Kaiser Health Tracking Poll: August 2016

KEY FINDINGS:

• Two-thirds of voters say the future of Medicare and access and affordability of health care are top priorities for the candidates to be talking about during the 2016 presidential campaign.
• More voters trust Hillary Clinton to do a better job dealing with health care issues than trust Donald Trump, although few believe their own ability to access affordable health care would get better regardless of which candidate is elected. Voters, age 65 and older, are split between which candidate they trust to do a better job dealing with the future of Medicare with a similar share saying they trust Trump (44 percent) as say they trust Clinton (47 percent).
• Almost all Americans have heard or read about the Zika virus (92 percent), and one-third (36 percent) say that passing new funding to deal with the outbreak in the U.S. should be a top priority for Congress, with an additional 40 percent saying it should be an important but not a top priority. A large majority of all partisans say that new Congressional funding should be at least an important priority for Congress.
• About half of the public says they would not feel comfortable traveling to places like parts of Florida where people have been infected with the Zika virus by mosquitoes. In addition, three-fourths (77 percent) say these places are generally unsafe for pregnant women. The Kaiser Family Foundation has been tracking public opinion on Zika since February 2016; for more poll results, visit the up-to-date Zika slideshow.
• About half of Americans are concerned that an unauthorized person might get access to their confidential records and information; despite this, 80 percent say it is important that their doctors use online medical records.
• Americans’ opinion of the health care law remains split, with 40 percent saying they have a favorable view and 42 percent saying they have an unfavorable view.

Voters and the 2016 Presidential Campaign

There are less than 10 weeks until the 2016 general election and no shortage of issues for the presidential candidates to discuss on the campaign trail and in upcoming debates. While health care has generally taken a backseat so far in the 2016 presidential election,¹ during the past month, there have been several health policy stories garnering media attention including the Zika virus outbreak, prescription drug costs, health insurers leaving ACA marketplaces, and the ongoing opioid epidemic. These are in addition to other health policy issues the next president will almost certainly have to address.

When asked which health issues the presidential candidates should prioritize discussing during the 2016 presidential campaign, two-thirds of voters say the future of Medicare and access and affordability of health care are top priorities for the candidates to be talking about. About half of voters also say the future of Medicaid (54 percent), the cost of prescription drugs (53 percent), and the future of the health care law (52 percent) are top priorities. Fewer than half say the ongoing opioid epidemic (41 percent) and women’s access to reproductive health services (40 percent) are top priorities, with 35 percent saying the same about the Zika virus outbreak and 29 percent saying the same about HIV/AIDS. While the Zika virus outbreak is not viewed by the majority of voters as a top priority for candidates to discuss during the campaign, it is the most closely followed health policy news story during August.

Partisans hold differing opinions on which health issues are a “top priority” for the presidential candidates to be talking about during the presidential campaign. Three-fourths (77 percent) of Democratic voters say access and affordability of health care is a top priority; however, this opinion is shared by a smaller majority of independent voters (62 percent) and Republican voters (55 percent). Six in ten Republican voters say the future of Medicare is a top priority for the candidates to be talking about, which is equal to the share of independent voters who say the same, and lower than the share of Democratic voters (73 percent) who say the same.

A smaller share of Republican voters than Democratic voters say that each health issue should be a top priority for the presidential candidates to discuss during the presidential campaign, with one notable exception — the future of the 2010 health care law. Similar shares of Republican voters (55 percent) and Democratic voters (59 percent) say the health care law should be a top priority for the candidates to be talking about, compared to a smaller share (44 percent) of independent voters.

Table 1: Top Health Priorities for the Candidates to Discuss During the 2016 Presidential Election
The percent who said the following should be a “top priority” for the presidential candidates to be talking about during the 2016 presidential campaign	All Registered Voters	Republican Voters	Democratic Voters	Independent Voters
Access and affordability of health care	66%	55%	77%	62%
The future of Medicare	66	60	73	60
The future of Medicaid	54	43	64	50
The cost of prescription drugs	53	47	63	48
The future of the 2010 health care law	52	55	59	44
The ongoing heroin and prescription painkiller addiction epidemic in the U.S.	41	34	51	35
Women’s access to reproductive health services	40	21	59	37
The Zika virus outbreak	35	30	44	30
HIV/AIDS	29	18	38	28

Who Do the Voters Trust On Health Issues?

