The Role Health Care Issues Played in the 2024 Election: An Analysis of AP VoteCast
The outcome of the 2024 presidential election is settled with Republicans regaining control of the U.S. house and controlling the U.S. Senate, with President-elect Donald Trump set to begin a second term in January 2025. With most votes counted and races called, this analysis takes a deeper dive into the role that health care issues played in the 2024 race. In the first presidential election since the overturning of Roe v. Wade and amid voters’ increased anxieties about the country’s economic direction, health care issues influenced voters’ decisions in complicated but rational ways.
In the 2022 midterm elections, Democratic candidates were able to capitalize on their base’s enthusiasm for protecting reproductive rights to encourage turnout in key electoral races. Two years post-Dobbs, voters in 10 states (including some staunchly Republican states) were directly voting on ballot measures aimed at expanding or protecting abortion access in their states, presenting a real test for abortion rights advocates who had seen other conservative states enshrine abortion rights or push back on restrictions through ballot initiatives in 2022 and 2023. Nationally, while abortion hadn’t risen to a top campaign issue when President Biden was the Democratic candidate – perhaps due to his reticence on the issue – when Vice President Harris became the nominee, the issue became more salient for voters who were confronted with two very different candidates talking about their positions on reproductive rights. President-elect Trump had successfully garnered support from the pro-life contingent of the Republican Party due to his Supreme Court appointments who overturned Roe, while he repeatedly stated throughout his campaign that he was not in favor of passing a national ban. Vice President Harris, on the other hand, embraced reproductive freedom as a core campaign issue during her short bid for president.
Yet, abortion policy never rose to a top campaign issue for voters. Instead, concerns about inflation continued to take center stage, and candidates on both sides of the aisle were tasked with crafting messages about how they would address voters’ economic concerns. Previous KFF polls before and during the campaign documented the important role that health care expenses played in voters’ economic worries.
This analysis examines the role that abortion policy and abortion-related state ballot initiatives, as well as the economy and health care costs, played in the 2024 election. In partnership with The Associated Press (AP), KFF added supplemental questions to AP VoteCast, a survey of around 120,000 voters conducted nationally and in 48 states, to provide a deep dive into how voters were weighing health care issues as they made their decisions. These questions and KFF’s analysis shed light on the role health care issues, including abortion, played in shaping the concerns voters brought to the ballot box, as well as their decisions about whether to vote and whom to vote for.
Key Findings
- President-elect Trump won key electoral victories in four states where voters also chose to expand or protect abortion access. Trump garnered small but important shares of votes from those who voted in favor of ballot measures protecting abortion access, including support from about a third of those who voted in favor of abortion access in Missouri and three in ten voters in the battleground states of Nevada and Arizona. Large shares of pro-Trump, pro-abortion voters say they think abortion should be legal, but few say it is the most important factor in their vote. In addition, in Arizona, a substantial share of this group (more than a quarter) are young men, who are less motivated by the issue of abortion than by other issues.
- Voters in seven states voted to expand abortion access through abortion-related ballot measures, while the ballot measures to expand or protect abortion access failed in Florida, South Dakota, and Nebraska.1 In Florida, while the ballot measure failed to reach the 60% threshold required to pass in the state (57% voted “yes”), it garnered support from majorities of voters across key demographics (including large majorities of Democratic voters (93%), Black voters (83%), independent voters (72%), women voters (66%), and Hispanic voters (65%)). However, most Florida Republicans opposed the measure (58%). Similarly, in Nebraska and South Dakota, large majorities of Republicans opposed expanding abortion access – helping to ensure the ballot measures’ defeat. And, while majorities of women voters in Nebraska voted in favor of expanding abortion rights, a majority of South Dakota women voters voted against.
- Nationwide, abortion continued to be a motivating factor for a notable share of women voters in 2024. About three in ten women voters said abortion policy was the “single most important factor” in their vote, including 44% of Black women, 39% of Hispanic women, and one third of women voters between the ages of 18 and 44. Black women and Hispanic women were also more likely than White women to say abortion policy had a major impact on their decision to turn out and which candidate they supported. Black and Hispanic women disproportionately voted for Vice President Harris over President-elect Trump.
- Voters’ economic anxieties were pervasive throughout the 2024 presidential campaign, and four in ten (39%) voters said “the economy and jobs” was the most important issue facing the country. With this in mind, voters also said they were worried about being able to afford many household expenses, including the cost of health care. President-elect Trump garnered majority support among voters who were most concerned with the cost of household expenses, including over half (58%) of voters who said they were “very concerned” about their own health care costs – even as Harris was seen as the more trusted candidate on health care. Overall, President-elect Trump had a ten-point advantage over Vice President Harris on who voters trust to better handle the economy.
