Health Issues

In 2022, nearly half (47%) of metropolitan areas across the nation had only one or two hospitals or health systems offering general inpatient hospital care, according to a recent KFF analysis.

The analysis explores the level of competition among hospitals amidst a surge of hospital consolidations that has garnered the attention of both state and federal regulators. Approximately one in five (19%) metropolitan statistical areas are served by just one hospital or health system, while more than a quarter (27%) are under the control of two hospitals or systems.

In a vast majority of metropolitan areas (82%), one or two hospitals or health systems accounted for at least three-quarters of all inpatient hospital discharges, thus fulfilling the criteria for highly concentrated markets as outlined by current federal antitrust standards.

The quantity of hospitals or health systems in a metropolitan area commonly increases with the population size of the region. A significant majority of smaller metropolitan areas (fewer than 200,000 residents) have only one or two hospitals or health systems providing inpatient care, while almost all of the largest areas (with at least one million residents) host a minimum of four hospitals or health systems.

Additional findings include:

• Almost all (97%) metropolitan areas exhibited highly concentrated markets for inpatient hospital care in 2022, as measured by the Herfindahl-Hirschman Index, which assesses the market shares of participants in a specific market. This metric is utilized by the Federal Trade Commission and Department of Justice in their current guidelines for evaluating hospital or health system mergers.
• Two-thirds (67%) of hospitals across the country were affiliated with health systems in 2022, an increase from 56% in 2010. This rise in affiliated hospitals impacted both rural and urban areas, despite the fact that nearly half (48%) of hospitals in rural regions remain independent of larger health systems.

Immigrant adults represent a diverse segment of the population, constituting 16% of adults in the United States and significantly contributing to the nation’s workforce and communities. As we approach the 2024 election, anti-immigrant sentiment has surged, with immigration becoming a focal issue for various candidates. The Trump campaign has frequently labeled immigrants as contributors to crime, a financial burden on taxpayers, and a liability for government programs such as Medicare and Social Security. Meanwhile, the Harris campaign has centered its immigration narrative around her strong law enforcement background as a former attorney general in a border state, while also emphasizing her family’s immigrant heritage. Certain states have enacted restrictive measures aimed at immigrants, including mandates for hospitals to gather patient immigration status.

In light of this rhetoric and recent state actions, information on immigrants’ health care utilization and costs, as well as their economic contributions, particularly in the health care sector, is essential. This brief presents important data on these subjects, utilizing KFF analysis from various sources, including the KFF/LA Times Survey of Immigrants, the largest nationally representative survey of immigrants conducted to date, along with other studies.

Immigrants are no more likely than U.S.-born citizens to report using government assistance for food, housing, or health care; undocumented immigrants remain ineligible for federally funded assistance.

The 2023 KFF/LA Times Survey of Immigrants reveals that, despite experiencing lower household incomes and encountering financial difficulties, immigrant adults are just as likely as U.S.-born adults to state that they or someone in their household received government assistance for food, housing, or health care in the last year. In fact, approximately one-quarter (28%) of both immigrant adults and U.S.-born citizen adults reported receiving such assistance within the past 12 months (Figure 1).

Lawfully present immigrants face eligibility restrictions for federal programs like Medicaid and the Children’s Health Insurance Program (CHIP). Generally, lawfully present immigrants must possess a “qualified status” to access Medicaid or CHIP. Many, including most lawful permanent residents or green card holders, must wait five years after achieving qualified status before enrolling, provided they meet all other eligibility criteria. Some lawfully present immigrants, such as refugees and asylees, are exempt from this five-year waiting period. Additionally, states can expand coverage to lawfully residing immigrant pregnant individuals and children without this waiting period. Lawfully present immigrants can also purchase coverage through the Affordable Care Act (ACA) Marketplace and qualify for tax credits to help lower their costs immediately. Those meeting the work requirements can enroll in Medicare, while others may purchase Medicare Part A after maintaining legal residence in the U.S. for five consecutive years.

Undocumented immigrants cannot enroll in federally funded programs like Medicaid, CHIP, or Medicare, nor can they buy coverage through the ACA Marketplaces. Medicaid can cover emergency services for individuals eligible for Medicaid but for their immigration status. Emergency conditions encompass those that threaten the individual’s health or result in serious bodily impairment, although states hold discretion regarding what services qualify for Emergency Medicaid reimbursement.