When it comes to dealing with health issues facing the country, a larger share of voters say they trust Hillary Clinton to do a better job than say they trust Donald Trump to a better job. In fact, across all of the health issues included in this survey, at least half of voters say they trust Clinton to do a better job, and on the majority of the health issues, she has a double digit percentage point advantage over Trump. The largest difference between the two presidential candidates is on women’s access to reproductive health services; 64 percent of voters say they trust Clinton to do a better job dealing with this compared to 28 percent of voters who say they trust Trump to do a better job, giving Clinton a 36 percentage point advantage. A majority of female voters (71 percent) say they trust Clinton to do a better job on women’s access to reproductive health services compared to one in five (20 percent) who say they trust Trump.  The smallest difference is on the future of the 2010 health care law, on which Clinton has a 9 percentage point advantage over Trump (50 percent compared to 41 percent). Voters, age 65 and older, are split between which candidate they trust to do a better job dealing with the future of Medicare with a similar share saying they trust Trump (44 percent) as say they trust Clinton (47 percent).

Majorities of voters from each political party say they trust their party’s candidate to do a better job dealing with each of the health issues compared to the other party’s candidate. Across all health issues, about nine out of ten Democratic voters say they trust Clinton to do a better job while a smaller share, yet still a majority, of Republican voters say they trust Trump to do a better job. Independent voters are more divided on all of these health care issues.

Access and Affordability of Health Care

When asked about how access to affordable health care in the country would change if Trump were elected, four in ten voters (43 percent) say that it would get worse, three in ten (29 percent) say it would get better, and one-fourth say it would not make much of a difference. When asked the same about if Clinton were elected president, 27 percent of voters say access to affordable health care in the country generally would get worse, one-third say it would get better, and four in ten (38 percent) say it would not make much of a difference.

When asked how a Trump or Clinton presidency would affect their own ability to access affordable health care, half of voters (52 percent) say if Clinton is elected president it would not make much of a difference, while similar shares say it would get better (22 percent) as say it would get worse (24 percent). This is compared to 37 percent of voters who say that if Trump is elected, it would not make much of a difference in their own ability to access affordable health care, 36 percent who say it would make their own ability to access affordable health care get worse, and 24 percent who say it would get better.

Partisan voters are divided on how access to affordable health care would change, both in the country generally and for them personally, under a Trump or Clinton presidency. Three-fourths of Democratic voters say that if Donald Trump were elected president, access to affordable health care in the country generally would get worse (compared to 11 percent of Republican voters); two-thirds of Democratic voters say their own ability to access affordable health care would get worse if Trump were elected (compared to 7 percent of Republican voters). On the other hand, if Hillary Clinton were elected president, 53 percent of Republican voters say access to affordable health care in the country generally would get worse (compared to 3 percent of Democratic voters), and 48 percent say their own ability to access affordable health care would get worse (compared to 3 percent of Democratic voters). Independent voters are split on what would happen if Trump or Clinton is elected, with about one-fourth saying their own ability to access affordable health care would get worse if either candidate was elected.

Americans’ Opinions of the Affordable Care Act

Americans’ opinion of the health care law remains divided, with 40 percent saying they have a favorable view and 42 percent saying they have an unfavorable view.

Furthermore, partisans continue to hold widely differing views; two-thirds of Democrats (67 percent) report a favorable view, while three-fourths of Republicans (76 percent) report an unfavorable view and independents tilt negative, with 37 percent saying they have a favorable opinion and 47 percent saying they have an unfavorable opinion.

When asked about the news media’s coverage of the health reform law, four in ten say that the coverage is mostly balanced while 27 percent say it is biased in favor of the law and 21 percent say it is biased against the law. About half (47 percent) of Republicans say the news media coverage of the health reform law is biased in favor of the law while half of Democrats and 43 percent of independents say the news coverage is mostly balanced.

