Bob Ward [00:00:03]:
I want to be able to let members of Congress know that not only are these numbers big from a sort of policy standpoint, but they’re also pretty good numbers to supporting these programs from a political standpoint. And I think that is something that, you know, the members of Congress need to hear.

Narrator [00:00:24]:
Welcome to Hospitals in Focus from the Federation of American Hospitals. Here’s your host, Chip Kahn.

Chip Kahn [00:00:33]:
Today we’re diving into the intersection of public opinion and health policy with a focus on two programs that are the keystones of health coverage for Americans. Medicaid, the state federal partnership that ensures coverage for millions and nursing home care for so many seniors. And the enhanced premium tax credits that assure millions individual health coverage in the health insurance marketplaces. Recently, two surveys conducted by Fabrizio Ward, who also conducted polling for President Trump’s 2024 campaign, offers insights into how voters view Medicaid, the tax credits, and the role they play in the lives of Americans. What’s striking is the support for these programs across party lines. Americans, regardless of political affiliation, overwhelmingly back them. Joining me today to break it all down is Bob Ward, a partner at Fabrizio Ward and a leading expert in public opinion research. Bob, welcome to Hospitals in Focus.

Chip Kahn [00:01:48]:
Thanks for being with us.

Bob Ward [00:01:50]:
Thank you, Chip. Happy to be here. Looking forward to talk through some of the survey data.

Chip Kahn [00:01:54]:
Bob, before we get into talking about specific, the specific survey work, I’d like to talk about what you do generally when you’re sort of building a sample that’ll be reflective of American voters. And so looking at this from a 30,000 foot perspective, how do you define the groupings that we’re gonna be discussing in a few minutes in terms of their attitudes about programs that you explore in your surveys?

Bob Ward [00:02:23]:
Sure. Well, I think the first thing, if we’re talking about public opinion on policy issues and how the White House, how Congress views these issues and how they want to know what the American people think. We look at slicing up the electorate and that’s who we surveyed in these polls, the registered voters into groups that would be relevant to those policymakers. So if we go Back to the 2024 election, Donald Trump won the popular vote by one and a half percentage point margin over Kamala Harris. So whether you voted for Trump or Harris really kind of cleaves the electorate in half and allows us to look at a group that, if you’re the White House, how is the people who put me here, you know, thinking about these various issues? And if I’m, you know, Democrats in Congress, I’m going to look at the Harris voters. And see, you know, those folks who probably largely voted Democratic for their Congress and senators as well, how do they think about these issues? Because you know, we do have in this country, as you know, can be no surprise to anybody, divided views on a lot of issues based on how you vote. A third group who we look at are what we call swing voters. Now if you ask people how they vote typically in an election, do you vote almost always or always for the Republican or mostly or always for the Democrat? You get about 75% of the electorate who fall into one side or the other.

Bob Ward [00:03:58]:
And that leaves about a quarter of the electorate who are in the middle who say when you ask that question that, you know, sometimes I vote Republican and other times I vote Democrat. And those are key voters also for both, if I’m a Democrat or a Republican policymaker to look at. Because ultimately in close elections it’s swing voters largely tip the scales as to, you know, the election is going to go one way or the other. So those are the three main groups that I’ll be talking about as we go through the data. There’s some differences across those groups that I think are worth noting. Trump voters distinguish themselves from Harris voters demographically in a few big ways. They tend to be more male. There’s more men identify as Trump voters, more females identify as Harris voters.

Bob Ward [00:04:47]:
Trump voters tend to be older. And there’s a few demographics there that stand out. The youngest cohort of age 18 to 34 year olds disproportionately voted for Harris over Trump. Although Trump made gains in that group, there’s still more of them Democratic leaning, Harris leaning and the older end. Those voters over 50, let’s say, tend to be more Republican, particularly the age group that’s in the sort of the last stage of working, age 50 to 64 that is the most Trump voting and Republican group. So there’s a difference there. Harris voters are more diverse when it comes to race and ethnicity, whereas Trump voters gonna be a little bit more white and less of people of color. And I think one of the other big ones is education.

Bob Ward [00:05:34]:
There’s a big divide between Trump voters and Harris voters. On your level of highest attained education, over two thirds of Trump voters do not have a college degree, whereas half of Harris voters do. And so that is another big distinction. I think the last one I think I’ll mention is where you live. And about half of America lives in the suburbs and they’re actually pretty divided between Trump voters and Harris voters. Quarter live in urban areas which over index on the Democratic side and another quarter live in the rural areas of America. And they way over index for Trump and Republicans. So I think that sort of gives you a sense of how we break down the electorate, how we look at things.