Abortion Ballot Initiatives
In the 2024 election, voters in 10 states were asked to cast ballots on abortion-related ballot measures. In all of the states, the ballot measures were aimed at protecting or expanding abortion access, while Nebraska’s ballot also included a competing measure curtailing abortion rights. Voters in seven states voted to expand abortion access, while the ballot measures to expand or protect abortion access failed in Florida, South Dakota, and Nebraska. To see a complete explanation of the abortion-related ballot measures and the outcome of the election, check out KFF’s dashboard.
About half of voters in each of the 10 states said the outcome of the abortion ballot initiative was “very important” to them. This includes majorities of voters who said they cast their ballot in support of the ballot measures in each of the 10 states. Voters who were opposed to the ballot measures were less likely than their counterparts to say the outcome of the ballot initiative on abortion was “very important” to them, except in Nebraska and South Dakota – two states where the ballot measure seeking to expand abortion access failed. In both these states, majorities of voters on both sides of the ballot measure said the outcome of the measure was “very important” to them – suggesting that both sides were equally motivated by the potential outcome of these ballot measures.
In Florida, the ballot measure failed to reach the 60% threshold needed to pass.2 About six in ten Florida voters who voted in favor of expanding abortion access said the outcome of the ballot measure was “very important” to them compared to nearly half of voters who voted against the ballot measure in the state who said the same, suggesting while enthusiasm for the outcome of the ballot measure was on the pro-access side, it wasn’t enough to overcome the high vote percentage threshold required by Florida law.
President-elect Trump won key electoral victories in four states where voters also chose to expand or protect abortion access. Across the ten states with abortion ballot measures, Trump garnered small but important shares of votes from those who voted in favor of ballot measures protecting abortion access, including support from about a third of those who voted in favor of abortion access in Missouri and at least three in ten voters in the battleground states of Nevada and Arizona.
Arizona and Nevada: Two Battleground States
Arizona and Nevada are two swing states that President-elect Trump won and a majority of voters passed ballot measures expanding abortion access. This is largely due to significant shares of Republican voters in each of the states voting in favor of expanding abortion access.
Arizona’s Proposition 139 (“Right to Abortion”) proposed enshrining the right to abortion in the state constitution, allowing abortion until fetal viability or at any stage in cases where the pregnant person’s health or life is at risk. The ballot measure will add an amendment to the Arizona state constitution which will provide protections similar to those in place at the federal level before Roe v. Wade was overturned. Arizona law currently bans abortions after 15 weeks. Majorities of voters across age groups and gender voted in support of Proposition 139, even as fewer men said the outcome of the measure was “very important” to them. Nearly eight in ten Black voters and three in four Hispanic voters in Arizona voted in support for expanding abortion access, as did nearly two in three White voters.
Yet, the proposition was viewed largely through a partisan lens. The vast majority of Democratic voters and those who voted for Kamala Harris in the state also voted in support of the proposition (95% and 94%, respectively). On the other hand, most Republicans in the state and those who voted for Donald Trump voted against the proposition, yet about four in ten in both groups voted in favor of the measure. Importantly, while about three-fourths of Democratic voters and Harris voters in the state said the outcome of the ballot measure was “very important” to them, less than half of independent voters, Republican voters, and Trump voters said the same.
Nevada’s ballot featured the Right to Abortion Initiative, Question 6, which sought to affirm a constitutional right to abortion up to fetal viability and after viability in cases where the pregnant person’s life or health is endangered.3 Similar to Arizona, majorities of voters across age groups, race and ethnicity, and gender voted in support of the measure – but with more variation. For example, a much larger majority of younger voters ages 18-29 in Nevada voted in support of the measure (80%) compared to older voters (63%), ages 65 and older. Younger voters were also twenty points more likely than their older counterparts to say the outcome of the initiative was “very important” to them. In addition, while two-thirds of men voted in support of the measure, just four in ten said the outcome of the initiative was “very important” to them. Less than half of white voters said the outcome of the initiative was “very important” to them, even as two-thirds voted in support.
The measure passed, receiving support from over nine in ten Nevada Democrats (94%) and those who voted for Harris (93%), as well as nearly half of Republicans (46%) and those who voted for Trump (46%). While nearly half of Republican voters and Trump voters supported the measure, just three in ten said the outcome of the ballot measure was “very important” to them.
Who Were the Pro-Trump and Pro-Abortion Voters?