Some states have initiated fully state-funded programs to extend coverage to immigrants regardless of status, although the eligibility criteria and benefits provided vary. Studies indicate that expanding health coverage for immigrants can lead to decreased rates of uninsurance, increased health care utilization, reduced costs, and improved health outcomes.

Immigrants, especially undocumented ones, utilize health care services, including emergency care, less than U.S.-born individuals.

Research indicates that immigrants, both lawfully present and undocumented, engage less with health care services than U.S.-born citizens. The KFF/LA Times Survey of Immigrants shows that undocumented immigrants are less likely to seek or receive care in the U.S. compared to lawfully present immigrants and naturalized citizens. Approximately 63% of likely undocumented immigrant adults report having a health care visit in the past year, compared to 74% of lawfully present immigrant adults and 82% of naturalized citizen adults.

This lower health care utilization among immigrants can be attributed to their overall healthier and younger demographics, along with increased barriers such as language access issues, confusion, and fears related to immigration. Analysis from KFF indicated that policies from the Trump administration intensified these fears and led to increased hesitance in seeking care.

Immigrants incur lower health care costs compared to U.S.-born individuals.

Reflecting their reduced health care utilization, immigrants exhibit lower health care expenditures than their U.S.-born counterparts. KFF’s analysis of 2021 medical expenditure data indicates that the average annual per capita health care expenditures for immigrants are about two-thirds that of U.S.-born citizens ($4,875 vs. $7,277) (Figure 3). This includes lower spending across various health care services such as office visits, prescription medications, inpatient and outpatient care, and dental services. These findings support other research revealing that immigrants’ overall health expenditures range from half to two-thirds compared to those of U.S.-born individuals, irrespective of immigration status, with lower per capita expenses noted across private and public insurance sources, especially among undocumented immigrants. A particular study highlighted that undocumented immigrants tend to be uninsured and have significantly reduced yearly health care expenditures compared to U.S.-born individuals, with no substantial differences in rates of uncompensated care between the two groups.

Immigrants bolster the economy through their workforce participation and tax contributions, with evidence suggesting they help subsidize health care for U.S.-born individuals and bolster Medicare and Social Security.

Immigrants play a crucial role in addressing the nation’s labor shortages by occupying unmet manufacturing and service needs, with research indicating they do not displace U.S.-born workers. Their contributions are particularly evident in essential sectors such as construction and agriculture, which are vulnerable to health risks and injuries, including climate-related hazards. Furthermore, immigrants, alongside their adult children, significantly enhance the health care workforce, serving as physicians, surgeons, nurses, and long-term care workers (Figure 4). With ongoing projections of shortages in health care employment and a growing population aged 65 and older, immigrants could be pivotal in alleviating these workforce deficits.

Studies show that undocumented immigrants contribute billions yearly in federal, state, and local taxes, with more than a third attributed to payroll taxes funding programs they cannot access, such as Social Security and Medicare. Additional research indicates that immigrants contribute more to the health care system than they use through taxes and premiums, effectively subsidizing health care for U.S.-born citizens. Earlier studies found that without the input of undocumented immigrants into the Medicare Trust Fund, it would face insolvency sooner, and demonstrably, undocumented immigrants positively impact the financial health of Social Security.

Starting Nov. 1, 2024, Georgia residents will use a state-run health insurance enrollment platform, Georgia Access, to shop for and enroll in Marketplace health coverage for 2025. ^{Here’s a look at the changes that consumers can expect:}

* HealthInsurance.org, LLC and INSXCloud, Inc. indirectly share common corporate ownership.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.

