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H E A L T H  A F F A I R S  
W E B  E X C L U S I V E  

11  D E C E M B E R  2002  

Where Was Health Care In The 2002 Election?

A review of preelection opinion polls finds that health care was not the most pressing issue on voters' minds this year.

by Robert J. Blendon, Mollyann Brodie, Drew E. Altman, John M. Benson, Stephen R. Pelletier, and Marcus D. Rosenbaum

ABSTRACT:

An analysis of eleven national media polls finds that despite rising health care costs and the growing number of uninsured Americans, health care played a relatively modest role as an issue in the 2002 congressional elections. The top health care issue was the cost of prescription drugs. The results suggest that health care's role in the 2004 election is uncertain, depending on future concerns about terrorism, worsening health care problems, and how Republican and Democratic candidates handle health care issues.

The congressional election of 2002 was the first since 1934 in which a president's party gained seats in the U.S. House of Representatives in the first midterm election after the president took office. The Republicans now have a twenty-three-seat majority (228-205, with one Independent and one race undecided, as of this writing), a gain of at least five seats.¹ In the aggregate, Republican congressional candidates won 51.8 percent of the vote, compared with 45.2 percent for Democratic candidates.² Republicans also took control of the U.S. Senate, where they now have a three-seat majority (51-48, with one Independent), a gain of two seats.³ Voter turnout was 39.3 percent of all voting-age citizens, a slight increase from the 37.6 percent turnout in the previous midterm election in 1998.⁴

This report presents the results of national opinion surveys of likely voters on the importance of health care in the 2002 election and what voters thought were the most important health care issues.

Data Sources And Methods

The survey data in this paper are derived from three main sources: (1) a National Public Radio/Kaiser Family Foundation/Kennedy School of Government preelection survey, conducted 23-27 October 2002 (n = 1,007 adults nationwide, including 641 likely voters); (2) questions from ten other nationwide surveys; and (3) two surveys of likely voters in Oregon.⁵

One limitation is that the data analyzed here provide a national picture of the role of issues in what were actually 435 congressional races. Only a small percentage of these races were thought to be hotly contested. Thus, the data from these surveys give an overall picture but do not address the role health care might have played in particular races.

An analysis such as this would normally include results from the national Election Day poll of voters as they left their polling places. However, as a result of technical problems encountered on Election Day, the results of that survey, conducted by Voter News Service for a consortium of major newspapers and television networks, have not been released. Data from the exit poll might have provided more detail on the topics we discuss here.

Study Results

The role of issues in the 2002 election. When asked in three surveys conducted during the week before the election to name in their own words the one or two issues most important to them in making their voting decision for Congress, no more than one-fourth of likely or registered voters agreed on any particular issue. The leading issue on all three surveys was the economy and jobs. Between 14 percent and 35 percent of likely or registered voters did not name any issue at all (Exhibit 1).⁶
In three other surveys, where likely voters were asked to choose from short lists of issues, two areas stood out as most important: terrorism and Iraq, and the economy and jobs.⁷

Prior research suggests that voters who do not name issues as important in deciding for whom to vote make their voting decisions based on party affiliation, the candidates' character and experience, and general approval or disapproval of the president.⁸ While a majority of likely voters said that President Bush was not a factor in their vote choice for Congress, nearly twice as many characterized their vote as an expression of support for the president (27 percent) than as an expression of opposition (15 percent).⁹

Health care as an issue in the election. Even though health care costs have risen by double digits during the past year, the proportion of Americans without health insurance has been increasing, and 60 percent of the public report being dissatisfied with the availability and affordability of health care, health care was not a dominant issue in the 2002 election.¹⁰ Regardless of whether the question was asked open-ended or using a list, health care generally ranked fourth or fifth when likely voters were asked to name the most important issues in deciding their vote for Congress.¹¹ In the three open-ended questions, taxes ranked about the same as health care.¹² This may act as a constraint on future health care spending.

Which health care issue was most important? When asked during the week before the election to name the most important health care issue in deciding their vote, no more than one-fourth of likely voters agreed on any particular issue (Exhibit 2). The most frequently cited health care issue was prescription drug costs (25 percent). This was an especially important issue for likely voters age sixty-five and older, 45 percent of whom cited it as the most important health care issue. But prescription drug costs were not just an issue for seniors. This issue was also cited as most important by 20 percent of likely voters under age sixty-five, making it one of three issues statistically tied for first among nonseniors. Women were also more likely than men (29 percent to 21 percent) to cite prescription drug costs.¹³

The three other highest-ranked issues were health care costs other than prescription drugs (18 percent); expanding health insurance coverage (18 percent); and Medicare, Medicaid, and care for the elderly (14 percent). During the course of the campaign the proportion of likely voters citing prescription drug costs as the most important health care issue increased, from 17 percent in June to 25 percent in late October.¹⁴ During the same period the proportion that said expanding health insurance coverage was the most important health care issue declined slightly, from 23 percent to 18 percent. Both of these changes were statistically significant.

