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A new KFF poll finds that many older voters are unaware of the provision in the Inflation Reduction Act that for the first time requires the federal government to negotiate the price of some prescription drugs in the Medicare program, a key campaign issue for President Joe Biden.
The 48% of voters ages 65 and older who are aware of the landmark change represents a 12 percentage point increase from November, the poll shows.
Fifty-two percent of older voters are aware of another provision in the IRA, signed into law by Biden in 2022, that has received attention, capping the out-of-pocket cost of insulin for people on Medicare at $35 per month. And 40% are aware of another less widely discussed but significant provision that places an annual limit on out-of-pocket costs for people on Medicare, up from 27% in November.
The poll probed voters’ views of major health policy issues and how they line up with the presidential candidates’ approaches, both in office and on the campaign trail.
“It is commonly believed this is not a health care election because there is no national health reform debate,” said KFF President and CEO Drew Altman. “But in a close election voter concerns about a variety of health care issues, including abortion, prescription drugs and health care costs, could add up and make a difference in key states.”
The poll also finds that large majorities of voters overall, and across political identification, support extending to all adults with health insurance several of the IRA’s Medicare drug provisions – echoing what Biden has proposed. That includes the monthly insulin cost cap, favored by 88% of Democratic voters and 89% of Republican voters, and the annual drug spending limit, backed by 85% of Democrats and 87% of Republicans. Three-quarters of voters (75%) want to expand the number of Medicare drugs covered by price negotiations, including 79% of Democrats and 68% of Republicans.
Trust on health issues
On health care issues overall, partisans predictably put more trust in their own party’s candidate, but the poll shows that Biden has a clear trust advantage over former President Donald Trump with independent voters, a key voting group, on many areas of health care.
The poll finds that independent voters tilt toward Biden over Trump when it comes to whom voters trust more to determine the future of the ACA (49% v. 23%); ensure access to affordable health insurance (47% v. 22%); maintain protections for people with pre-existing health conditions (47% v. 23%); and determine the future of Medicare (44% v. 23%) and Medicaid (44% v. 24%).
On the issue of health care costs, which rises to the top of many voters’ concerns, Biden has a somewhat smaller advantage over Trump with independent voters (39% v. 26%) — although about a third (34%) of independent voters say they trust neither candidate on this issue.
At the same time, among all voters – not specifically independents — most are pessimistic about what either candidate would accomplish in addressing the issue of prescription drug costs. Fewer than half of voters say it is “very” or “somewhat” likely that Biden’s policies would lower prescription drug costs for people on Medicare (47%) or for everyone (43%) if he were re-elected. About four in ten voters say the same about Trump (41% for people with Medicare, 40% for everyone).
Abortion policy
The poll examined voter support for two broad approaches to abortion policy, among the most contentious issues in the election. Most voters (62%) support guaranteeing a federal right to abortion, as advocated by Biden. Fewer (42%) support leaving it up to individual states to decide the legality of abortion, as advocated by Trump.
While partisans divide, the share of Democratic voters who support a federal guarantee (89%) is larger than the share of Republican voters who support leaving the matter up to the states (60%). About six in ten (62%) independent voters favor a federal right to abortion. (For a deeper look at abortion in the election, see KFF’s March 2024 Health Tracking Poll.)
Future of the ACA
Although a majority of voters have favorable views of the ACA, attitudes towards the law continue to be marked by partisanship, with Democrats expressing more favorable views of the ACA than Republicans.
Nevertheless, the poll shows majority support (72%) for extending enhanced federal financial assistance for people who purchase ACA marketplace coverage. That includes large majorities of Democratic (90%) and independent voters (73%) and a smaller majority of Republican voters (57%). The enhanced subsidies are scheduled to expire at the end of 2025.
A large majority of voters say they think Trump – who tried to repeal the ACA when he was president – would either try to repeal the ACA (50%) or scale back what the law does (30%) if he is re-elected. Republican voters are less likely than Democratic voters to say Trump would attempt to repeal the entire ACA (37% v. 67%). Previous KFF polling has found that few voters think Trump has a plan to replace the ACA.
Future of Medicare, Medicaid, and Social Security
Majorities of voters are worried that, in the future, people covered by Medicare, Social Security, and Medicaid won’t be able to get the same level of benefits that are available today, with at least three in four saying they are at least somewhat worried about this when it comes to Social Security (83%), Medicare (78%), and Medicaid (73%). A recent report by the Medicare and Social Security trustees projects both programs will have insufficient funds to pay full benefits in about a decade.
When it comes to determining the future of these programs, voters overall are mixed in terms of which candidate they trust more, but older voters give a clear advantage to Biden. For example, about half of voters ages 65 and older say they trust Biden more to determine the future of Social Security (49%), Medicare (49%), and Medicaid (50%), while about a third of older voters say they trust Trump more on each.
Regarding Medicaid, the poll finds most voters across gender, age, and racial and ethnic groups are opposed to the idea of capping the federal government’s contribution to the states in paying for the program. However, while large shares of Democratic voters (87%) and independent voters (74%) say they want Medicaid to continue as it is today, Republican voters are evenly divided, with 50% preferring Medicaid to stay as it is today and 49% saying the federal government should limit how much it pays states and give them greater flexibility to administer their Medicaid programs.
Designed and analyzed by public opinion researchers at KFF. The survey was conducted April 23-May 1, 2024, online and by telephone among a nationally representative sample of 1,243 registered voters in English and in Spanish. The margin of sampling error is plus or minus 4 percentage points for registered voters. For results based on other subgroups, the margin of sampling error may be higher.
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