Key Takeaways

• The Biden administration recently announced a projected reduction of out-of-pocket costs for seniors as part of the Medicare drug negotiations, yet large majorities of voters have not heard about these savings, with almost half (45%) who say they have heard “nothing at all,” while a quarter have heard “a lot” or “some.” Larger shares of older voters, those ages 65 and older, say they’ve heard “a lot” or “some” about these savings, with a third (32%) who say so, compared to two in ten (22%) of those under age 65. Most voters continue to be unaware of the Medicare drug pricing provisions in the Inflation Reduction Act, or IRA, that was passed by Congress and signed into law by President Biden more than two years ago, though awareness of some of the provisions is higher among older voters – the group most impacted by the provisions.
• While awareness of Medicare drug negotiations continues to lag, KFF finds widespread support for this policy. Majorities of voters support authorizing the federal government to negotiate drug prices, while one in seven (14%) oppose. This provision is supported by nine in ten Democrats and independent voters (92% and 89%, respectively) and three-quarters of Republican voters (77%). It is also supported by 88% of older adults, those ages 65 and over, including majorities across partisans.
• Voters’ views of who is responsible for the legislation as well as the expected savings from the negotiations are largely partisan. Overall, a slight majority (55%) of voters ages 65 and older think Medicare negotiating will lower their own prescription drug costs, but the share who expect to see savings increases to nearly two-thirds (64%) of older Democratic and Democratic-leaning voters. On the other hand, about half (52%) of older Republican and Republican-leaning voters say they don’t expect the negotiations to have any impact on their drug costs. In addition, voters are also more likely to give their own party leaders credit for passing legislation aimed at lowering the price of prescription drugs for people on Medicare, though Republican voters are less enthusiastic about their party leaders’ roles. Larger shares of Democratic voters than Republican voters say President Biden, Vice President Harris, and the Democrats in Congress played a “major” or “minor” role in passing legislation for lowering drug prices for people on Medicare, while Republican voters are more likely than Democratic voters to say the same about Republicans in Congress. A similar share of Republican voters give former President Trump credit for passing the legislation as give credit to President Biden.
• Vice President Harris’ campaign has announced proposals for expanding some of the IRA provisions beyond those with Medicare coverage. Majorities of voters, overall and across partisanship, support these proposed provisions, though smaller shares of Republicans are on board. Three-quarters (77%) of voters support the proposal to expand the $35 cap on out-of-pocket costs for insulin beyond those with Medicare, including majorities of Democratic voters (84%), independent voters (79%), and Republican voters (70%). Seven in ten (69%) voters support the proposal to expand the $2,000 annual limit on out-of-pocket prescription drug costs beyond those with Medicare, including 83% of Democrats, 70% of independents, and 58% of Republicans.

Most Voters Continue to Be Unaware of IRA Provisions to Reduce Prescription Drug Prices

Most voters continue to be unaware of the Medicare drug pricing provisions in the Inflation Reduction Act, or IRA, that was passed by Congress and signed into law by President Biden more than two years ago, though awareness of some of the provisions is higher among older voters – the group most impacted by the provisions.

Four in ten voters are now aware there is a federal law in place that caps the cost of insulin for people with Medicare at $35 per month, while another third (35%) are aware of the law that requires the federal government to negotiate the price of some prescription drugs for people with Medicare. A quarter of voters (27%) are aware of the federal law that places a limit on out-of-pocket prescription drug costs for people with Medicare, and one in eight (12%) are aware that there is a law in place that penalizes drug companies for increasing prices faster than the rate of inflation for people with Medicare.

Larger shares of voters ages 65 and older are aware of some of these drug pricing provisions of the IRA. For example, six in ten (61%) voters ages 65 and older are aware of the law that caps the cost of insulin for people with Medicare and about a third (34%) of older voters are aware of the provision that places an out-of-pocket limit on prescription drug costs. Similar shares of older voters compared to younger voters are aware of the provision that requires the government to negotiate the price of some prescription drugs and that penalizes drug companies for increasing prices faster than the rate of inflation for people with Medicare.

While awareness of the Medicare drug pricing provisions increased, especially among older voters, from November 2023 to May 2024, awareness has remained steady over the past several months.

Voters Remain Unaware of Impact of Medicare Drug Negotiations, Older Adults Are Unclear if It Will Reduce Their Prescription Costs

The Biden administration recently announced that the lower prices negotiated for some prescription drugs would have saved the federal government $6 billion in 2023 with an estimated $1.5 billion reduction in out-of-pocket costs for older adults when lower prices take effect in 2026. Large majorities of voters have not heard about these projected savings, with almost half (45%) who say they have heard “nothing at all” about the negotiations, while a quarter (25%) have heard “a lot” or “some.” Another three in ten (30%) have heard “a little” about the negotiations.