Bob Ward [00:06:20]:
Swing voters are the type of voter who’s probably not gonna show up in as great a numbers in the midterm elections. Call those low propensity voters. They showed up in 2024, and a bunch of them aren’t going to show up in 2026. They tend to be younger, they tend to be a little bit more male. So the younger men are probably going to drop off in the midterm elections. It’s typical and is likely to be the case in our current politics. So there’s a bunch of things that we’re looking at from a demographic and data perspective as we go through the survey. But if I’m from the White House, I’m going to be looking at those Trump voters and swing voters.

Bob Ward [00:07:01]:
And if I’m Republican in Congress, the same if I’m a Democrat in Congress, I’m going to be looking at those Harris voters and swing voters as well to see where they fall on these various issues.

Chip Kahn [00:07:12]:
You know, I have to admit I’ve been doing this a long time. I guess the first big legislative process in terms of health coverage I got involved in was in 93, 94, when Clinton care was being considered and at that point was like working for the health insurance industry. And over that time, through all of the changes, and then finally in 2009, 2010, with the ultimate passage of Obamacare and the Affordable Care act, there’s been an evolution of where some of these groups may stand on health care generally. I think as far as Republicans are concerned, you know, maybe Obamacare in quotes as a label is problematic, but maybe some things have changed and maybe they’ve changed because of the demographics. You obviously have been doing this a long time. Can you sort of describe from the groupings that you, you just went through, how that may not reflect what a, what the Republican base would have looked like in 2000 or in 2004 or even in 2009 and 10?

Bob Ward [00:08:17]:
Well, I think the biggest change is the change in education, which correlates to income. And so I think, you know, if you were during the Clinton care debates in the 90s, going up through the early 2000s, you know, the Republican Party was the party of the country club. And I would think it’s fair to say that since that time, and certainly since Donald Trump has become sort of the head of the Republican Party. It’s really more the party of Sam’s Club than the country club, as one of my former clients, Tim Pawlenty, used to say. I think that is the biggest change. Republican voters are not as high income as they used to be. And there has been a change on the other side of the aisle where Democratic voters have picked up higher educated voters. If you looked at the numbers today, the party of the working class is the Republican Party.

Bob Ward [00:09:19]:
If you have 50% of Democratic voters, Paris voters who have a college degree, more than two thirds of Republican voters who don’t, it is inarguably the Republican Party is the party of the working class. And I think that is the biggest change that we’ve seen over the timeframe that you’ve talked about, that more people who had formerly been politically disaffected are now involved in politics. That’s been part of the change. There’s been a realignment at the higher education, higher income end where people have left the Republican Party and gone over to the Democratic Party. So those are big differences. So when you’re talking about healthcare policy and you’re talking about these programs like Medicaid, like the Affordable Care act, there is a big constituency in the Republican Party that rely on these programs. And I think 20 years ago, 30 years ago, that wouldn’t have been the same situation.

Chip Kahn [00:10:19]:
So now let’s delve into your work and into the implications of what you just described for that work. I think I want to note as we get into this that we have a survey on Medicaid we’re going to talk about that was released by the modern Medicaid alliance. And we have a survey on the marketplace enhanced tax credits, and that was released by Building America’s Future. And in the show notes on our website, we’ll make both of those surveys available so that those of our listeners who would like to take a deeper dive can have an opportunity to do that. So now I’ll get into the questions, Bob, and I think that the work that you did here was really interesting. And as we take a dive into it, can you give us a sense, starting with Medicaid, about how that program fared across these different groups and the implications of that?

Bob Ward [00:11:19]:
Yeah, I think a good place to start when we talk about Medicaid. So we asked a few questions just to sort of level set to see where the sample of the registered voters we spoke to are relative to the program. And so when we think about the electorate, there’s about 10% or less of voters who are currently on Medicaid. It’s not a big number. You ask people, have they ever been on Medicaid, that number more than doubles. And then you ask, has a family member either on or have been on Medicaid? You get up to 46% of the electorate has that personal connection to the program. So that, I think is the number one finding that puts the rest of what I’m going to talk about in context. So many people out there are affected by Medicaid and the political difference within that grouping.

