Cutting Through the Rhetoric: What Voters Really Want When It Comes to Healthcare
In the ongoing debate over healthcare costs and coverage, “Medicare for All” is a hot topic within the Democratic Party — and potentially a litmus test for candidates in Democratic primaries. But dive into policy specifics and voters start backing away. FTI Consulting polled American voters to find out what they really want.
Since passage of the Affordable Care Act (ACA) in 2010, healthcare has dominated the national political dialogue. Unsuccessful efforts by Republicans to repeal the law in 2017 ultimately backfired, bolstering public support for the ACA and contributing to a Democratic takeover of the House of Representatives in 2018. Still, even with the law largely intact, healthcare cost growth continues to outpace inflation and American voters are looking for new solutions.
With the 2020 campaigns heating up, FTI Consulting, in a poll of 1,000 registered voters, finds that healthcare is top of mind for the American electorate. Unsurprisingly, a strong majority of voters — 61 percent — want Congress to focus on “reducing the cost of healthcare” as their number one priority over the next two years.
As the poll shows, voters’ heightened desire for solutions crosses partisan, generational and regional divides. The American electorate is hungry for change and is willing to support proposals that promise to reduce costs and hold the industry accountable.
Medicare for Whom?
As more elected officials and the media present “Medicare for All” as the left’s solution to rising costs, FTI Consulting sought to determine voter support for a single-payer system (such as Medicare for All), as well as for more moderate proposals. The poll yielded three interesting results:
- Despite pockets of enthusiasm for Medicare for All, the concept of allowing Americans to buy into Medicare enjoys more broad-based support, particularly among key Democratic constituencies.
- Progressive voters, the group most commonly associated with support of a single-payer proposal, may be less wedded to it than previously assumed.
- Medicare buy-in — often discussed as a step toward Medicare for All — appeals to voters across the ideological spectrum.
As seen below, the details of these results offer crucial insights into how the key healthcare proposals of Democratic candidates will play in the 2020 campaigns.
Defining the Issue
In January of this year, the Kaiser Family Foundation released results from a poll it conducted showing that a majority of Americans — 52 percent — support Medicare for All. Rather than ask voters' opinion about Medicare for All as a campaign slogan, FTI Consulting sought to better understand their thinking about the policy behind Medicare for All. The concept was explored through two different questions:
Extend Medicare for All?
61% of voters support extending Medicare coverage to all Americans under 65.
38% of voters support requiring all Americans under 65 to enroll in Medicare.
Voters were asked if they support a policy that extends Medicare coverage to all Americans under the age of 65. Nearly two-thirds said they support this policy, with heightened enthusiasm among key voting blocs. Majorities of Democrats and urban residents (53 percent each) strongly support this proposal with impactful pluralities of Independents (45 percent strongly) and Generation X voters (48 percent strongly) rounding out some broad-based appeal.
Require Medicare for All?
When asked if all Americans under 65 should be required to enroll in Medicare, overall support plunged to 38 percent. Key groups abandon this proposal, including Democrats (support shrinks to 40 percent); white college-educated women (36 percent); and suburban residents (32 percent).
Overall, the data showed that voters clearly like the idea of expanding coverage — and likely associate Medicare with quality, affordable healthcare — but do not understand what Medicare for All actually entails. Notably, just one demographic emerged as supporters of “requiring” enrollment in Medicare — young male voters (millennials and Gen Z) — the same voting bloc that supported Bernie Sanders in the 2016 Democratic primary.
The Public Option is Back
67% of voters support providing people under 65 with the option to buy-in to Medicare.
Recognizing the political risk associated with advocating for Medicare for All, pragmatic candidates are turning to Medicare “buy-in” as a stepping stone toward universal coverage. Similar to the “public option” that was first proposed as part of the ACA but was ultimately dropped under pressure from moderate Democrats, the concept is enjoying a revival. In fact, assuming the eventual nominee pivots to the center, a buy-in option is likely to become the central policy of the Democrats’ healthcare reform platform.
That decision has merit according to poll results. The version of Medicare buy-in tested by FTI — which would provide the option to all people under 65 — garners two-thirds support (67 percent) overall and crosses party lines. (Poll results show 76 percent of Democrats, 69 percent of Independents and 75 percent of Republicans). The same broad-based support holds along regional lines, with 76 percent of urban voters, 63 percent of suburbanites and 67percent of rural voters in favor.
Rhetoric vs. Reality
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As the top priority on voters’ wish lists, policy makers in Washington will likely make healthcare a rhetorical focus over the next two years. Medicare for All will undoubtedly continue to make waves in the Democratic primaries but, when reality catches up with the rhetoric, be prepared for Medicare buy-in to emerge as the dark horse, and potentially the future of healthcare reform.
Senior Managing Director