Larger shares of older voters, those ages 65 and over, say they’ve heard “a lot” or “some” about these savings, with a third (32%) who say so, compared to one in five (22%) of those under age 65.

Similarly, larger shares of Democratic and independent voters have heard about the projected savings, with about a third (34%) of Democrats and a quarter (27%) of independents who have heard at least “some,” compared to about one in six (16%) Republican voters.

Overall, almost nine in ten (85%) voters support authorizing the federal government to negotiate drug prices, while one in seven (14%) oppose. This provision is supported by 92% of Democratic voters, 89% of independent voters, and 77% of Republican voters. While support for the law is lower among Republicans, most Republican voters support it.

In addition to supporting the federal government negotiations, a slight majority (55%) of voters ages 65 and older think Medicare negotiations will lower their own prescription drug costs, while four in ten (43%) older voters think negotiating won’t have any impact on their prescription drug costs. Expectations that Medicare negotiations won’t lower drug costs seem to be partisan, with two-thirds (64%) of older Democratic and Democratic-leaning voters thinking it will lower their drug costs, while about half (52%) of older Republican and Republican-leaning voters thinking it won’t have any impact on their drug costs.

The Inflation Reduction Act was enacted under President Biden without any Republican support in Congress. Six in ten voters say President Biden had a “major” or “minor” role in passing the recent law aimed at lowering drug prices for people on Medicare, including four in ten (37%) who say he had a “major” role. Similar shares of voters say the same about Democrats in Congress, with six in ten (60%) who say they played a “major” or “minor” role. Another four in ten (42%) voters say Vice President Harris played a role. Credit for the recent law could be key as she picks up these issues on her own platform for president.

Almost half (46%) of voters think that Republicans in Congress played a role in passing the recent law, with a small share saying they played a “major” role (14%). About a quarter of voters credit former President Trump for the passage of the law aimed at lowering drug prices for those on Medicare, with a quarter (28%) who say he played a “major” or “minor” role, while 41% say he had no role in passing the recent law. Between a quarter and a third of voters aren’t sure how big of a role these groups played in the health care legislation.

Partisans are more likely to give their own party leaders credit for passing legislation aimed at lowering the price of prescription drugs for people on Medicare, though Republican voters are less enthusiastic about their party leaders’ roles. Larger shares of Democratic voters than Republican voters say President Biden, Vice President Harris, and the Democrats in Congress played a “major” or “minor” role in passing legislation for lowering drug prices for people on Medicare. While Republican voters are more likely than Democratic voters to say former President Trump and the Republicans in Congress played a role, only about a quarter of Republican voters said either (23% and 24%, respectively) played a “major role.” In fact, a similar share of Republican voters give former President Trump credit for passing the legislation as give credit to President Biden.

Overall, eight in ten (81%) Democratic voters say Biden played a role in passing the legislation, four in ten (39%) of Republican voters say the same about Trump. Another eight in ten Democratic voters say Democrats in Congress played a “major” or “minor” role in passing the legislation, while over half (54%) of Republicans say the same about Republicans in Congress.

Voters Support Expanding on IRA Provisions

Vice President Harris’ campaign has announced that, if elected, her administration hopes to expand some of the drug pricing legislation beyond just those with Medicare, allowing others to benefit from the cap on monthly out-of-pocket costs for those with insulin and the annual limit on out-of-pocket prescription drug costs. Former President Trump has remained silent on some of these issues, though his administration implemented a program under which Medicare plans voluntarily lowered insulin copays to $35 per month. Majorities of voters, overall and across partisanship, support these proposed provisions, though smaller shares of Republicans are on board. Three-quarters (77%) of voters support the proposal to expand the $35 cap on out-of-pocket costs for insulin beyond those with Medicare, including majorities of Democratic voters (84%), independent voters (79%), and Republican voters (70%). Seven in ten (69%) voters support the proposal to expand the $2,000 annual limit on out-of-pocket prescription drug costs beyond those with Medicare, including 83% of Democrats, 70% of independents, and 58% of Republicans.

