politics
Politics

Health Issue Looms Large in Key Senate Races

by Ari Pinkus October 15, 2018

As this contentious campaign season rolls on, the American Communities Project examines how voters see healthcare from recent polls of toss-up Senate elections in November, pointing out uninsured rates at or above the U.S. average as well as common health worries in the dominant community types in each state.

The twin bottom lines: Healthcare matters significantly to voters in the seven states below, and in several cases, keeping costs low is of greater concern than covering everyone.

Arizona

The Grand Canyon State’s uninsured rate: In 2017, 10.1% of Arizonans did not have health insurance, according to the Census. The U.S. average was 8.7%.

Health worries in Arizona’s prominent community type: Arizona is made up of 15 counties, including populous and diverse Maricopa, a Big City county that includes Phoenix. The uninsured rate here is 12%, according to the 2018 County Health Rankings. Access to primary care physicians is also a challenge.

Other notable community types: Graying America, Hispanic Centers, and Native American Lands

Arizona voters’ healthcare views: In a CBS News/YouGov poll of 1,010 registered voters from Oct. 2-5, voters offered their views on the particulars of healthcare:

  • 78% expressed “a lot” of concern about keeping costs down, 20% shared some “some” concern, and 2% reported “not much” concern.
  • 72% said they are concerned “a lot” with access to treatments and medications, 23% reported “some” concern, and 5% said “not much.”
  • 54% said they are concerned “a lot” about making sure everyone is covered, 29% said they had “some” concern, and 17% said “not much” concern.

How issues stack up: Healthcare is a significant issue in Arizona voters’ decision-making. 77% said a political candidate must agree with them on healthcare to get their vote. In comparison, 81% said a candidate must share their views on immigration, and 69% said a candidate needs to agree with them on taxes.

Healthcare and the horse race: Of registered voters, 43% said Kyrsten Sinema (D) is better on healthcare, 31% said Martha McSally (R) is better, and 17% said they are not sure yet. Overall, McSally garners 47% in the poll;  Sinema stands at 41%.

Arizona’s 2016 presidential vote: Arizona ended in President Donald Trump’s column. He drew 48.1% of the vote to Hillary Clinton’s 44.6%.

Florida

The Sunshine State’s uninsured rate: In 2017, 12.9% were uninsured, according to the Census.

Health worries in Florida’s prominent community types: Florida has 67 counties, including 27 in Graying America. African American South is the next highest at 14.

In Florida, Graying America’s average uninsured rate is 17%. The community type’s access to primary care physicians is lower than the national average; injury deaths are particularly high in Graying America.

Meanwhile, the African American South counties in Florida have an average uninsured rate of 16% and struggle with access to care. The African American South has the second-highest premature death rate among all types (more than 10,000 years lost per 100,000 population). Obesity, insufficient sleep, physical inactivity, and smoking rates are high here as well.

Other notable community types: Urban Suburbs and Hispanic Centers

How issues stack up: When Florida voters were asked about the national issues currently most important to them, “healthcare was the most frequently selected response, chosen by 17% of respondents,” according to the WCTV-TV poll of 800 likely voters conducted Sept. 17-30.

Horse race: Sen. Bill Nelson (D) is drawing 45%, while Gov. Rick Scott (R) is getting 44%.

Florida’s 2016 presidential vote: President Trump won Florida in a squeaker, 48.6% to Hillary Clinton’s 47.4%.

Missouri

The Show Me State’s uninsured rate: In 2017, 9.1% were uninsured, according to the Census.

Health worries in Missouri’s prominent community types: Missouri contains 114 counties. Working Class Country comprises 33 counties and Evangelical Hubs contain 24 counties.

Missouri’s Evangelical Hubs post an average uninsured rate of 14%. Hubs struggle with healthcare access, having fewer primary care physicians and mental health providers. Also, teen pregnancy is high in these counties.

At the same time, the average uninsured rate for Working Class Country in Missouri is 15%. Access to primary physicians and mental health providers is difficult.

Another notable community type: Rural Middle America

How the issues stack up: In a CNN poll of 1,003 voters who are registered or plan to register by Election Day that was conducted Sept. 25-29, voters were asked to identify the issues that will be most important to them when deciding how to vote for U.S. Senate. Healthcare was first with 31% of respondents, the economy was second with 21%, and immigration was third at 12%.

Horse race: Sen. Clare McCaskill (D) takes 47%; Josh Hawley (R) is at 44%.

Missouri’s 2016 presidential vote: President Trump won 56.4% of the vote; Hillary Clinton received 37.9%

Montana

The Treasure State’s uninsured rate: In 2017, 8.5% were uninsured, according to the Census.

Health worries in Montana’s prominent community types: Montana is made up of 56 counties, 16 of which are classified as Graying America, 15 as Aging Farmlands.

In Montana, Graying America’s average uninsured rate stands at 16%. Graying America’s access to primary care physicians is lower than the national average; the community type’s injury deaths are particularly high.

In the state’s Aging Farmlands, an average of 17% of the population is uninsured. Aging Farmlands counties also struggle with poor access to primary care physicians and drunk driving deaths.

