Key Findings

At the beginning of the 2018 primary season, congressional candidates’ positions on President Trump are weighing greater on most voters’ minds than any issue – including health care. When asked what will make the biggest difference in how they vote for Congress, larger shares of both Democratic and Republican voters say a candidate’s support for or opposition to President Trump will make the biggest difference than say the same about specific national issues or local or state issues.

Health care is among the top issues that voters want to hear candidates talk about during their congressional campaigns but ranks much lower among Republican voters, including those living in areas where there are competitive House, Senate, and Governor’s races.

Democrats have a clear edge when it comes to voter enthusiasm six months out from the 2018 midterm elections. Yet, similar to 2014, no issue – including health care – seems to be a driving force among enthusiastic voters. When asked to say in their own words why they are more enthusiastic about voting this year, the most common response offered by Democratic voters was a “desire for change” (22 percent) while one in five Republican voters said they are more enthusiastic because they want to vote “to support President Trump and the current administration.” About six percent of voters who are more enthusiastic this year explicitly mention concern over a specific issue (few explicitly mention health care) as the main reason for their enthusiasm.

Over the next six months, we will be tracking a unique group of voters – health care voters. Health care voters are a liberal-leaning, Democratic group of voters who say a candidate’s position on health care will be the “most important factor” in their 2018 congressional vote choice. These voters want to hear candidates talk about bringing down health care costs and while majorities say they plan to vote for the Democratic congressional candidate in their district, they are not more enthusiastic than other voters about participating in this year’s election.

Top Issues for 2018 Congressional Campaigns

This month marks the big push in the Democratic and Republican primary season and with congressional campaigns gearing up, the latest Kaiser Health Tracking Poll examines the top issues that voters want to hear the candidates talk about on the campaign trail. Overall, the top issues chosen by voters are the economy and jobs (23 percent), health care (22 percent), and gun policy (22 percent) – an issue back in the news following recent school shootings and subsequent protests. Health care also ranks among the top issues that voters who live in areas where there are competitive House, Senate, or Governor races want to hear candidates discuss (20 percent), along with gun policy (23 percent), economy and jobs (20 percent), and immigration (17 percent).

2018 Midterm Election Analysis As part of Kaiser Family Foundation’s effort to examine the role of health care in the 2018 midterm elections, throughout the year we will be tracking the views of voters – paying special attention to those living in states or congressional districts in which both parties have a viable path to win the election. This group, referred to in our analysis as “voters in battlegrounds” is defined by the 2018 Senate, House, and Governor ratings provided by The Cook Political Report. Congressional and Governor races categorized as “toss-up” were included in this group. A complete list of the states and congressional districts included in the comparison group is available in Appendix A.

Health Care Ranks Higher as Campaign Issue for Democrats

The ranking of these issues varies across party lines with fewer Republican voters (15 percent) saying health care is the “most important issue” for candidates for Congress to talk about. Larger shares of Republican voters say the economy and jobs (24 percent), immigration (22 percent), and gun policy (19 percent) are the most important issue for candidates to discuss. Health care ranks among a series of second tier issues for Republican voters including other issues such as the federal budget deficit (14 percent), and tax cuts and tax reform (14 percent). This may mark a turning point for the prominence of health care in Republican campaigns compared to the past four election cycles – since the passage of the 2010 health care law – health care has been a major talking point for Republican candidates.

Health care ranks higher among issues for both Democratic voters and independent voters. Three in ten Democratic voters say health care is the “most important issue” for candidates to talk about, which is similar to the share who say the same about gun policy (28 percent). The top issues for independent voters are the economy and jobs (22 percent), gun policy (19 percent), and health care (19 percent).

Health Care v. Other Voting Factors

When forced to choose the most important issue they want to hear the congressional candidates discuss among all issues polled, gun policy (14 percent), the economy and jobs (13 percent) and health care (12 percent) are the top issues for voters overall. However, nearly four in ten voters (36 percent) say none of the issues on this list are the “most important” for the candidates to discuss.

One reason why nearly four in ten (36 percent) say none of the issues provided are the “most important” for congressional candidates to discuss may be because voters seem to care more about the candidates’ character and experience or their support for or opposition to President Trump. When national issues are put up against these other voting factors, majorities of Republican and Democratic voters say “a candidate’s support or opposition to President Trump” or the “candidate’s character and experience” will make the biggest difference in how they vote for Congress.

Nearly one-third of Republican voters (32 percent) and three in ten Democratic voters say a candidate’s support for or opposition to President Trump will make the biggest difference in their congressional vote choice. Smaller shares – about one five – say either “specific national issues” or “local or state issues” will make the biggest difference. Independent voters are less likely than partisan voters to say a candidate’s support for or opposition to President Trump will make the biggest difference (17 percent).

Even among voters who say health care is the most important issue for 2018 congressional candidates to talk about, three in ten (28 percent) say a candidate’s support for or opposition to President Trump will make the biggest difference in their vote for Congress and another one in five say it will be the candidate’s character and experience.