Allowing Medicare to negotiate drug prices on behalf of older Americans remains broadly popular across partisans, though many voters are unaware of the new law and the billions of dollars it is expected to save in 2026, a new KFF Health Tracking Poll finds.

A large majority (85%) of voters say they support allowing the federal government to negotiate the price of some prescription drugs for people with Medicare. This includes at least three quarters of Republican (77%), independent (89%) and Democratic (92%) voters.

The Inflation Reduction Act of 2022 authorized such negotiations, and the Biden administration recently completed the first round of negotiations on 10 drugs, resulting in an estimated $1.5 billion in lower out-of-pocket costs for Medicare beneficiaries in 2026.

The poll shows that nearly two thirds (65%) of voters are unaware or unsure that there is a law allowing Medicare drug-price negotiations. The share (62%) is similar among older voters (ages 65+) who are generally covered by Medicare.

A large majority (75%) of voters also say they have not heard much about the savings resulting from the first round of price negotiations, including almost half (45%) who say they have heard “nothing at all.” 

One in four say they have heard “a lot” (4%) or “some” (21%) about the savings. Older voters are somewhat more likely to have heard either “a lot” (7%) or “some” (26%) about the savings.

Other findings include:

• Most (55%) voters ages 65 and older expect that Medicare drug-price negotiations will lower their own prescription costs, with 43% saying it will not have any impact. Older Democratic and Democratic-leaning independent voters are more likely than older Republicans and Republican-leaning independent voters to expect savings (64% vs. 45%). 

• Minorities of voters are aware of other Medicare drug-price provisions in the Inflation Reduction Act, including the $35 cap on out-of-pocket costs for insulin (40%) and limiting annual out-of-pocket prescription drug costs (27%). Older voters are more likely than younger voters to know about both of these provisions. 
• While the Inflation Reduction Act was enacted under President Biden without any Republican support in Congress, partisans are divided on who deserves credit for the law’s Medicare drug price provisions. Substantial shares of GOP voters say that Republicans in Congress (54%) and President Trump (39%) had either a “major” or “minor” role in enacting those provisions. Larger shares of Democratic voters say that Democrats in Congress (80%), President Biden (81%), and Vice President Harris (69%) had a role. 
• Most voters say they would be in favor of extending Medicare’s $35 cap on monthly insulin costs (77%) and the $2,000 limit on out-of-pocket drug spending (69%) beyond people with Medicare, as Vice President Harris has proposed. Majorities of Democrats, Republicans and independent voters support extending each of the two provisions. 

Designed and analyzed by public opinion researchers at KFF, the survey was conducted August 26-Sept. 4, 2024, online and by telephone among a nationally representative sample of 1,312 U.S. adults, including 1,084 registered voters, in English and in Spanish. The margin of sampling error is plus or minus 4 percentage points for the full sample and among registered voters. For results based on other subgroups, the margin of sampling error may be higher.

Most individuals view their health expenditures primarily as the monthly premium payments they make, along with any out-of-pocket expenses for medical services or prescription medications. Nevertheless, there is a considerable amount of health spending that remains less apparent in everyday life.

This interactive tool, recently updated with data from 2022, aids users in understanding how health care costs differ based on family size, income, insurance coverage, and health conditions. Utilize the dropdown menus to examine various scenarios and trends related to household health spending.

The tool, along with additional data on health expenses, can be found on the Peterson-KFF Health System Tracker, a dedicated online resource aimed at monitoring and evaluating the performance of the U.S. health care system.

Note: The third bullet in the key findings was revised on Sept. 17, 2024, to rectify a typographical mistake, where former President Trump had been incorrectly identified as President Biden.

