Three-quarters of Americans across party lines say healthcare will be one of the top three issues deciding their vote, finds a new survey.
The People’s Health Care Survey, USofCare’s annual survey that captures people’s experiences with and challenges in healthcare, reached over 2,700 registered voters from June 12 through July 16. It was designed to be nationally representative, and responses were weighted to match the U.S. population based on recent Census data. USofCare describes itself as a nonpartisan nonprofit focused on advancing policies that improve access to quality, affordable healthcare.
Three-quarters of Americans feel frustrated, overwhelmed or helpless about healthcare costs, the survey found. Frustration peaks among people with commercial coverage (54%), Marketplace coverage (54%) or no coverage at all (49%). Among people insured through Medicare, Medicaid and the VA, frustration drops to just over a third.
“We believe there's a real chance for reform in ‘29, regardless of who’s elected. […] The mandate's just too loud and too big,” Natalie Davis, USofCare’s CEO, told Fierce Healthcare.
Satisfaction with insurance follows similar patterns. Satisfaction, the survey suggested, should be thought of generally as not going into debt to get care. Two-thirds of Medicare members and 60% of veterans through the VA say they’re satisfied with their insurance, compared to 42% of people with employer coverage and 40% of those with Marketplace coverage.
In general, over half of respondents said healthcare is unaffordable to them, with 49% saying it feels more expensive than a year ago. Only a fifth paid for their care in the past year with no difficulties. Meanwhile, 16% delayed care, 16% skipped care, 12% cut back on food, housing or utilities, and 11% went into debt to pay for care.
Democrats were slightly more likely to say healthcare will be a top-three issue deciding their vote (89%) compared to Independents (74%) and Republicans (64%). These differences are marginal, Davis said. “Not only are people saying that they’re going to vote on it now, but that their feelings of frustration—overwhelming and helplessness—are really driving the desire for government to do something about it,” Davis noted.
Nearly half of respondents want major or radical change to the system, with half of those having employer coverage and two-thirds being uninsured. A third of people say the system needs targeted improvements, while 13% say it needs small fixes. Both groups share the same goals, which have remained unchanged for five years: affordable care, reliable coverage, personalized care and a system that is easier to navigate.
Two-thirds of people rank insurers among the top three drivers of high costs, followed by hospitals (48%) and pharma (46%). “We’re starting to see a lot more angst about hospitals and healthcare systems, because I think people are starting to feel some of the changes,” Davis said. These include services being discontinued, disjointed care journeys and rising costs.
In past USofCare surveys, Davis explained, respondents indicated they were well aware of how changes in ownership worsened their care experience. Without leading questions, “they knew the term [hospital consolidation], they knew exactly what they felt like in their community,” Davis said.
Among people with employer coverage, 71% say it plays at least some role in their job decisions, and a third say it plays a big role. Half of people on Medicaid and over a third of people with Marketplace coverage are concerned they could lose their coverage in the next year, most often because of rising costs or changes to their benefits.
Trust is highest in clinicians, more than any institution—over half fully trust their PCP and nearly half trust specialists and nurses. From there, only a quarter fully trust hospitals, 15% fully trust federal health agencies and 12% fully trust insurers and pharma. Trust in AI health tools and elected officials sits at 9%.
Over a third of people report checking a recommendation against an outside source in the past year because they didn’t trust someone in the system, which Davis suggested could help explain the rise of the Make America Healthy Again and high use of chatbots.
People largely blame the industry for rising costs. An earlier USofCare poll on affordability found 53% don’t trust private healthcare companies to regulate costs on their own. In priorities outlined in the current survey, over four in 10 want a system that puts outcomes above profits.
“We’re seeing a public that believes the government has to do something ‘cause industry won’t,” Davis said. “They just don’t think industry understands it enough and is able to center patients over their own needs and over their own profits.”
People most often look to the president and Congress (53%) to make care more affordable (more likely to be seen as responsible by Democrats and Independents), ahead of payers (19%; more likely to be seen as responsible by Republicans). And, whereas 66% of Democrats and 53% of Independents say the government should play a large role in making care affordable, 39% of Republicans agree.
“I really believe the call for action is only going to get louder,” Davis said. The industry has not come up with solutions, so “I think that’s going to require the government to.”
For the next two years, USofCare plans to follow about 100 Medicaid beneficiaries in five states to see how the impact of H.R. 1 and Medicaid cuts plays out.