EMBARGOED for release
Tuesday, Tuesday, March 1, 2005, 12:01 a.m. EST

Jon Gardner, Health Affairs

Craig Palosky, Kaiser Family Foundation

Health Care A `Second-Tier’ Issue In 2004 Election,
Trailing Values, Economy, And War, Health Affairs Article Says

Voters Divided On Major Health Issues, Complicating Reform;
Malpractice, Cost Of Government Programs Most Immediate Initiatives

BETHESDA, MD — Health care was a second tier issue in the 2004 election, falling behind such qualities as “moral values,” the state of the economy, terrorism, and the war in Iraq, according to a review of pre-election and Election Day polls published today on the Health Affairs Web site.

In two separate polls, health care was ranked fifth or seventh as the most important issue voters considered when voting on Election Day 2004, according to Robert Blendon, professor of health policy and political analysis at Harvard University, and a team of political opinion researchers from Harvard and the Henry J. Kaiser Family Foundation.

In a poll taken by the National Election Pool—a consortium that provides exit-polling data for the main television networks and major newspapers—health care was cited as the most important issue by 8 percent of the voters, fifth in a list of seven issues. In a poll by the Los Angeles Times, health care was rated as one of the two most important by 9 percent of voters, tied for seventh in a list of eleven issues; Medicare/prescription drugs placed eleventh on that list, rated as most important by 3 percent of voters.

That’s a departure from early in 2004, when voters ranked health care and Medicare second (19 percent of voters cited it as most important) as a voting issue in a poll by Newsweek and Princeton Survey Research Associates, behind only the economy and jobs (36 percent) and ahead of terrorism (14 percent) and the war in Iraq (11 percent).

“The candidates’ positions on health care issues had relatively little effect on voting behavior [in 2004], either because the issues were not seen as salient enough or because the candidates’ positions were not articulated well enough,” Blendon says. “In the end, most voters did not make their presidential voting decision based on health care issues. With concerns about future presidential leadership and issues of moral values, the economy, terrorism, and Iraq on their minds, most voters postponed their concerns about health care in considering their vote.”

Blendon adds that since President Bush has listed malpractice reform as his number-one health care priority, and since the federal government is running large deficits, no new health care initiatives are likely to emerge in Bush’s second term. If anything, the federal government is likely to approach health care as a budget issue, seeking to constrain spending in government programs, he says.

“The question for the future is whether health care will once again make the transition from being a problem about which people have deep concerns to a voting issue, as it did in the 1992 presidential election,” says coauthor Drew Altman, president of the Kaiser Family Foundation. “This may depend in part on whether health care can be framed as an issue of fundamental principles, rather than a series of complex health financing plans. That it is not now a voting issue suggests that politicians will not feel compelled to mount major health care reform efforts, at least as long as other issues dominate.”

In addition to the National Election Pool, Los Angeles Times, and Newsweek polls, the authors also examined data from a Kaiser Family Foundation/Harvard School of Public Health pre-election poll from October 2004, and ten other national surveys conducted between January and December 2004.

Among the findings of the various polls:

—On major health care issues, voters were more likely to trust Sen. John Kerry (D-MA), the Democratic candidate for president, than President Bush, by an average of 50 percent to 40 percent, but his lead was smaller than Democrats traditionally have held. A February 2004 poll gave Democrats a twenty-one-point lead over Republicans (52 percent to 31 percent) on which party would do a better job on health care issues.

—Costs were the most important health care issue for registered voters, cited by 30 percent of them. Next were the uninsured and access to health care (18 percent) and Medicare and seniors’ health care (16 percent).

—The top four health care issues cited as “extremely important” for Republican registered voters were abortion (30 percent), bioterrorism (28 percent), health care and insurance costs (20 percent), and medical malpractice (20 percent). The top four health care issues cited as “extremely important” for Democratic registered voters were the uninsured (43 percent), health care and insurance costs (39 percent), prescription drug benefits for seniors (39 percent), and the cost of prescription drugs (38 percent).

“The fact that personal concern about health care costs and access is already so high also suggests that raising awareness about these issues is not the paramount challenge for supporters of health care reform,” Altman says. “Rather, the biggest challenge is to forge consensus on policy solutions and ways to pay for them that politicians can effectively champion.”

Blendon’s coauthors are Mollyann Brodie, vice president and director of public opinion and media research at the Kaiser Family Foundation; Altman, the foundation’s president; John Benson, managing director of the Harvard Opinion Research Program; and Elizabeth Hamel, associate director of public opinion and media research at the Kaiser Family Foundation.

You can read the article at content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.86.

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org. The full text of this Health Affairs Web Exclusive is available free of charge to all Web site visitors for a two-week period following posting, after which it will revert to pay-per-view for nonsubscribers. The abstracts of all articles are free in perpetuity. Web Exclusives are supported in part by a grant from the Commonwealth Fund.



©2005 Project HOPE–The People-to-People Health Foundation, Inc.