Key Takeaways

• Approximately 40% of voters (38%) prioritize the economy and inflation as the dominant issue influencing their vote this fall, amid a range of national concerns, including various health care topics. With the economy being a critical factor in the 2024 election, constituents from both parties express a desire for their candidates to address health care costs. When asked to articulate in their own terms which health care issue they wish to see candidates discuss, around 40% of voters from both sides mention concerns pertaining to health care expenses. Democratic voters and those leaning Democratic express interest in Vice President Harris discussing overall health care costs (20%), prescription medication costs (15%), and insurance costs or efforts to reduce monthly premiums (6%). Approximately one in seven voters cite abortion as the health care issue they are most eager to hear from Harris, while 13% advocate for universal health care—an issue previously prominent in the 2020 Democratic primaries. In a similar vein, nearly half (45%) of Republican voters and those leaning Republican convey a strong interest in hearing former President Trump speak on health care costs, followed by one in eight (12%) wanting to learn more about Medicare, Medicaid, or Social Security.
• Abortion remains a key motivator for a select group of voters, especially Democratic women and those leaning Democratic within the reproductive age range (ages 18-49). Around 20% of this demographic identify abortion as their primary voting concern, with half indicating they will only support candidates whose views align with theirs on this issue. This group overwhelmingly desires the preservation of legal abortion, with 90% advocating for federal legislation that reinstates nationwide access akin to the protections formerly established by Roe v. Wade. The percentage of Democratic-leaning women of reproductive age believing that the presidential election will significantly impact abortion access has surged by 31 percentage points over the past six months (90% v. 59%), coinciding with Vice President Harris’s nomination and her emphasis on this topic during her campaign.
• Currently, a majority of voters express greater trust in the Democratic nominee to handle abortion issues compared to former President Trump (53% v. 34%), marking a substantial increase from the relatively narrow edge that President Biden held over Trump earlier this year (38% v. 29%). This shift underscores Harris’s notable standing among Democratic voters concerning this matter.
• A strong majority of voters prefer a federal law that reinstates a nationwide right to abortion similar to those protections established by Roe v. Wade (61%), as opposed to leaving the legality of abortion to state discretion (39%). Furthermore, an overwhelming 87% of Democratic voters and 68% of independent voters favor such a federal law, corresponding with the political stance of the Democratic nominee, Vice President Harris, while 70% of Republican voters prefer state-level control over abortion regulations—a viewpoint championed by former President Trump. Interestingly, a significant portion of Republican women voters of reproductive age also support the federal restoration of abortion rights, with roughly half favoring this proposal.

How Voters Are Prioritizing Health Care Issues in 2024

Voter concerns regarding the economy and inflation continue to overshadow other issues during the current presidential election cycle, with 38% identifying it as their primary concern in the 2024 race. Following economic issues are concerns about threats to democracy (22%), immigration and border security (12%), and individual health care matters including abortion (7%), Medicare and Social Security (7%), and health care expenses, including prescription drugs (5%). Collectively, health care concerns are highlighted by around 19% of voters as the most crucial issue.

While substantial proportions of voters across party lines emphasize the economy and inflation as their main voting issue, the prioritization of other topics proves to be more partisan. For instance, Republican voters are significantly more likely to cite immigration as their most critical voting issue, with nearly a quarter (23%) considering it paramount compared to just 9% of independent voters and 4% of Democrats. Conversely, threats to democracy take precedence as the primary issue for Democratic voters, with 40% stating it is their foremost concern, contrasted with 22% of independent voters and 5% of Republican voters.

Voters Want to Hear Candidates Talk About Lowering Health Care Costs

As voters express how the economy and health care are intertwined, concerns about costs also surface when queried on the health care topics they most desire candidates to discuss. Among Democrats and those leaning Democratic, 42% cite costs as the primary health care issue they wish Vice President Harris to address. This includes mentions of general health care expenses (20%), prescription medication costs (15%), and insurance premiums (6%). About one in seven voters identify abortion as the health care subject they would like Harris to cover, while 13% refer to universal health care—a topic that garnered significant discussion during the 2020 Democratic primaries.

In a similar vein, nearly half (45%) of Republican voters and those leaning Republican express a desire for former President Trump to address health care costs, with the second topic desired being discussions surrounding Medicare, Medicaid, or Social Security.

