Understand how we got here — and how to move forward.


November 25, 2019

Democratic candidates are still split on health reform. What do voters think?

Daily Briefing

    Presidential candidates largely took a break from rehashing their stances on so-called "Medicare for All" proposals during Wednesday night's Democratic primary debate. But new polling suggests voters don't want a break from Medicare-for-All debates—they want more details. Let's take a closer look.

    Dec. 3 webinar: What 2020's elections will mean for health care

    Health care is front and center in Democratic primary debates

    According to a New York Times analysis, the six Democratic presidential primary debates since June have totaled 659 minutes—and candidates spent 95.4 of those minutes discussing health care, more time than they devoted to any other issue. (The second most-debated issue so far, according to the Times, has been foreign policy, at 73.1 minutes.)

    During the 95.4 minutes the candidates have spent debating health care, candidates mostly have focused on two broad types of health reform proposals:

    • Medicare-for-All proposals—touted by Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.), along with some other candidates—which would largely eliminate private health insurance and shift the United States to a single-payer health system; and
    • Public option proposals—touted by former Vice President Joe Biden and South Bend, Indiana, Mayor Pete Buttigieg (D), as well as some other candidates—which would create a government-run health plan to compete with private health plans.

    Candidates have been pretty starkly divided over which proposal they support—and even within those proposals, there's little agreement over how far each should go, leading to some contentious exchanges.

    But where do U.S. voters stand on the controversial topic?

    What voters want

    The Democratic presidential candidates aren't the only ones divided over a public option and Medicare for All. Recent polling shows U.S. voters also are split—and their support for Medicare for All varies widely depending on what aspects of the plan pollsters emphasize.

    A Kaiser Family Foundation (KFF) tracking poll released Wednesday found that more U.S. voters support a public option than Medicare for All—but the difference isn't huge. According to the poll, 65% of all respondents said they support a public option, while 53% said they support Medicare for All. (For the poll, KFF defined a public option as "a government-administered health plan … that would complete with private health plans and be available to all Americans," and defined Medicare for All as "a national health plan in which Americans would get their insurance from a single government plan.")

    While a public option continued to be more preferred among respondents, the gap in support changed when respondents were broken out by political party:

    • 88% of Democratic respondents said they support a public option, while 77% said they support Medicare for All; and
    • 41% of Republican respondents said they support a public option, while 27% said they support Medicare for All.

    However, KFF found support for Medicare for All among all respondents dipped when the plan was described as requiring many employers and/or individuals to pay more in taxes to fund such a system.

    A separate KFF survey of voters in the battleground states of Michigan, Minnesota, Pennsylvania, and Wisconsin found 62% of voters hold negative views of eliminating private insurance—which would happen under most Medicare-for-All plans.

    Meanwhile, a poll released Tuesday by the Progressive Change Institute, Public Citizen, and Business for Medicare for All—all advocacy groups that support Medicare for All—found that 66% of registered voters support Medicare for All, including 63% who live in battleground states, when simply asked whether they support Medicare for All. Pollsters then described Medicare for All to respondents as a system that "would guarantee coverage to everyone from any doctor or hospital anywhere in the [United States] with no premiums, no deductibles, and no co-pays or other out-of-pocket costs," and "expand Medicare's benefits to cover more prenatal, dental, vision, home-based, and nursing home care." After hearing that description, support for Medicare for All rose to 70% among all respondents, and 69% among respondents in battleground states. But Medicare for All's favorability dropped to 62% among all respondents when pollsters said implementing such a system would mean "taxes might increase a little, [but] the total out-of-pocket costs of health care and taxes would be lower for all but the wealthiest" U.S. residents.

    Meanwhile, a CNN-Des Moines Register-Mediacom poll of Democratic voters in Iowa—which will host 2020's first Democratic primary election, known in Iowa as a caucus, on Feb. 3—found that respondents there are more closely divided. Pollsters ask respondents to choose between supporting:

    • Implementing a public option, which they described as "a health insurance program run by the government that people can choose to buy into";
    • Implementing "Medicare-for-All plan that eliminates private health insurance and covers everyone through a government-run program similar to Medicare";
    • Restoring Affordable Care Act (ACA) provisions that have been cut and "work[ing] incrementally" to improve health coverage "from there"; or
    • Leaving things as they are now.

    Respondents also could say they were not sure which option they supported.

    According to the poll, 36% of Democratic respondents said they support implementing the Medicare for All plan and 34% said they support the public option. Meanwhile, 20% of respondents said they support restoring the ACA and working incrementally from there, meaning a total of 54% of respondents preferred a health reform option that isn't Medicare for All.

    According to Reuters' Joseph Ax and Amanda Becker, strategists have said the conflicting findings "reflec[t] the extent to which many Americans are still fuzzy on Medicare for All's details."

    Democratic voters, candidates in line on prioritizing health care

    But although Democratic candidates and voters are split on which health reform proposals they support, the candidates and voters are in line on making health care a top focus leading up to 2020's primary elections.

    KFF found that, when asked about the issue they want to hear Democratic presidential candidates discuss the most, 24% of Democratic and Democratic-leaning independent respondents named health care, which was more than twice the percentage of respondents who named any other issue. But that doesn't necessarily mean voters want candidates to revisit old debates. KFF found respondents want more specific details on how candidates' proposals will affect taxes and out-of-pocket costs for Americans, as well as how the plans would affect seniors currently covered by Medicare.

    Have a Question?


    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.