Victoria Research & Consulting (VRC) recently completed a poll on healthcare in the midwestern counties newly christened “Pivot Counties” – those counties that went for Barack Obama in 2012 and then flipped to support Donald Trump in 2016. A full findings memo can be found here, as well as toplines and a full set of crosstabs. VRC was interested in knowing more about the political beliefs of the voters in these counties, in particular about the remarkable cluster of Pivot Counties around the Upper Mississippi River in four key states: Illinois, Iowa, Minnesota, and Wisconsin. For clarity, we decided to include all the Pivot Counties in these 4 states. A full list of counties included is in the methodology memo; the list was sourced from this CNBC article that has a nifty interactive map.
Since healthcare has been the only major legislative battle of the Trump Presidency thus far, we decided to focus largely on healthcare for this study. VRC may conduct other Pivot Counties Polls about other topics later in the year. We were also struck by (1) how much the AHCA proposal differed from what Trump said he supported on the stump, and (2) the many parallels between campaign statements by Trump on healthcare and the statements of Bernie Sanders. VRC used this latter contradiction to probe Pivot Voters’ desires for healthcare in the wake of the failure to pass the AHCA, the Republicans first healthcare reform bill.
A full methodology memo can be seen here. In all, 634 surveys were completed with registered voters in the Pivot Counties who voted in at least 1 of the last 3 Presidential elections (96% voted in 2016). Questions? donnaV@victoriaresearch.com
Views on Healthcare
In the Pivot Counties, Trump’s worst job ratings are on healthcare – the only major issue that has had a legislative proposal put forth in his first 100 days.
Only 31% of Pivot Voters approve of how Donald Trump is handling healthcare; even among Trump voters, only 58% approve of his handling of healthcare.
A 31% approval rating is hardly better than the national average of 29% approval on Trump’s handling of healthcare in the same timeframe.
Pivot Voters are more supportive of progressive, single-payer healthcare statements than they are of Trump the candidate’s healthcare statements – and those Trump statements were considerably more moderate than the failed AHCA proposal. We were struck by the similarities between candidates’ Sanders and Trump on healthcare rhetoric during the campaign, so we used this survey to test 4 quotes from Trump and 4 quotes from Sanders on similar themes. The speaker was not identified to the respondents; they were simply asked the extent to which they agreed or disagreed with “some statements that have been made by different politicians about healthcare in the U.S.” [In some instances we made minor edits to the quotes to make them more concise and to excise some rhetorical “tells” in the way Sanders and Trump speak].
Sixty-nine percent of Trump voters in the Pivot Counties agreed with a Sanders quote that attacked the “rip-offs” of the pharmaceutical companies. Both Trump and Sanders receive their greatest support when they are attacking pharmaceutical pricing – but the Sanders statement still outperforms the Trump statement overall, with 53% of all Pivot Voters strongly agreeing with the Sanders quote below, compared to only 47% strongly agree for the Trump quote. While Trump voters gave the Trump quote stronger support, the overall conclusion is that the appeal of both statements is quite high across the board, no matter which candidate they supported in 2016.
The other 3 statements on healthcare by Trump bombed, with all 3 scoring much lower than all of the Sanders’ quotes. The “strongly agree” responses, the best indicator of intensity, were all less than 25% on the remaining 3 Trump quotes. And for each quote, more Pivot Voters strongly disagreed with Trump’s sentiments than strongly agreed. Ironically, Trump’s claim that “Everybody has got to be covered. I am going to take care of everybody…” was driven down by the Trump voters, 52% of whom disagree with that statement.
- The remaining 3 very progressive, even radical statements about healthcare taken from Sanders speeches all were overwhelmingly supported in the Pivot Counties, ranging from 75% to 68% total agreement.
Majorities of Trump voters agreed with every one of the Sanders statements on healthcare.
We conclude that the Pivot Counties show no evidence of being likely to support Republican efforts on healthcare reform – certainly not what was packaged into the AHCA, nor what is likely to be added or changed when the House puts forth an AHCA version 2. They may have supported Trump’s rhetoric about healthcare reform on the campaign trail, especially when he talked about going after the pharmaceutical companies, but Trump’s rhetoric is pretty far from the reality of the GOP bill.
In contrast, there is much more uniform support for an aggressively pro-patient, single-payer advocacy in these swing Pivot Counties than many would think. VRC intentionally tested quotes from Sanders that were stridently mentioning “health care for all,” “eliminat[ing] private health insurance premiums and payments,” and “a Medicare for all single payer system.” Pivot County voters across the political spectrum agreed with these statements. VRC also intentionally tried to separate these issue positions from Sanders himself by quoting him anonymously, because our goal was to gauge sentiment on Democrats’ potential healthcare positions going forward, not to evaluate Sanders or the Sanders campaign. But it is undeniable that Sanders’ remarks about healthcare during the 2016 campaign continue to have resonance, and in fact, may paradoxically be positions that voters are more receptive to now than they were when the ACA was being debated or even in last year’s campaign. Given the floundering Republican efforts on healthcare, more Pivot Voters may be coming around to a single-payer option.
Additional findings on the Views on The Current Quality of Their Healthcare, Views on Political Figures, Views on Trump's Job Performance on Other Issues, and our Conclusions can be found in the full memo, available here.