Health Care Issues, Including Abortion, Resonate Highest With Certain Voters

Overall, the individual health care concerns presented are of greater significance to Democratic voters, who are more than twice as likely as their Republican counterparts to classify abortion, Medicare and Social Security, or health care costs as key voting issues (25% v. 11%). Furthermore, one in five independent voters also select health care as their primary voting issue. Notably, women voters are approximately twice as likely as men to prioritize health care issues (25% vs. 12%). Historically, Democratic voters and women have shown a stronger tendency to prioritize health care concerns than other demographics, with the exception being Republican voters focusing on repealing the Affordable Care Act. However, this election cycle marks a shift as abortion takes precedence for around 10% of Democratic voters and a similar proportion of women voters overall, particularly in the aftermath of the Supreme Court’s Dobbs decision that reversed Roe v. Wade.

Overall, the majority of voters (58%) indicate that a candidate’s stance on abortion is just one of numerous factors influencing their vote this year. In contrast, approximately a quarter of voters assert they will only support candidates who align with their views on abortion. About 18% of voters claim that abortion is not a significant consideration in their voting decision.

Democratic voters are more inclined to assert they will only vote for candidates who share their abortion views (31%), though most still classify it as one of many influential factors (61%). This sentiment is similarly reflected among women of reproductive age, with a third acknowledging they will only support a candidate in agreement with their abortion stance.

Abortion Is an Important Voting Issue for Democratic Women of Reproductive Age

Although abortion may not resonate universally as a primary voting concern, it stands out prominently for a critical group: Democratic women voters of reproductive age. Within this cohort, abortion is acknowledged as a leading issue, with 21% citing it as their foremost concern, ranking alongside the economy (23%) and threats to democracy (25%).

A majority of Democratic women of reproductive age express that they will solely support candidates who align with their abortion beliefs (48%), a position they hold more emphatically than any other demographic. A comparable percentage (48%) consider abortion a significant factor in their decisions, while only a small fraction (4%) see it as unimportant. This group largely advocates for abortion rights, evidenced by 93% of Democratic women of reproductive age believing abortion should remain legal in most or all circumstances.

Vice President Harris Has Strong Advantage on Abortion, Former President Trump Leads on Economy and Immigration

Former President Trump exhibits a distinct advantage over Vice President Harris regarding voter trust on two pivotal issues: the economy and inflation (52% vs. 37%) and immigration and border security (54% vs. 36%). In contrast, Vice President Harris maintains a near-equal edge on the abortion issue (53% vs. 34%). A KFF Tracking Poll from earlier this year, when President Biden was still considered the Democratic nominee, indicated that Biden’s edge over Trump on abortion was narrower (38% vs. 29%), showcasing Harris’s increasing strength with the Democratic electorate on this topic.

Neither presidential candidate has garnered majority trust regarding other key voting issues, including Medicare and Social Security or health care expenses. However, Vice President Harris does hold an advantage regarding health care costs. Former President Trump attracts more trust concerning the Israel-Hamas conflict, but many voters express no confidence in either candidate’s ability to manage this issue effectively.

Both presidential candidates are actively seeking to win over independent voters, who currently show a preference for Trump concerning their primary concern—the economy and inflation. About half of independent voters (52%) believe Trump would manage economic issues better, while only 32% express trust in V.P. Harris for this area. Harris holds a marginal advantage on their secondary concern regarding threats to democracy (46% vs. 37%). When examining health care issues, V.P. Harris has a considerable lead over Trump among independent voters, including a decisive 36-point advantage on abortion. Conversely, Trump commands a 20-point lead on immigration and border security.

Most Voters Expect Presidential Election to Have Major Impact on Abortion Policy

An overwhelming 89% of voters believe that this year’s presidential elections will affect abortion access in the U.S., including 61% who assert it will have a “major impact.” Only 11% of voters feel that the election will not influence abortion access at all.

Democratic voters are over twice as likely as their Republican counterparts (84% vs. 40%) to assert that the election will significantly influence abortion access. Among women voters of reproductive age—who are directly impacted by abortion policy—72% believe the presidential election will have a major effect, culminating in 90% of Democratic and Democratic-leaning independent women voters aged 18-49 expressing the same. Conversely, only 43% of Republican and Republican-leaning independent women voters within the same age bracket share this sentiment.