More than one-fourth (27 percent) of likely voters could not name a single health care issue of importance in their voting decision. One-third of men (33 percent), compared with 22 percent of women, did not name an issue.¹⁵

Medicare and prescription drugs. One in seven (14 percent) said that Medicare/Medicaid/care for the elderly was the most important health care issue in making their voting decision. While most likely voters believed that Medicare had major problems, few thought that the program was in crisis. One in ten believed Medicare was in crisis, while 53 percent thought the program had major problems but was not in crisis. About one-third thought Medicare had minor problems (31 percent) or no problems (2 percent). Likely voters age sixty-five and older were less likely than those under age sixty-five were to think that the program is in crisis (6 percent versus 12 percent, respectively).¹⁶

On the one health care issue in the campaign that appeared to receive the most attention from politicians--what approach to take in helping seniors pay for prescription drugs--57 percent of likely voters favored expanding Medicare to pay directly for part of the costs. About one-third (34 percent) preferred the government to help seniors buy private health insurance that would pay part of their costs, and 5 percent wanted to keep things as they are now, with Medicare not paying for prescription drugs.¹⁷

Which party is better able to handle health care issues? An October 2002 survey showed that more likely voters trusted the Democrats than the Republicans to handle health care and prescription drugs benefits for the elderly (Exhibit 3). On handling health care, 50 percent trusted the Democrats to do a better job, and 39 percent trusted the Republicans. On prescription drugs, 53 percent trusted the Democrats more, and 36 percent trusted the Republicans more. Republicans held a substantial edge when likely voters were asked which party they thought was better able to handle the war on terrorism and the situation in Iraq.¹⁸

Voters versus nonvoters. Which people choose to vote can have an effect on the message sent to the new Congress about the role voters prefer government to play in dealing with the health care system. While only 20 percent of likely voters surveyed a week before the 2002 election expressed the belief that the American health care system has so much wrong with it that we need to completely rebuild it, 32 percent of non-likely voters shared that evaluation (Exhibit 4). When given a list of health care issues, those who did not expect to vote were also more likely (30 percent to 21 percent) than were those who expected to vote to say that helping the uninsured get health insurance was the most important health care issue in deciding their vote for Congress.¹⁹

Oregon voters' views on Proposition 23. Out of the hundreds of initiatives on statewide ballots in 2002, one health care issue appeared to have the greatest potential national significance. Eight years after the defeat in California of Proposition 186, which would have created the first statewide single-payer system, Oregon voters had a chance to vote on this issue. By almost four to one (79 percent against and 21 percent in favor), Oregonians voted against Proposition 23.

Two statewide polls of likely voters conducted in Oregon about one month before the election showed a relatively close contest. In one poll 36 percent favored Proposition 23, 39 percent were opposed, and the remainder were undecided.²⁰ The other poll showed 40 percent supporting or leaning toward Proposition 23 and 47 percent opposing or leaning toward opposed.²¹ The proportion of Oregon likely voters favoring the proposition at that time was nearly identical to that found among registered voters nationwide (38 percent) in a March-May 2002 survey.²²

As in the case of Proposition 186 in California, the last two weeks before the Oregon election saw well-financed campaigns by single-payer opponents that seem to have greatly decreased voters' willingness to go ahead with this type of change in the state's health care system.²³

Conclusions

Although a majority of Americans are dissatisfied with the availability and affordability of health care, health care issues played a relatively modest role in the outcome of the 2002 congressional election. Between now and the 2004 election, 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. However, if terrorism and war with Iraq continue to be of major concern to voters and if the Republicans have enacted a number of health care bills, it is not clear whether health care will play any more of a decisive role in 2004 than it did in 2002. But if health care problems worsen and if one or more Democratic candidates champion the issue, health could emerge as an important voting issue.

In the 2002 election, no single health care issue stood out as most important in voters' minds. Prescription drug prices ranked the highest among health care issues, but they were not the first choice of a majority of voters. Looking at these results, there does not appear to be any clear public mandate for the future direction of health care policy.

However, because Republicans will control both houses of Congress and the presidency, they are likely to feel free to move ahead with the health care agenda they articulated during the 2000 election.²⁴ This agenda is likely to include a private sector-oriented plan to help seniors pay for prescription drug costs, more private-sector reforms for Medicare, a tax credit program to help the uninsured buy private health insurance, and greater limits on the availability of abortion. In addition, the high priority given by both voters and candidates to combating terrorism is likely to lead to increased expenditures on preparing for possible bioterrorist attacks. However, other health care expenditures are likely to be constrained, as a result of the effect of current and future tax cuts and of increased defense spending.

