KFF/AP VoteCast: Abortion and Other Health Care Issues in the 2024 Election

This interactive dashboard provides KFF’s insights from AP VoteCast election polling of the 2024 election, focusing on how abortion, including abortion-related ballot measures, and other health care issues have played into voters’ decisions.

KFF examined 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 the 2024 electorate, providing 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 these issues 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.

AP VoteCast is a survey of nearly 120,000 voters conducted nationally and in 48 states, fielded between Oct. 28 and concluding as the polls close on Nov. 5. Results have been adjusted to reflect preliminary vote totals as of 10 a.m. ET on Nov. 11, 2024.

Updated: November 22, 2024 4:00PM ET

Abortion Ballot Initiatives

In the 2024 election, 10 states voted on ballot measures aimed at protecting abortion rights, including one state (Nebraska) whose ballot also included a competing measure curtailing abortion rights. Voters in seven states voted to expand abortion access, while the ballot measures to expand abortion access failed in Florida, South Dakota, and Nebraska. More details about the different state ballot measures are available at this KFF Ballot Tracker.

About half of voters in each of these states said the outcome of the abortion ballot initiative was “very important” to them. In all 10 states, more than half of those who voted in favor of protecting abortion access said the outcome of the measure was “very important” to them. In most states, proponents of abortion access were more likely than opponents to say the outcome was very important.

Voters in South Dakota and Nebraska voted against expanding abortion access in their states. In both of those states, a majority of voters on both sides of the ballot measure viewed its outcome as “very important” – suggesting that supporters and opponents were similarly motivated by the measures’ results. In Florida, the ballot measure failed to reach the 60% threshold needed in order to pass. About six in ten Florida voters who voted in favor of expanding abortion access said the outcome of the ballot measure was important to them compared to about half of voters who opposed the measure.

In each of the states where abortion was on the ballot in 2024, about one in four voters said abortion was the single most important issue to their vote, similar to the share of voters nationally who said so. About four in ten voters in these states said abortion policy had a “major impact” on whether they voted, and more than half said it had a major impact on which candidates they supported this election.

President-elect Donald Trump won key electoral victories in four states where voters also chose to expand or protect abortion access: Arizona, Nevada, Montana and Missouri. Across all 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 three in ten of those who voted in favor of abortion access in Missouri and Montana and in the battleground states of Nevada and Arizona.

Arizona and Nevada: Key Swing States with Abortion Ballot Initiatives

Arizona and Nevada are two battleground states where President-elect Trump won at the same time as a majority of voters passed ballot measures expanding abortion access.

Arizona's Proposition 139 passed with a majority of voters voting "Yes." It 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. This ballot measure will codify protections similar to those under Roe v. Wade before it was overturned. Arizona law currently bans abortions after 15 weeks. This proposition was supported by a majority of voters in the state across age, gender, race, and ethnicity. The vast majority of Democratic Arizona voters and those who voted for Kamala Harris voted Yes on the proposition. Most Republicans 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.

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. The measure passed receiving support from over nine in ten Nevada Democrats and those who voted for Harris, as well as nearly half of Republicans and those who voted for Trump.

Ballot measures have to pass in two successive general elections in Nevada. This measure will have to appear on the ballot again in 2026 before the proposed amendment is added to the Nevada constitution.

Many Arizona and Nevada Voters Voted to Expand Access to Abortion, While Supporting Republican Candidates for Senate and President

Roughly one quarter to one third of voters in Arizona and Nevada who voted “Yes” on their state’s ballot measures to protect access to abortion voted for Republican candidates for senate and Trump for president. The vast majority of those who voted “No” on these measures voted for Republican candidates as well.

Spotlight on Florida

Amendment 4, the "Florida Right to Abortion Initiative," failed to meet the 60% vote threshold required to pass. It 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. Currently, Florida has a 6-week abortion ban. The passage of Amendment 4 in Florida would have provided a legal pathway to abortion for women in the region currently considered an abortion desert.

While the ballot measure failed to reach 60% support, large majorities of independent and Democratic voters in the state supported it, as did a majority of both men and women and voters across race and ethnicity. While most Republicans and Trump voters opposed the measure, about four in ten Republicans and about a third of those who voted for Trump voted in favor of the proposition.

Spotlight on Nebraska

Nebraska was the only state in this election to have two competing abortion-related ballot measures. One 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/. The second measure, which passed, 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. Currently, abortions are legal in Nebraska up to 12 weeks of pregnancy.

Support for the two ballot measures was largely divided along partisan lines, with nine in ten Democrats supporting the Right to Abortion Initiative and about three-quarters of Republicans supporting the measure restricting abortion access. Among independent voters, a larger share supported the measure expanding abortion access than the one restricting abortion access.

