Deep dive: The issues that drove the 2020 vote

The 2020 election provided much-needed clarity on the issues that matter most to Americans. Here are three key takeaways

Tom Wilbur
Tom WilburNovember 13, 2020
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Deep dive: The issues that drove the 2020 vote.

The 2020 election provided much-needed clarity on the issues that matter most to Americans. Here are three key takeaways:

  1. After months of tracking the issues one thing is now clear: Americans went to the ballot box (or their mailbox) to send a message about leadership on COVID-19 and the economy. In our election night survey conducted with Public Opinion Strategies, 43% selected the economy and 33% selected coronavirus as one of the top two issues affecting their vote. Other public election polls identified these as the top two issues as well. Partisan differences on the top voting issue were stark. Biden voters were much more likely to select coronavirus as a key issue compared to Trump voters (57% to 8%), whereas roughly three-quarters (74%) of Trump voters selected the economy compared to just 14% of Democrats. Race relations was the #2 issue for Democrats at 37% compared to just 4% of Republicans who selected this item.


  1. Health care (outside of COVID-19) was not a key driver of the vote this year, but it was important to many voters. Three issues stood out:

    • Protecting pre-existing conditions: A bipartisan consensus emerged this year that pre-existing conditions should be protected and not overturned. Support on this issue increased across the board this year, to 79%, and Republican support jumping 19 points to 67%, according to Kaiser Family Foundation’s October tracking. Our own election night polling found the issue leading the way among health care issues at 26%, followed by coverage-related health care costs.


    • Rising out-of-pocket costs and declining health coverage: These related issues were at the top of most polls this year, including on election night. Our election night poll found the cost of coverage in a top tier with pre-existing conditions, including the cost of premiums (18%) and out-of-pocket costs not covered by health insurance such as as co-pays and deductibles (15%). Anxieties over affordability are rooted in consumers bearing more of their health care costs. More than four in ten (41%) Americans in our Morning Consult tracking poll from November said they pay more for their health care now than they did four years ago. This plays out in voters’ biggest concerns around affordability. The Morning Consult poll further showed voters are most worried about not being able to afford out-of-pocket costs to pay for hospital bills (61%), not having the coverage they need to afford major medical expenses (60%) and going into debt because of medical expenses (58%).
    • Prescription drug affordability was a narrower electoral issue this year, and it sits within the larger insurance coverage conversation: Because Americans with insurance coverage pay significantly more out-of-pocket for prescription medicines than for other health services. And for some, it is a key voting issue. Eight percent of voters in our election night poll said that “the cost of prescription medicines” was the most important issue in health care and only 2% said it was the top issue affecting their vote.


  1. Looking to the next Congress, what is clear is that voters want policymakers to address COVID-19 and their existing concerns around pre-existing conditions and out-of-pocket costs. Among the top four issues most important for policymakers to address are stopping the spread of COVID-19 (among 30% of voters’ top two issues), as well as developing and distributing a COVID-19 vaccine (20%), making health insurance more affordable (26%) and protecting patients with pre-existing conditions (17%), according to our November Morning Consult issue tracking.

The biopharmaceutical industry continues to play a critical role in these areas, leading efforts to address COVID-19 and working to ensure that Americans can access and afford the care and treatment they need. And PhRMA remains committed to advocating for effective policies that advance solutions to these clear needs.

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