NOTES

1. R.E. Cohen and M.W. Serafini, "A House Less Divided," National Journal (9 November 2002): 3280-3283.
2. The aggregate percentages are preliminary results reported by the Pew Research Center, "Big GOP Gain in Popular Vote Not Reflected in Modest House Seat Shift," 11 November 2002, people-press.org/commentary/display.php3?analsyisID=58 (25 November 2002).
3. K. Victor and J. Maggs, "Sweep Stakes," National Journal (9 November 2002): 3274-3277.
4. Curtis Gans, director of the Committee for the Study of the American Electorate, quoted in E. Walsh, "Election Turnout Rose Slightly, to 39.3 Percent," Washington Post, 7 November 2002.
5. National Public Radio/Henry J. Kaiser Family Foundation/Kennedy School of Government poll, 23-27 October 2002 (Storrs, Conn.: Roper Center for Public Opinion Research, 2002). The methodology for surveys of the sort used in this paper is described in R.J. Blendon et al., "Americans' Health Priorities Revisited after September 11," 13 November 2001, www.healthaffairs.org/WebExclusives/Blendon_Web_Excl_111301.htm (8 November 2002). The results are based on sample sizes ranging from 600 to 1,867 respondents (likely voters in all but two cases, which are noted). The margin of error for a survey of 600 respondents is plus or minus five percentage points; for 1,867 respondents, plus or minus two percentage points. In the NPR/Kaiser/Kennedy School poll (23-27 October 2002), respondents were defined as likely voters if they were currently registered to vote, voted in the 2000 presidential election, and said they were almost certain to vote or would probably vote in the 2002 election. Other organizations define likely voters in various ways.
6. NPR/Kaiser/Kennedy School poll (23-27 October 2002); Zogby poll, 26-29 October 2002 (Roper Center, 2002); and Pew Research Center/Princeton Survey Research Associates poll, 30 October-2 November 2002 (Roper Center, 2002).
7. Gallup/CNN/USA Today poll, 31 October-3 November 2002 (Roper Center, 2002); ABC News poll, 31 October-2 November 2002 (Roper Center, 2002); and CBS News poll, 2-4 November 2002 (Roper Center, 2002).
8. R.G. Niemi and H.F. Weisberg, Classics in Voting Behavior (Washington: CQ Press, 1993), chap. 9.
9. CBS News poll (2-4 November 2002).
10. Henry J. Kaiser Family Foundation and Health Research and Educational Trust, Employer Health Benefits: 2002 Annual Survey, www.kff.org/content/2002/3251/3251.pdf (19 November 2002); U.S. Census Bureau, Health Insurance Coverage: 2001, www.census.gov/hhes/www/hlthin01.html (3 December 2002); and Harvard School of Public Health/Robert Wood Johnson Foundation/International Communications Research poll, 29 May-2 June 2002 (Roper Center, 2002).
11. NPR/Kaiser/Kennedy School poll (23-27 October 2002); Zogby poll (26-29 October 2002); Pew/PSRA poll (30 October-2 November 2002); Gallup/CNN/USA Today poll (31 October-3 November 2002); ABC News poll (31 October-2 November 2002); and CBS News poll, (2-4 November 2002).
12. NPR/Kaiser/Kennedy School poll (23-27 October 2002); Zogby poll (26-29 October 2002); and Pew/PSRA poll (30 October-2 November 2002).
13. NPR/Kaiser/Kennedy School poll (23-27 October 2002).
14. NPR/Kaiser/Kennedy School poll, 26-30 June 2002 (Roper Center, 2002); and NPR/Kaiser/Kennedy School poll (23-27 October 2002).
15. NPR/Kaiser/Kennedy School poll (23-27 October 2002).
16. Washington Post/Kaiser/Harvard University poll, 2 August-1 September 2002 (Roper Center, 2002).
17. Washington Post/Kaiser/Harvard poll (2 August-1 September 2002).
18. ABC News poll, 24-27 October 2002 (Roper Center, 2002).
19. NPR/Kaiser/Kennedy School poll (23-27 October 2002).
20. Portland Tribune poll, www.portlandtribune.com/archview.cgi?id=14312 (8 November 2002).
21. Oregonian/KATU poll, 8 October 2002.
22. NPR/Kaiser/Kennedy School poll, 28 March-1 May 2002 (Roper Center, 2002).
23. R.J. Blendon and M. Brodie, "Public Opinion and Health Policy," in Health Politics and Policy, ed. T.J. Litman and L.S. Robins (Albany, N.Y.: Delmar Publishers, 1997); and M. Bellotti, "Voters Lean Away from Measure that Would Guarantee Health Care," Portland Tribune, 1 November 2002, www.portlandtribune.com/archview.cgi?id=14736 (8 November 2002).
24. R.J. Blendon et al., "The Implications of the 2000 Election," New England Journal of Medicine (1 March 2001): 679-684.

Robert J. Blendon is a professor of health policy and political analysis at the Harvard School of Public Health and John F. Kennedy School of Government. Mollyann Brodie is vice-president and director of public opinion and media research at the Henry J. Kaiser Family Foundation. Drew Altman is that foundation's president and chief executive officer. John M. Benson is managing director, Harvard Opinion Research Program, Harvard School of Public Health. Stephen Pelletier is the program's assistant director. Marcus Rosenbaum is a senior editor at National Public Radio in Washington, D.C.

©2002 Project HOPE–The People-to-People Health Foundation, Inc.