The Zika Virus Outbreak

The Zika virus outbreak continues to be the health policy story most followed by Americans. In July, health officials confirmed the first cases of individuals being infected by mosquitoes in the U.S. in a Miami, Florida neighborhood, and a subsequent travel advisory recommended that pregnant women stay away from the area.²

The August tracking poll takes a look at the public’s knowledge of these recent developments, their attitudes about travel to – and safety of – areas affected by Zika, and their views on the importance of Congressional funding to deal with the outbreak in the United States. The Kaiser Family Foundation has been tracking public opinion on Zika since February 2016; for more poll results, visit the up-to-date Zika slideshow.

Knowledge of Local Transmission and Domestic Travel Warnings

Three-fourths of the public (76 percent) are aware that there are cases of local transmission in the country – that is, cases where people are being infected with the Zika virus by mosquitoes. A smaller share, but still a majority, report being aware of travel warnings issued for areas in the United States affected by the outbreak (58 percent).

Attitudes Toward Traveling to Places Affected by Zika

About half of the public (48 percent) say that they would be “not too” or “not at all” comfortable traveling to places in the U.S., like parts of Florida, where people have been infected with Zika by mosquitoes. In contrast, six in ten say they would be not be comfortable traveling to U.S. territories like Puerto Rice where people have become infected (59 percent) or to places outside the U.S. where people have become infected (61 percent).

Individuals who report being aware of travel warnings for areas in the U.S. affected by Zika are more likely to say they are not comfortable traveling to places affected by the virus. For example, when asked about traveling to places in the U.S. like Florida where people have been infected by mosquitoes, 59 percent of individuals aware of travel warnings say that they would not be comfortable, compared to 39 percent of those who thought travel warnings had not been issued. In addition, women are not as comfortable traveling to places affected by Zika than men. Fifty-three percent of women, compared to 43 percent of men, report being not comfortable traveling to places in the U.S. where people have been infected by mosquitoes.

Evaluations of Safety for Pregnant Women

A large majority – 77 percent – of the public say they think areas in the U.S. where people have been infected by mosquitoes are generally unsafe for pregnant women. A small share appears concerned about the safety of these places for themselves, with half saying that areas in the U.S. where people have been infected with Zika by mosquitoes are generally safe for them, personally and 39 percent saying they are generally unsafe.

Individuals aware of the travel warnings issued for places in the U.S. affected by Zika are more likely to say that places with local transmission are generally unsafe for pregnant women (89 percent v. 77 percent of those who thought travel warnings had not been issued). They are also more likely to say that such places are generally unsafe for them, personally (47 percent v. 32 percent). Furthermore, women are more likely than men to say that places with local transmission are generally unsafe for pregnant women (81 percent v. 74 percent) and to say they are generally unsafe for themselves, personally (43 percent v. 35 percent).

Most See Congressional Funding to Deal with the Virus as an Important Priority

Despite President Obama’s February request for almost $1.9 billion to deal with the Zika virus outbreak,³ U.S. Congress has not passed any additional funding. Thirty-six percent of the public say that passing new funding to deal with the outbreak in the U.S. should be a top priority, with an additional 40 percent saying it should be an important but not a top priority. Nine percent think passing new funding is not too important, and 5 percent say that new funding should not be passed at all.

There are partisan differences in these findings, with a larger share of Democrats than independents or Republicans saying Congressional funding to deal with the Zika virus outbreak should be a top priority (46 percent v. 34 percent and 27 percent). However, a large majority of all partisans say that new Congressional funding should be at least an important priority of Congress.

Table 2: Majorities of Democrats, Independents, and Republicans Say New Funding to Deal with Zika from Congress Should at Least Be an Important Priority
Percent who say new Congressional funding to deal with the Zika virus outbreak in the U.S. should…	Total	Democrats	Independents	Republicans
Be a top priority	36%	46%	34%	27%
Be an important but not top priority	40	36	41	46
Be not too important	9	6	12	10
Not be done	5	2	5	8

Electronic Health Records

In 2009, the federal government passed the Health Information Technology for Economic and Clinical Health (HITECH) Act which allocated $27 billion for an incentive program encouraging health care providers to adopt electronic health records systems (EHR).⁴ In a 2009 poll⁵ conducted by the Kaiser Family Foundation, NPR, and the Harvard School of Public Health, about half of the public (46 percent) reported that their doctor entered their health information into a computer during a visit. In the most recent survey, eight in ten Americans say their doctor or health care provider enters their health information into a computer during a visit.