Battleground Republican Voters in 2018 midterms

Nearly four times as many Republican voters living in battleground areas say a “candidate’s support for or opposition to President Trump” will make the biggest difference in how they vote for Congress (37 percent) than say health care is a top issue for congressional candidates to discuss (10 percent). A large share of this year’s competitive elections are taking place in traditionally strong Republican areas, where voters may be more conservative than Republicans overall.

Nearly Half of Democratic Voters Say They Are More Enthusiastic About Voting This Year

As other polls have shown, Democrats have a clear edge when it comes to voter enthusiasm six months out from the midterm elections. While a majority of all voters say their enthusiasm about voting this year is “about the same” as in previous congressional elections, 45 percent of Democratic voters say they are “more enthusiastic” this year than in the past, compared to three in ten Republicans and independents (31 percent).

The current enthusiasm gap is flipped from KFF’s 2014 midterm polling, in which a slightly larger share of Republicans said they were “more enthusiastic” (27 percent) compared to one in five Democrats and independents (18 percent). Yet, similar to 2014, no issue – including health care – seems to be a driving force among enthusiastic voters – across both Democrats and Republicans.

When asked to say in their own words why they are more enthusiastic about voting this year, the most commonly offered response from Democrats was “a desire for change” (22 percent) while one in five Republicans said they are more enthusiastic because they want to vote “to support President Trump and the current administration.” About six percent of voters who are more enthusiastic this year explicitly mention concern over a specific issue (few explicitly mention health care) as the main reason for their enthusiasm.

Who Are the Health Care Voters?

Over the next six months, the Kaiser Family Foundation will be tracking a unique group of voters – health care voters. When asked whether a series of issues will be an important factor in their 2018 congressional vote choice, these voters say a candidate’s position on health care will be the “most important factor” in their decision. Overall, one-fourth of voters (23 percent) are “health care voters,” which includes five percent who are single-issue health care voters (meaning they only chose health care as the most important factor). To compare the demographic profile of health care voters to other voters, see our health care voter interactive.

Health Care Voters May Play larger role in Democratic primaries

Six in ten health care voters are Democrats (47 percent) or Democratic-leaning independents (15 percent), while seven percent describe themselves as independents and one-fourth are Republicans (15 percent) or Republican-leaning independents (8 percent).

A more liberal-leaning, Democratic group of voters, seven in ten disapprove of the way Donald Trump is handling his job as President, and six in ten (59 percent) say that if the November election was held today, they would vote for the Democratic candidate in their district. Yet, this group is not more enthusiastic about voting in the 2018 midterm election with four in ten (38 percent) saying they are “more enthusiastic” compared to 34 percent of voters who are not health care voters.

Table 1: Health Care Voters Lean Democratic on All Measures Health Care Voters Not Health Care Voters Percent who disapprove of the way Donald Trump is handling his job as President: 70 49 Percent who say this November, they are more likely to support the Democratic Party’s candidate in their district: 59 42 Percent who are more enthusiastic about voting this year compared to previous congressional elections: 38 34

What Health Care Issues do Health Care Voters Want to Hear Candidates Talk About?

When asked to say in their own words what specific health care issues they most want to hear the 2018 candidates discuss, health care costs are the top issue mentioned by both Democratic-leaning health care voters (31 percent) and Republican-leaning health care voters (55 percent). The other health care issues vary in importance by partisanship. About one in five (18 percent) of Democratic health care voters say they want to hear candidates discuss universal coverage and about one in ten (11 percent) mention concerns about quality of coverage or care. About one in ten Republican-leaning health care voters want to hear candidates talk about Medicare/senior concerns (9 percent) and improvements in the way health care is delivered (8 percent). Health care costs are also the top health care issue that all voters want to hear candidates talk about during the 2018 campaign.

The Role of Candidates’ Positions on Health Care in Midterm Elections

While health care is not the driving issue for most voters, a candidate’s position on specific health care issues may influence voters’ decisions this fall – especially when it comes to health care costs. Two-thirds of Republican voters, nearly eight in ten Democratic voters (78 percent), and 72 percent of independent voters say that if a candidate for Congress supports bringing down prescription drug costs, they would be “more likely” to vote for that candidate. The same is true of a candidate who wants to lower health care or health insurance costs, with six in ten Republican voters (63 percent), three-fourths of Democratic voters, and 68 percent of independent voters saying they would be more likely to vote for that candidate. Few partisans – regardless of party identification – say they would be “more likely” to vote for a candidate who wants to reduce government spending on health programs such as Medicare and Medicaid.

That is seemingly, where the partisan agreement ends, with majorities of Democratic voters saying they would be more likely to vote for a candidate who supports universal coverage (77 percent), supports the Affordable Care Act (74 percent), or supports passing a national health plan (59 percent). On the other hand, a majority of Republican voters say they would be more likely to support a candidate who wants to repeal the Affordable Care Act (67 percent).

The Affordable Care Act

Partisanship still drives views of the 2010 Affordable Care Act (ACA). About half (49 percent) of the public and vast majorities of Democrats (79 percent) hold a favorable view of the ACA, while 43 percent of the public and majorities of Republicans (79 percent) hold an unfavorable view of the law. This is similar to last month’s tracking poll and continues the nearly year-long trend of a larger share of the public holding favorable than unfavorable views.