In all 10 states with abortion-related ballot measures, a larger share of voters voted in favor of abortion access than voted for either presidential candidate. This is largely due to significant shares of Republicans and Democrats voting in favor of the ballot measures, suggesting that partisans may agree more on abortion policy than on the candidate they want to guide national legislation on abortion access. Throughout the campaign, Trump said that abortion laws should be left to the states and that he didn’t plan on signing a national abortion ban, while Harris, on the other hand, said she would sign a national law to restore the abortions rights set by Roe.
This analysis focuses on two key battleground states and finds the demographic profile of pro-abortion ballot measure voters who also voted for President-elect Trump looks very different than the Democratic voters who voted in favor of abortion access in terms of how motivated they were by the issue. Yet, Trump voters who voted in support of abortion access also differ from the other segment of Republican voters (those opposed to the ballot measure) in their views on abortion access legality.
Young men represent the largest segment of Trump voters who voted in support of abortion access in Arizona. More than a quarter (28%) of pro-abortion Trump voters were men between the ages of 18 and 49, while older women represent the largest segment of Harris voters who voted in support of abortion access (31%). Unsurprisingly, partisanship matters a lot. Republican men and Republican women constitute nearly all of pro-abortion Trump voters.
Trump voters who voted in favor of abortion access were much less motivated by the issue of abortion compared to Harris voters who supported the ballot initiative. While four in ten (43%) Harris voters who supported the abortion initiative said that abortion was the single most important factor to their vote, just one in seven (15%) pro-abortion Trump voters said the same. While large majorities of Harris supporters who voted for the ballot measure said the issue of abortion impacted whether they turned out to vote (81%) and who they voted for (76%), far fewer Trump supporters who voted for abortion access said the same.
When comparing Trump supporters who voted for and against the ballot measure, supporters of the Arizona abortion initiative tended to be younger (51% were under age 50 compared to 39% of anti-abortion Trump voters). About seven in ten (71%) Trump voters who supported the measure said abortion should be legal in all or most cases, while the large majority of Trump voters who voted against the measure said it should be illegal in all or most cases. Among both groups, few (about one in eight) said abortion was the single most important factor in their vote.
Some of the same patterns in Arizona were also present in Nevada, with pro-abortion Harris voters more likely to rate abortion as the single most important factor than pro-abortion Trump voters, and pro-abortion Trump voters being more likely than anti-abortion Trump voters to say they think abortion should be legal in at least most cases. In Nevada, there wasn’t as much of an age and gender difference between Harris supporters and Trump supporters who voted in favor of the ballot measure, with 18-49 year old men representing about a fifth of each voting group.
Voters in South Dakota, Florida, and Nebraska Rejected Constitutional Amendments Which Would Have Invalidated Current State Bans or Restrictions
For the first time since voters have been asked to vote on abortion access since the Dobbs decision, abortion-related ballot measures failed to pass in three states—Florida, Nebraska, and South Dakota. In each of these three states, the views and motivations of Republican voters proved to be important in determining the future of abortion access.
Florida
Florida’s Amendment 4, the “Florida Right to Abortion Initiative,” would have amended the state constitution to enshrine the right to abortion until the point of fetal viability or to protect the mother’s health. While a majority (57%) of the electorate voted in favor of the initiative, it failed to meet the 60% supermajority required to pass.4 Therefore, Florida’s current 6-week abortion ban will remain in effect in the state.
While the ballot measure failed to reach the 60% threshold, large majorities of Democratic voters (93%), Black voters (83%), and independent voters (72%) in the state voted in favor. About two-thirds of women voters (66%) and Hispanic voters (65%) also supported the measure, as well as six in ten White voters (60%) and male voters (61%). While most Republicans opposed the measure, around four in ten (42%) voted in favor.
Nebraska
Nebraska was the only state in this election cycle to have two competing abortion-related ballot measures. One, Initiative 434, would have established a fundamental right to abortion until fetal viability or when needed to protect the life or health of the pregnant person at any time during pregnancy, while Initiative 439, which passed, has amended the constitution to ban abortions past the first trimester, except in medical emergencies or when the pregnancy is a result of rape or incest. The state’s current 12 week ban will stay in effect, and the legislature cannot enact any protections beyond the first trimester – 14 weeks gestation.
Support for the two ballot measures was largely divided along partisan lines, with nine in ten (89%) Democrats supporting the “Right to Abortion Initiative” and about three-quarters (76%) of Republicans supporting the measure restricting abortion access. Among independent voters, a larger share supported the measure expanding abortion access (60%) than the one restricting abortion access (42%).