In addition, half (52 percent) of Americans say it is “very important” for their health care provider to use electronic or computer-based medical records instead of using paper-based records, up from 42 percent in 2009.

When asked about what type of medical information is important to be able to access, the majority of the public say each type of information included in the survey is at least “somewhat” important. Eight in ten (79 percent) say being able to access the results of their lab tests is at least somewhat important. This is followed by about three-fourths who say the same about being able to access their general health history (75 percent), their prescription drug history (74 percent), and the notes written by their doctor of health care provider from their visit (73 percent). A smaller share (63 percent) say accessing information about their mental health or substance abuse treatment is at least somewhat important.

Some Availability But Limited Accessing of EHRs

While the vast majority of Americans say it is important for their health care provider to use electronic medical records and most say that being able to access different types of medical information is important, a large share currently say their medical information is not available online. Across all the different types of health information, about a third say these types of information are not currently available to them online, with a slightly larger share (41 percent) saying the notes written by their doctor or health provider are not available.

While 78 percent of Americans report that at least some of their medical information is available online, much smaller shares report accessing this information. Less than half of Americans report having accessed any type of medical information online. When they do access medical information, 29 percent say they have accessed the results of lab tests, such as blood tests, x-rays, and mammograms, 26 percent say they have accessed general health history, 23 percent say they have accessed prescription drug history, and 21 percent say they have accessed notes written by their doctor or health care provider. A much smaller share report accessing information about mental health or substance abuse treatment (9 percent).

Majority of Americans Have Security or Privacy Concerns Regarding Online Medical Records

About eight in ten (78 percent) Americans have at least some medical records and personal health information available online. Of these, 60 percent (47 percent of total population) say they are either “very” or “somewhat” concerned that an unauthorized person might get access to their confidential records and information. Larger shares of Hispanic individuals (58 percent of total) and Blacks (56 percent of total) report having privacy concerns than Whites (42 percent of total).

Why Some Americans Still Don’t Access Online Medical Records

One-third of Americans report that they have the ability to access their medical records or personal health information online but have not done so. The main reason given is that they did not have a need to access the information (49 percent), followed by not having access to the internet (15 percent), not knowing how to access the information (13 percent), and being concerned about privacy or security (11 percent).

In addition, accessing online medical records or health information is seemingly dependent on education level and income, but noticeably, not on age. Almost half of individuals who have not accessed their own medical records have a high school diploma or less (49 percent) or earn less than $40,00 a year (47 percent).

Table 3: Demographics of Those Who Have and Have Not Accessed Their Own Medical Records or Personal Health Information Online
	Have Accessed	Have Not Accessed	Total
Education
High school or less	31%	49%	40%
Some college	30	31	30
College+	39	20	29
Income
<$40K	34	47	40
$40K to less than $90K	29	31	30
>$90K	26	12	20
Age
18-29	19	21	20
30-49	35	30	32
50-64	29	28	29
65+	17	20	19

Kaiser Health Policy News Index: August 2016

The August Kaiser Health Tracking Poll finds that the majority of Americans (71 percent) are following stories about conflicts involving ISIS and other Islamic militant groups as well as both Donald Trump’s presidential campaign (68 percent) and Hillary Clinton’s presidential campaign (67 percent). Other stories that capture the attention of Americans this month include the severe flooding in Louisiana (65 percent) and the Zika virus outbreak (60 percent). About half of Americans say they have been following stories about the 2016 Summer Olympics, which took place in Brazil from August 5^th to 21^st. While a majority of the public say they follow news about the Zika virus outbreak, fewer Americans report following three additional health policy stories: the ongoing heroin and prescription painkiller addiction epidemic in the U.S. (43 percent), reports about rising ACA health insurance premiums (39 percent), and news of health insurance companies leaving ACA marketplaces (36 percent).