Abortion as a Voting Issue

As it was in the 2022 midterm election, abortion continued to be a motivating factor for a notable share of voters in 2024. Overall, about a quarter 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. In addition, about four in ten voters in 2024 said abortion had a major impact on their decision about whether to turn out, and over half said it had a major impact on which candidates they supported.

For voters overall, abortion ranked behind democracy and inflation as a motivating factor but was on par with "the situation at the U.S.-Mexico border." Democrats were more than twice as likely as Republicans to say abortion policy was the most important factor to their vote.

The impact of abortion policy on voters’ decisions stood out among certain groups of voters, namely Black voters, younger voters, Democrats, and women – all of whom cited abortion policy as a motivating factor in higher shares than their peers. Additionally, among women voters, large shares of those who are younger, Black, or Democrats cited abortion as the single most important factor to their vote or said it had a major impact on their decision to turnout or the candidate they voted for.

VP Harris achieved high levels of support among voters who said abortion was the single most important factor to their vote as well as those who prioritized the future of Democracy. President-elect Trump won a larger share of voters who cited high prices and the U.S.-Mexico border as the most important factors in their vote. While a large majority of voters who said they want abortion to be legal in "all cases" voted for Harris, Trump gained notable support among those who want abortion to be legal in “most cases.”

Health Care Costs and Other Issues

When asked to choose the most important issue facing the country, about four in ten voters chose the economy and jobs, followed by about two in ten who chose immigration. Abortion and health care were next on the list, with about one in ten voters citing each respectively. The economy and jobs topped the list for both Trump voters and Harris voters, with immigration ranking second among Trump voters and abortion ranking second among Harris voters.

With the economy top of mind, health care costs were an integral part of voters’ economic concerns. About half said they were “very concerned” about their own health care costs, with an additional three in ten saying they were “somewhat concerned.” This is somewhat behind the two-thirds of voters who said they were “very concerned” about the cost of food and groceries, and similar to the shares who said they were “very concerned” about the cost of housing and gas. Regardless of partisanship, half or more voters said they were “very concerned” about the cost of these items, with the exception of gas, which generates almost twice as much concern among Republicans as among Democrats.

When it comes to who voters trust to handle different issues, President-elect Trump had a clear advantage over Vice President Harris on the economy, immigration, and crime with about half of voters favoring Trump on these issues compared to about four in ten choosing Harris. On the other hand, Harris had a clear advantage on abortion policy, health care, and climate change, with about half preferring Harris and between three and four in ten preferring Trump on these issues.

Despite the fact that Harris had an advantage on who voters trust to handle health care, Trump won a majority of votes among those with the greatest concern about their personal expenses, including half of voters who said they were “very worried” about their own health care costs. Trump also garnered majority support among voters who were very worried about the costs of gas, food, and housing.

When asked about the role government should play on key health care issues going forward, the largest share said they want more government action on lowering the price of prescription drugs, with three in four saying the government should be “more involved.” About six in ten also support greater government involvement when it comes to ensuring Americans have health care coverage and forgiving medical debt. Half of voters said the government should be "more involved” in ensuring that children are vaccinated for childhood diseases. On each of these topics, one in five or fewer said the government should be “less involved,” and similar shares said the government’s current involvement is “about right.”

On these topics, there was some partisan agreement, with majorities of Democrats, Republicans, and independents saying the government should be “more involved” in lowering the cost of prescription drugs. However, on the other topics, there were stark partisan divides, with about four in ten or fewer Republicans saying the government should be “more involved” and large majorities of Democrats wanting more involvement.

As of 2024, 41 states (including DC) have adopted Medicaid expansion under the Affordable Care Act while 10 states have not. In three of these non-expansion states, Alabama, Kansas and Mississippi, voters were asked whether they would favor or oppose expanding the program in their state. In each of these states, seven in ten or more voters overall said they would favor expanding Medicaid in their state, including majorities of Democrats and Republicans.

Methodology and Additional Resources

AP VoteCast is a survey of nearly 120,000 voters conducted nationally and in 48 states by NORC at the University of Chicago for The Associated Press, Fox News, PBS NewsHour, and The Wall Street Journal beginning on Oct. 28 and concluding as polls close on Nov. 5, 2024. AP VoteCast conducts interviews with a random sample of registered voters drawn from state voter files and combines them with interviews from self-identified registered voters selected using nonprobability approaches. It also includes interviews with self-identified registered voters conducted using NORC’s probability-based AmeriSpeak panel, which is designed to be representative of the U.S. population. Interviews are conducted in English and Spanish.

Note: Party labels include partisan leaning independents.

Find more details about AP VoteCast’s methodology at https://www.ap.org/content/politics/elections/ap-votecast/about.

For media inquiries contact KFFMedia@kff.org

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