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HEALTH CARE ISSUES PLAYED MODEST ROLE IN MID-TERM ELECTION
Despite Health Care Problems, Health Care Issues Ranked Low on Voters Agenda
Bethesda, MDDespite the spike in health care costs, rising numbers of uninsured people, and the public's growing dissatisfaction with the availability and affordability of health care, health care issues played a modest role in the 2002 mid-term elections. Results of national opinion surveys show that health care generally ranked fourth or fifth when likely voters were asked to name the most important issues in deciding their vote for Congress last November.
The analysis, which appears in a special Dec. 11 Web exclusive article (www.healthaffairs.org/WebExclusives/Blendon_Web_Excl_121102.htm) in the policy journal Health Affairs, was conducted by the Harvard School of Public Health/Kennedy School of Government, the Kaiser Family Foundation, and National Public Radio. The survey data are derived from an NPR/KFF/Kennedy School of Government pre-election survey conducted in late October, questions from 10 other national surveys, and two surveys of likely voters in Oregon. The data do not address the role health care might have played in specific congressional races, rather they give an overall picture of voter mindset before the Nov. 5 election.
Kaiser Foundation President and CEO Drew Altman, one of the co-authors of the analysis of the 2002 elections, says he is not surprised that health care was not a major factor at the ballot box. "It would have been a surprise if it was," he says. "Off-year elections are typically not about big national issues," he adds.
In addition, Altman says the American voting public is distracted by other things. "We are still in a post 9/11 world and the public is focused on terrorism and the possibility of war, and the economy." Altman says the November 2002 election "wasn't an election about national issues, rather it was en election about issues particular to a small number of contested congressional and gubernatorial races."
Co-author Robert Blendon, a professor of health policy and political analysis at the HSPH and the Kennedy School, agrees. "Terrorism has a subliminal effect in that it reduces the importance to voters of other domestic problems. As long as the stock market and terrorism remain important issues, health care issues are not likely to be a driving force at the voting booth," he says.
In fact, the top concerns of voters at the polls were terrorism, going to war with Iraq, the economy and jobs. But when pre-election voters were asked which health care issue was important in deciding their vote, no single issue stood out. The most frequently cited problem was the cost of prescription drugs. Not surprisingly, this was a very important issue for likely elderly voters; 45 percent cited prescription drug costs as the most important health issue. But younger voters also are paying attention to this problem. Twenty percent of voters under age 65 also cited prescription drug costs as an important issue. During the course of the campaign, the proportion of likely voters citing prescription drugs as the most important health care issue grew from 17 percent in June to 25 percent in late October, while the proportion that cared about expanding health insurance coverage declined slightly from 23 percent to 18 percent.
When asked what was the most important health care issue in making their voting decision, one in seven likely voters said that Medicare, Medicaid, and care for the elderly were the most important issues in making their voting decision. A majority of voters said they believed that Medicare had "major" problems but few thought the program is in crisis. Interestingly, elderly voters are less likely than younger voters to think the program is in crisis. When asked about how to help seniors pay for prescription drugs, a majority of likely voters said they favored expanding Medicare to pay for part of the costs, while a third preferred the government to help seniors buy private health insurance plans that would cover part of the costs.
The authors conclude that because no health care issue stood out as the most important in voters' minds and there was no consensus among voters on what health care issue to address first, voters aren't offering any clear direction to policymakers on the issue. Still, they argue that between now and 2004, there is "likely to be a great deal of debate" about what the government should do to address the problem of the uninsured and rising prescription drug and other health care costs.
Altman and Blendon agree that terrorism and/or a war with Iraq could derail anything on the national agenda, pre-empting debate on health care issues. But they and their co-authors add that "if health care problems worsen and if one or more Democratic presidential candidates champion the issue, health could emerge as an important voting issue" at the ballot box in 2004.
Health Affairs, published by Project HOPE, is a bimonthly multidisciplinary journal devoted to publishing the leading edge in health policy thought and research. Copies of the December 11 Web exclusive article - Where Was Health Care In the 2002 Election? - are available free on the journal's Web site, www.healthaffairs.org.
©2002 Project HOPEThe People-to-People Health Foundation, Inc.