Bob Ward [00:12:12]:
There is some, but it’s not big. 40% of Trump voters have a personal or family connection to Medicaid versus 50% of Harris voters. There’s a difference, but it’s not big. So we get to and one of the things we wanted to do in this survey was to put the idea of Medicaid first. You know, what are people’s feelings about the program? Well, three out of four voters have a favorable view of the program. And if you look at Trump voters, it’s six out of 10. And that is, you know, so Harris voters are a little bit more favorable to the program, but 6 out of 10 Trump voters have a favorable view of, of Medicaid. And so what, what we want to, you know, put this in the context of the current debate on Capitol Hill where there’s talk about cutting Medicaid and not just to cut the program for the sake of cutting the program.

Bob Ward [00:13:04]:
You’re cutting the program to pay for tax cuts, Right? So you have expiring tax cuts that are happening that were put in place in 2017. You’ve had a campaign where President Trump made a lot of promises about, you know, various tax policies that Republicans very much want to implement right now. And so they’re looking at ways to pay for these in the reconciliation process. And so the question that we asked voters is, do you support cutting Medicaid to pay for tax cuts? And the answer is that overwhelmingly voters do not support cutting Medicaid. 70% of voters oppose cutting Medicaid to pay for tax cuts. Only 20% say they would support that. And what’s interesting is if you’re going to put it out there as a program that’s going to help pay for tax cuts. You would think that somewhere across the spectrum of the electorate, there’s a large group of voters who are going to support cutting Medicaid to pay for tax cuts.

Bob Ward [00:14:06]:
And the fact is, there isn’t where you would expect to find them, perhaps might be among those people who voted for Donald Trump but what we found was by a 15 point margin, Donald Trump’s voters oppose cutting Medicaid to pay for tax cuts. And that margin is even higher among swing voters, where you have two thirds of swing voters opposed to cutting Medicaid to pay for tax cuts. So it’s fascinating, you know, and of course, you know, the president says he doesn’t want to cut Medicaid. He wants to cut fraud, waste and that sort of thing. But the issue is the program itself and how the details get worked out of this, you know, are I guess, yet to be determined. But from a starting point, Republican voters, swing voters, and certainly Democratic voters, there is no appetite to cut Medicaid to pay for tax cuts. And so I think it’s important that policymakers understand where voters are on this issue because as I said, you would expect somewhere along the political spectrum you’d find that support. And this survey just didn’t find it.

Chip Kahn [00:15:15]:
That’s really important. I think, you know, in one of the, there’s a fine line here. I know some in Congress are talking about not cutting Medicaid benefits versus cutting Medicaid. Frankly, I think they miss the nuance. I guess that’s polite to say they miss the nuance between Medicaid and Medicare. Medicare covers benefits. Medicaid is a partnership in which the money goes to the state and then the state determines the benefits. So any cut in money is in a sense going to end up cutting access to care and cutting benefits.

Chip Kahn [00:15:49]:
But what I’m sensing from you is that particularly for those that have had any experience with Medicaid, it’s a lifeline. Is that the case from what you found?

Bob Ward [00:15:59]:
That is absolutely the case. There is a difference. If you are part of that 46% who have a connection to the program, whether through your own history currently or through a close family member, your opposition to those cuts are going to be higher. But even among the other, you know, the 54% of the electorate that don’t have the connection, most of them also oppose cuts, that that number is going to be a little bit lower. And so the personal connection does matter. Here’s the other thing. It is rarely do you see numbers this high. We ask a question.

Bob Ward [00:16:35]:
How important is it that the most Americans are covered by health insurance as possible? It’s around 90% say that’s important and it’s 87% among Trump voters. So it’s like there’s no political difference here. Most people out there, it’s not unanimous, but it’s pretty darn close to being that people think it’s important that people be covered by health insurance. And so, you know, as we talk about Medicaid and what it provides to families and we’ll talk about the tax credit, but that is a sort of a given starting point that the electorate is delivering this very broad set opinion that more people should be covered by health insurance than less.

Chip Kahn [00:17:20]:
Well, I guess 160 million Americans who are in employment are covered by their employers. And those who are not fortunate enough to be covered by employers, you know, they want health insurance, too. I mean, if you get sick, what are you going to do? And I think the populations that you looked at get that issue. Let’s move on to the enhanced tax credits survey you did. Now, clearly here we’re talking about 21 million people who are in marketplace coverage, the individual market coverage across the country, and virtually half of those are receiving a significant subsidy to cover their insurance that comes through this enhanced tax credit. What were the views there? I mean, is it the same issue of coverage is coverage? People want to have coverage and want their fellow Americans to have coverage?