A greater proportion of voters currently believe that this election will have a “major” impact on abortion access than those who felt the same in March when President Biden was still a candidate, potentially indicating discomfort surrounding the issue. Currently, 61% of voters feel this election will exert a “major” impact, up from 51% in March. Notably, the rise in this belief has been pronounced among independent and Democratic voters, with 84% of Democrats now affirming the presidential election’s major influence on abortion access, surging from 71% previously. Similarly, independent voters’ agreement has risen to 58%, a 14-point increase from March. The sentiment among Republican voters, on the other hand, has shown no significant change.

Democratic and Democratic-leaning independent women voters of reproductive age are also increasingly emphasizing this election’s relevance to abortion access. Recent polling indicates that 90% of Democratic women under age 50 now believe this year’s presidential election will majorly affect abortion access in the U.S., a marked increase from the 59% who expressed this in March.

Six In Ten Voters Want Roe Protections Restored

Sixty-one percent (61%) of voters support a federal law that reinstates a nationwide right to abortion akin to protections previously established by Roe v. Wade, whereas 39% would prefer to leave the decision up to individual states. A significant number of both Democratic voters (87%) and independent voters (68%) favor this federal law. Conversely, around 70% of Republican voters advocate for allowing states to dictate abortion laws.

Moreover, nine out of ten Democratic and Democratic-leaning women of reproductive age support reestablishing a federal law regarding a nationwide right to abortion, while Republican women voters of the same age exhibit more varied opinions, with roughly equal proportions favoring a federal law (49%) and state-level decisions (51%).

Additionally, nearly 70% of voters residing in states where abortion remains legal support a nationwide federal law, alongside a majority of voters in states where abortion is restricted (54%).

This is particularly significant as ten states are poised to have voters make decisions on abortion-related measures in the upcoming 2024 election. In those states, 62% of voters indicate a preference for federal legislation reinstating a nationwide right to abortion similar to the former protections under Roe.

As the presidential campaigns progress, a significant majority of voters express the necessity for the 2024 presidential candidates to address abortion (84%), access to birth control (79%), and in vitro fertilization (IVF) (57%) during their campaigns.

A significant majority of Democratic voters affirm that it is “very important” or “somewhat important” for candidates to discuss these issues, with a considerable number of independent voters echoing that sentiment. Although a majority of Republican voters also believe it is essential for presidential candidates to speak about abortion and birth control access, their agreement is not as pronounced, and fewer than half express the same regarding IVF.

Moreover, at least 90% of Democratic and Democratic-leaning women of reproductive age stress the importance of candidates discussing abortion (97%) and access to birth control (95%) on the campaign trail, with three-quarters (76%) considering discussions around IVF equally important.

Over two in five (42%) or approximately 57.4 million adults under the age of 65 with private insurance may qualify under clinical criteria for GLP-1 medications, which are used to manage type 2 diabetes, obesity, or weight-related health concerns, according to a recent analysis by KFF.

Despite only about 3% of adults with employer-sponsored insurance obtaining a prescription in 2022, the interest and expenditure on GLP-1 drugs have risen significantly and may continue to increase. Due to the high costs and growing demand for these medications, employers and insurers might further tighten the eligibility criteria for coverage beyond the clinical guidelines established by the Food and Drug Administration.

For a comprehensive analysis and additional health cost data, please visit the Peterson-KFF Health System Tracker, an online resource dedicated to evaluating and monitoring the U.S. health system’s performance.

As Vice President Harris commits to tackling medical debt within her economic strategy, KFF Executive Vice President for Health Policy Larry Levitt examines how this issue reflects a wider challenge of accessible healthcare. He also discusses recent initiatives aimed at resolving the problem in this JAMA Health Forum post.

High cost-sharing and expenses that are not covered by insurance can result in substantial medical bills for some individuals. However, financial burdens are not the sole obstacles to accessing health care.

A recent analysis by KFF indicates that many adults encounter logistical challenges when seeking care, such as conflicting work schedules or difficulty in finding an in-network provider or securing an appointment. In 2022, approximately 1 in 5 adults under 65 faced at least one barrier to obtaining care beyond just cost.

The comprehensive analysis and additional data related to health costs are accessible on the Peterson-KFF Health System Tracker, an online platform dedicated to tracking and evaluating the performance of the U.S. health system.