Health Care Costs Top the Public’s List of Financial Worries, and Those Who Are Struggling the Most Want to Hear Presidential Candidates Discuss Economic and Health Care Issues

At a time when kitchen table economic problems are on voters’ minds, unexpected medical bills and health care costs top the public’s list of financial concerns, and voters who are struggling to pay their monthly bills are the most eager to hear the presidential candidates talk about economic and health care issues, the latest KFF Health Tracking Poll finds.

Nearly 3 in 4 adults say they are worried about being able to afford unexpected medical bills (74%) and the cost of health care services (73%), more than say the same about other everyday expenses, such as gas, utilities, food, and housing costs, and about paying for prescription drugs (55%). Health care worries top the list regardless of partisanship.

About half of all voters (48%) say health care costs are a major reason for their negative views of the economy, though larger shares cite everyday expenses, inflation, and housing costs. Overall, two thirds (67%) of voters view the economy negatively. Republican voters are more than twice as likely as Democratic voters to hold such negative views. 

The poll probes how people’s economic struggles color their views of the economy and their priorities for candidates. Overall, 1 in 5 adults (19%) say they have trouble affording their monthly bills, and nearly 4 in 10 (37%) say they say they can just afford their monthly bills. These groups hold very different views than those who say that they afford their bills with money left over (44% of all adults).

Those who report difficulty affording monthly bills are more likely to view the national economy negatively and are more likely to worry about affording health care and other routine expenses. They are also more likely to want the presidential candidates to talk about economic issues, including health care costs and the future of Medicaid, compared to voters who can easily afford their bills. 

The ACA Remains Popular, and More Want to Expand It Than Scale It Back or Repeal It

The poll also explores views of the Affordable Care Act (ACA), which remains popular generally, though voters again split sharply along partisan lines over what should happen to the law next. 

Most of the public (59%) views the law favorably, as has been true since Republicans’ failed attempt to repeal and replace it during President Trump’s presidency. Fewer hold unfavorable views (39%), though most Republicans do (67%).  

In addition, half (50%) of the public, including nearly a quarter of Republicans (23%), want the next president and Congress to expand what the ACA does, as President Biden has advocated. Another 16% want to keep it as is. In contrast, only about a third of the public favor either scaling back the law (14%) or repealing it entirely (18%), the options preferred by most Republicans.

While President Trump has talked about wanting to replace the ACA during his campaign, just 1 in 6 voters (16%) say that he has a plan to do so. Even among Republican voters, just 3 in 10 say that President Trump has a plan to replace the ACA.

On the flip side, while the ACA was originally enacted during Biden’s tenure as vice president, just half of the public says he had either a major (21%) or minor (28%) role in its passage. Democrats ages 50 and older are most likely to say President Biden played a role in the ACA becoming law. 

Most adults want the law’s prohibition on insurers from denying coverage based on pre-existing medical conditions to stay. Two thirds (67%) of the public say that it is “very important” that this provision remain in place, including most Republicans (54%) However, only about 4 in 10 people (39%) are aware that that provision is part of the ACA.

The poll also finds gaps in the public’s knowledge about the ACA’s impact on health coverage. While the share of adults under age 65 who are uninsured has fallen sharply since the ACA’s enactment, just over a third (35%) of the public correctly says the uninsured rate has gone down since the law’s enactment, while similar shares incorrectly say it has gone up (32%) or stayed the same (31%).

The poll findings are featured in two reports: a main report that captures the main findings on health costs, the Affordable Care Act, and the election, and a companion report that looks at differences in the economic views and priorities for adults based on their economic circumstances.

Designed and analyzed by public opinion researchers at KFF, the survey was conducted from January 30-February 7, 2024, online and by telephone among a nationally representative sample of 1,309 U.S. adults, including 1,055 registered voters. Interviews were conducted in English and in Spanish. The margin of sampling error is plus or minus 4 percentage points for the full sample and the registered voter sample. For results based on other subgroups, the margin of sampling error may be higher.