Other notable community types:  Native American Lands and Rural Middle America

Montana voters’ healthcare views: In a CBS News/YouGov poll of 543 registered voters conducted September 10-14, voters shared their perspectives on four facets of the healthcare issue:

  • 84% said they have “a lot” of concern about keeping costs down, 14% cited “some” concern, and 2% said “not much.”
  • 72% said they have “a lot” of concern about making sure pre-existing conditions are covered, 19% said “some” concern, and 9% reported “not much” concern.
  • 71% expressed “a lot” of concern with improving healthcare quality, 23% said “some” concern, and 6% said “not much.”
  • 50% reported “a lot” of concern about making sure everyone is covered, 29% expressed “some” concern, and 21% reported “not much” concern.

Healthcare and the horse race: Of registered voters, 41% say Sen. Jon Tester (D) is better on healthcare, 35% say Matthew Rosendale (R) is better, and 17% are not sure yet. In the race, Tester stands at 47%; Rosendale is at 45%.

Montana’s 2016 presidential vote: President Trump clinched Montana with 55.6% of the vote. Hillary Clinton took 35.4%.

Nevada

The Silver State’s uninsured rate: In 2017, the uninsured rate was 11.2%, according to the Census.

Health worries in Nevada’s prominent community type: Nevada is composed of 16 counties, including Clark County, home of Las Vegas. Classified as a Big City county, Clark has an uninsured rate of 15%, according to the County Health Rankings. Access to primary care physicians is another challenge.

Other notable community types: Graying America and Exurbs

How issues stack up: 26% of Nevada’s likely voters said the top issue that might factor into their voting decision is economy and jobs; 25% said healthcare; 18% said immigration; and 9% said taxes and spending, according to an NBC/Marist Poll of 574 likely voters conducted from Sept. 30 to Oct. 3.

Horse race: Sen. Dean Heller (R) is at 46%; Jacky Rosen (D) stands at 44%.

Nevada’s 2016 presidential vote: Hillary Clinton captured Nevada with 47.9% of the vote to President Trump’s 45.5%.

Tennessee

The Volunteer State’s uninsured rate: In 2017, 9.5% of people did not have health insurance, according to the Census.

Health worries in Tennessee’s prominent community types: Tennessee is composed of 95 counties. Evangelical Hubs counties number 43 while 27 counties are classified as Working Class Country.

In Tennessee, Working Class Country’s average uninsured rate is 13%; Evangelical Hubs show a rate of 12%. Both community types struggle with access to primary care physicians.

Another notable community type: Exurbs

Tennessee voters’ healthcare views: In a CBS News/YouGov poll of 1,002 registered voters conducted Oct. 2-5, voters were asked about their views on healthcare:

  • 79% reported “a lot” of concern about keeping costs down, 18% cited “some” concern, and 3% reported “not much.”
  • 75% were concerned “a lot” with access to treatments and medications, 21% expressed “some” concern, and 4% said they had “not much” concern.
  • 56% expressed “a lot” of concern about making sure everyone is covered, 30% reported “some” concern, and 14% revealed “not much” concern.

How issues stack up: Healthcare is a big issue in Tennessee voters’ decision-making. 81% said candidates must agree with them on healthcare to get their vote. In comparison, 72% said candidates must share their views on immigration, and 71% said they have to agree with them on taxes.

Horse race: Rep. Marsha Blackburn (R) stands at 50%, and Gov. Phil Bredesen (D) is at 42%.

Tennessee’s 2016 presidential vote: President Trump won 60.7% of the statewide vote; Hillary Clinton took 34.7%.

Texas

The Lone Star State’s uninsured rate: In 2017, 17.3% of people did not have health insurance, according to the Census.

Health worries in Texas’ prominent community type: Texas is made up of 254 counties, 78 of which are categorized as Hispanic Centers. In these Texas counties, the average uninsured rate is 24%. Documentation troubles may be a reason for this high rate. Access to primary care physicians is also poor here.

Other dominant community types: Big Cities, Evangelical Hubs, Graying America, and Exurbs.

Texas voters’ healthcare views: In a CBS News/YouGov poll of 1,031 registered voters conducted Oct. 2-5, voters’ shared their opinions about healthcare:

  • 52% said making sure everyone is covered concerns them “a lot,” 29% said “some,” 19% reported “not much.”
  • 78% said keeping costs down concerns them “a lot,” 19% said “some,” 3% said “not much.”
  • 69% said access to treatments and medications concerns them “a lot,” 23% said “some,” and 8% said “not much.”

How issues stack up: Healthcare is a crucial issue in Texan voters’ decision-making. 76% said candidates must agree on healthcare to get their vote. In comparison, 77% said the same about immigration, and 71% said candidates need to share their views on taxes to get their vote.

Horse race: Sen. Ted Cruz (R) is at 50%, while Beto O’Rourke (D) receives 44%.

Texas’ 2016 presidential vote: President Trump carried Texas with 52.2% of the vote. Hillary Clinton received 43.2%.

Methodology

To calculate the dominant community type averages, the American Communities Project looked at the insurance rates by county broken up into the ACP’s 15 community types by the County Health Rankings team. After adding all the state’s counties and uninsured percentages in each type, we divided the community type’s total uninsured rate by the number of counties in that type.

Vol. 1 October 2018

Health and Place in America

The American Communities Project releases its first report supported by the Robert Wood Johnson Foundation.

Learn More