to kind of help you understand some of the basics of how polls were conducted, and how to, to tell, you know, there’s no sort of gold seal of approval. But, there are some questions that you can ask to kind of help yourself be a better consumer of polls as American Academy of Public Opinion Research, right? That’s a good associations, public, such, Great. They’ve got a lot of plugs here. Great. We’re all for good quality research.
59:03
I want to hand it to Allison just to wrap us up here and I just wanna thank each of our panelists, really interesting and novel conversation. I really appreciate you joining us.
59:15
Thank you, Claire, Liz, Rachel, and Annie for joining us for this important discussion today. And I want to thank all of you in the audience who took the time out of your busy day to be here and ask these fabulous questions. Before you go, we want to hear from you. We appreciate you taking a few minutes to complete the brief evaluation survey that you’ll receive via e-mail later today, and that the team will be dropping in the chat here.
59:39
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1:00:07
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