Bob Ward [00:18:14]:
Yes, and even more so, you know, so while there wasn’t a pocket of support to cut Medicaid, there is even less support out there to have these premium tax credits expire as they’re set to do by the end of this year. The level of support for this program is high and it is even more bipartisan than opinions, as Medicaid were. So, for example, we ask people if they support or oppose extending the tax credits that allow working families to afford premiums for health insurance they buy directly, which expire this year. 80% of all voters support extending these tax credits, 78% of Trump voters. So there’s no difference whether you’re on the right or the left on this one. And I think it goes back to that data point I mentioned of how many people think it’s important that as many Americans are covered by health insurance as possible. And so this is actually a smaller percentage of the electorate who actually are buying their health insurance through the exchanges than people who are on Medicare. Not much smaller, but it’s a little bit smaller.

Bob Ward [00:19:31]:
And so the data from these surveys are largely being delivered by people who are not on this program. Right. But they realize how important health insurance is. And if there is a tax credit out there that’s helping people to stay insured, they’re for it. And, you know, we’ve tested this issue, as mentioned in the survey, for Building America’s Future, and the numbers are strikingly bipartisan. The Other thing is, from a political standpoint, the candidate who is supportive of extending these tax credits gets a bump. So if it’s the Republican candidate who supports extending these tax credits, we saw a net 25 point gain on the generic ballot for the Republican. And that’s the type of thing.

Bob Ward [00:20:20]:
As a pollster, along with sort of like the broad sort of policy opinions, I want to be able to let members of Congress know that not only are these numbers big from a sort of policy standpoint, but they’re also pretty good numbers to supporting these programs from a political standpoint. And I think that is something that, you know, members of Congress need to hear.

Chip Kahn [00:20:43]:
So what I’m hearing from you is that it’s both good policy because Americans want it and could play into being good politics. Both to oppose cuts in Medicaid spending which would reduce care that’s available through Medicaid. And at the same time, we know that these tax credits we’re talking about, these enhanced tax credits expire at the end of 25. So those you sampled would want to see that extended beyond on 25 and that both of those are pluses in terms of the body politic today.

Bob Ward [00:21:21]:
Absolutely. And of course, the inverse is true. As I said, I think there’s little appetite in the electorate to taking away people’s health insurance. And if that in fact is what’s going to happen, I think there’s a political price to be paid in the midterm elections.

Chip Kahn [00:21:35]:
Bob, this has been such an important discussion and we’ve been talking in our other time with experts about these programs in terms of so many millions Americans. But I think getting the views of those Americans, not just talking about what these programs do for them, is really a really critical path to any kind of policy discussion covering everything it needs to. So I deeply appreciate your work and obviously I think your conclusions should be taken seriously by those in Washington who are making policy and just want to.

Bob Ward [00:22:13]:
Thank you, appreciate it. Thank you for having me.

Chip Kahn [00:22:16]:
As a takeaway here, I’m struck that as lawmakers debate cuts to health coverage on the Hill, that voters, MAGA swing and Democrats alike want the security of health coverage for all Americans. They’re overwhelmingly supportive of Medicaid, which provides over 72 million Americans the coverage they depend on and they’re supportive of the enhanced tax credits that for millions is a lifeline to affordable care. As we think about health coverage in America, we can’t lose sight of these real people behind the polls and the fact that they believe that everyone should have access to to coverage in this country.

Narrator [00:23:07]:
Thanks for listening to Hospitals in Focus from the Federation of American Hospitals. Learn more at fah.org. Follow the Federation on social media @FAHHospitals and follow Chip, @ChipKahn. Please rate, review and subscribe to Hospitals in Focus. Join us next time for more in depth conversations with healthcare leaders.

Bob Ward is a partner of Fabrizio Ward, a public affairs polling firm he co-founded with Tony Fabrizio, lead pollster for President Donald Trump. Ward is a veteran political pollster, having worked for Republican candidates at all levels of government. Internationally his political work extends to elections and NGOs in Europe, Asia, and Africa. He provides political polling and election insights for a range of advocacy groups.  

Ward has over 30 years of public and stakeholder opinion research experience, specializing in public affairs research, corporate image, reputation, and issues management. His counsel and research have guided a wide range of client engagements including public affairs campaigns designed to influence policy makers, product liability crises, high profile litigation, long-term reputation measurement and management, to message development supporting everything from rebranding universities, launching advocacy groups, and product roll-outs.