WEDNESDAY, Sept. 22, 2004 (HealthDayNews) -- Health care may not be the defining issue in this fall's presidential race, but it could become critical in some "swing states," new research suggests.

"It depends on how close the election is," said Robert J. Blendon, a professor of health policy and management at the Harvard School of Public Health, and lead author of a new study examining public opinion survey results.

The report, co-authored with Kaiser Family Foundation President and Chief Executive Officer Drew E. Altman and his colleagues, appears in the Sept. 23 issue of the New England Journal of Medicine.

Health care ranks as a top domestic issue, ahead of education and Social Security, the study found. Asked to describe in their own words which health-care issues would be most important in deciding their vote for president, voters most frequently mentioned the cost of health care and prescription drugs, and Medicare and health care for the elderly.

Yet voters say they're more concerned about the economy and jobs, the war in Iraq and terrorism, the survey revealed. These same issues remain dominant themes in the candidates' pre-election stump speeches and will likely frame the three upcoming debates between President George W. Bush and Sen. John Kerry.

If it's a tight race, the candidates may look for an issue on which they might "hit a home run," Blendon said, and that could put health care on the playing field. "I think after the first week in October, we'll see if the candidates think it's really worth battling it out," he said.

Gail Shearer, director of health policy analysis for Consumers Union in Washington, D.C., sees health care playing a more pivotal role in the election than its fourth-place ranking in the new survey might indicate. "To me, I read into this that health care could be very important," she said.

If the election is close, then the swing states will be critical in deciding the election, Shearer said. And, she added, because most Americans get health insurance coverage through the workplace, it's difficult to separate the impact of the economy and job creation -- voters' No. 1 election issue -- from their concern about rising health-care costs.

To test the importance of health care as an issue in the election, health-care researchers examined data from 22 national opinion polls, including two surveys designed specifically for the new study.

In all of the surveys, voters were given a list of issues to help them recall the ones they considered most important. The results of the surveys were statistically re-weighted to reflect the composition of the U.S. population.

Democrats were more likely to cite health care as the single most important issue for deciding their vote for president. The issue gained top billing among 19 percent of Democrats, vs. 13 percent of independents and 9 percent of Republicans.

Likewise, the issue gained more traction among Americans aged 65 and older than younger adults.

Asked to rate the importance of 11 specific health-care issues, most voters said the cost of health care and health insurance, the cost of prescription drugs, prescription drug benefits for the elderly, and the uninsured would be most important in deciding their vote for president.

Only 1 percent of voters cited quality of health care. "It isn't that they're not concerned about quality issues, but they don't see candidates as solving this problem," Blendon reasoned. "They don't think that either Kerry or Bush is going to make the doctor better."

One-third of voters -- particularly white males -- do not regard health care as an important election issue, the study found. For them, none of the 11 health issues was deemed critical to deciding their vote.

"It's not important to them that health care be a big issue to the top leader of the country," Blendon said.

What's important to older voters, however, may be a different story. The survey revealed deep divisions over the Medicare prescription drug law backed by the Bush administration last year. Forty-eight percent of those polled have an unfavorable impression of the law, and only 27 percent view it favorably.

"I think that could be a major issue for many voters," Shearer said.

More information

The Kaiser Family Foundation can help you compare the presidential candidates' health policy positions.

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