Over half (58%) of male voters in Nebraska voted in favor of the restrictive abortion initiative, while similar shares (57%) of women voters voted in favor of the initiative to expand abortion rights.
South Dakota
South Dakota voters rejected Amendment G, which would have amended the state constitution so that the government could only prohibit abortion after the end of the second trimester, except when necessary to preserve the life or health of the pregnant person.
Four in ten (41%) voters in South Dakota supported the measure, though there were pronounced partisan differences. Nine in ten (90%) Democrats, voted in favor of the measure, compared to about one in five Republican voters including a quarter (25%) of Republican men and one in five (19%) Republican women. A larger share of voters, including six in ten (59%) voters ages 45 and older, voted against the amendment rather than in support. Women, ages 18-44, were more divided with about half saying they voted “yes” (48%), and 52% saying they voted “no.”
Abortion as a Voting Issue
Abortion continued to be a motivating factor for a notable share of voters in 2024, especially a core constituent of the Democratic base – women. Overall, a quarter (25%) of voters said abortion was the “single most important” factor to their vote, similar to the share in 2022 who said the Supreme Court overturning Roe v. Wade was the most important factor (24%). In addition, about four in ten voters (43%) in 2024 said abortion had a major impact on their decision about whether to turn out, and over half (56%) said it had a major impact on which candidates they supported.
While the overall share of voters who said abortion had an impact on their vote is unchanged from the 2022 midterm elections, it ranked well behind two key factors for voters: the future of democracy in this country and the high prices for gas, groceries, and other goods. Abortion policy also ranked behind the future of free speech in this country and the situation at the U.S.-Mexico border. For Democratic voters, abortion policy ranked above all other issues other than the future of democracy, and Democrats were more than twice as likely as Republicans to say abortion policy was the “single most important factor” to their vote.
The impact of abortion policy on voters’ decisions stands out among certain groups of voters, namely groups of women voters. Three in ten women voters said abortion policy was the “single most important factor” in their vote, including 44% of Black women, 39% of Latina women, and one third of women voters between the ages of 18 and 44. Similar shares of college educated women and women without college degrees said abortion policy was the “single most important factor” in their vote.
In addition, majorities of several groups of women voters said abortion policy had a “major impact” on their decision to turn out and which candidates they supported. More than half of women ages 18 to 44, Black women, and Hispanic women said abortion policy had a major impact on their turnout in the election. Additionally, two thirds or more of Black women voters and Hispanic women voters said abortion policy had a major impact on which candidates they supported. Vice President Harris garnered majority support among Black and Hispanic women.
Vice President Harris Did Better Among Voters Who Prioritized Abortion
A large majority of voters (69%) who said abortion was the single most important factor to their vote supported Vice President Harris. The only other issue that one candidate had such a strong advantage on was among those who said the situation at the U.S.- Mexico border was their most important factor in their vote, a group that overwhelmingly voted for President-elect Trump. Other issues, such the future of democracy or high prices for gas, food, and groceries, were more mixed with an advantage for Harris on the former, and Trump on the latter. Voters whose most important issue when voting was the future of free speech in this country split between Harris (45%) and Trump (54%).
Health Care Costs and Other Issues
Voters’ economic anxieties were pervasive throughout the 2024 presidential campaign, and four in ten (39%) voters said “economy and jobs” was the most important issue facing the country. With this in mind, voters also said they were worried about being able to afford many household expenses, including the cost of health care. Two-thirds (67%) of voters said they were “very concerned” about the cost of food and groceries, followed by more than half who said the same about affording their own health care costs (54%). About half of voters said they were “very concerned” about being able to afford the cost of their housing (51%) or the cost of gas (48%).
Overall, President-elect Trump had a ten-point advantage over Vice President Harris on who voters trust to better handle the economy. Trump’s advantage on the economy was present among voters, regardless of age, but varied among other groups. For example, his advantage was larger among White voters and men voters. Hispanic voters were split on which candidate they trusted to do a better job handling the economy, while Black voters were much more likely to say they trusted Harris to do a better job. Women voters, on the other hand, were also split on which candidate they trusted on the economy.
Democratic voters predictably gave Harris a big advantage and Republican voters gave Trump the advantage, while independent voters also gave Trump the advantage. Fifteen percent of independent voters said they trusted neither candidate on the economy.
President-elect Trump garnered majority support among voters who were most concerned with the cost of household expenses, including over half (54%) of voters who said they were “very concerned” about their own health care costs – even as Harris was seen as the more trusted candidate on health care. Trump also garnered majority support among voters who were very concerned about the costs of gas (67%), food (61%), and housing (56%).