I have no idea what the outcome of this very close election will be. I do, however, have a fix on several of the ways health care played a role in the election and in campaign strategy. It won’t change much by election day.

With no big health reform debate to command the attention of the nation and no big health proposal from either candidate, this is not a “health care election,” except, of course, for the impact abortion will have on voting and turnout, whatever the outcome on November 5.

But health care has played a role in the campaign and the election in the following significant ways.

First and foremost, voter concerns about their medical bills are an integral part of their worries about the economy and their costs, mixed in with general inflation and other pocketbook issues such as food, gas prices, and the rent or the mortgage. Most national polls continue to miss this, treating health care as a separate issue. When you treat health care as a stand-alone issue, it ranks as a fairly low priority. However, out-of-pocket health care costs and worries about unexpected medical bills are a big part of the public’s economic worries. Exit polls have made the same mistake. Determining the role health plays on voters’ decisions requires an extra question, which takes time that short polls often do not have. The question that needs to be asked is a variation on this follow-up: “You said the economy was your number one concern. What about the economy most worries you?” The question can be open ended, or respondents can be given a list to choose from. There are arguments for either approach.

The advantage Vice President Harris and the Democrats have on health has also had an impact on former President Trump and his campaign strategy. He has generally backed off plans to repeal the Affordable Care Act (ACA), saying various things, including recently that he has “concepts of a plan,” but mostly protesting that he now wants to “make the ACA better” with no specifics. He’s also pledged that he will not cut Medicare (no such pledge on Medicaid). And he backtracked on his earlier, more bullish positions on drug costs, going silent on his plan to tie drug costs in the U.S. to what other countries pay, apparently wanting to stay away from even popular health proposals. Overall, he has ceded health care to Harris, likely wary that she will get traction with criticisms that he would take health coverage away from millions and weaken protections for pre-existing conditions.

Harris has taken the opposite approach on the issue that Trump has about an equivalent advantage on—immigration—by taking the offensive to try to close the gap. And she has tried to do the same on the economy with some success, according to several recent polls. (Of course, positions taken in campaigns do not necessarily presage positions a candidate will take if elected.)

The sweeping proposals made by several conservative think tanks to fundamentally change Medicare, Medicaid, and the ACA have been swept under the rug by the Trump campaign, even as Democrats have had some success making Project 2025 a symbol of right-wing extremism. That doesn’t mean the candidate and his administration will not embrace some elements of these plans if elected or appoint some of their architects to high positions. It is, however, a notable element of the campaign, and an acknowledgment that these ideas are a target for Democrats and that Trump and his campaign know that many of them would be controversial and unpopular.

Senator JD Vance’s brief and somewhat vague foray into segmenting healthy and sick people into separate risk pools as an alternative to ACA protections for people with pre-existing conditions was treated by Trump almost the same way he treated the think tank plans: he ignored it. It was as if health had become radioactive for Trump, who campaigned on other issues, including immigration, which he saw as more favorable to him.

Health might have been more of an important issue in the campaign if differences between the candidates and the parties on converting Medicare to a voucher-like, premium support plan, or Medicaid to a block grant to the states, were clarified for voters by the candidates themselves, the debate moderators, or the media generally. Debate moderators focused more on the ACA, likely because of the drama associated with Trump’s earlier attempts to repeal it. Had Trump been forced to choose between embracing or rejecting either of these big and controversial policy proposals, it would have elevated health in the campaign and might have been a flashpoint.

The Democratic left’s concern that Trump might be elected has led them to hold fire on pushing for the more expansive health reform proposals they favor, instead supporting President Biden’s more moderate, incremental policies, and subsequently, the proposals made by Vice President Harris. Should Harris prevail, expect the left to feel less constrained and to hear again about Medicare for All, the public option, Medicare Buy-In, and other policies favored by the left. Passage of legislation on these ideas, or others, is an entirely different matter, especially if Congress is divided.

Harris’s new proposal to add a home care benefit to Medicare may find favor with some elderly and near elderly voters, especially senior women or their family members. That’s one thing to watch as the voters go to the polls. The idea should be popular unless voters come to doubt that Harris can deliver. So far Harris has proposed popular benefits such as extending the $2,000 cap on out-of-pocket drug costs and the $35 monthly cap on Insulin to the private sector, and she has endorsed continuing the enhanced ACA subsidies. She has avoided proposals that would inflame the powerful health care industry, such as extending drug price negotiation to employer coverage.

These are some of the ways in which health care and health care costs have played a role in the presidential campaign. It’s certainly true that health care has not been decisive in this election, but it has played a role, and always will.

View all of Drew’s Beyond the Data Columns

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Usually I worry about amplifying misinformation by calling attention to it. But when it comes to misinformation about immigrants—and most recently Haitian immigrants in Springfield, Ohio—it can’t be elevated much more than it already has been by the Republican candidates for Vice President and President and subsequent media coverage of their remarks. As if acknowledging the role politicians can play magnifying misinformation, vice presidential candidate JD Vance told CNN: “I have to create stories so the media pays attention.” In this case, sharing a few facts won’t elevate the misinformation further and might help dispel myths.

Black immigrants make up only 8% of all adult immigrants. Nearly half (47%) of Black immigrants—or about 4% of immigrants overall—are from the Caribbean, while about four in 10 (43%) are from sub-Saharan Africa. Most Black immigrants are U.S. citizens (68%), while one in five (21%) has a valid visa or green card. Just about one in 10 (8%) are likely undocumented. There are about 700,000 Haitian immigrants in the U.S. and by the way, around 100,000 of them work in the health care sector.

Overwhelmingly, as with all waves of immigrants before them, Black immigrants come to the United States to improve their lives (87%) and their children’s life chances (80%). To accomplish that, most are working (76%). In the case of Haiti, of course, some are fleeing chaos and political instability and have been granted Temporary Protected Status.

They face all the challenges immigrants have always faced in the U.S. Half of Black immigrants (56%) say they face discrimination or unfair treatment at work, but Black immigrants can experience the double trouble of racism and anti-immigrant sentiment.

Politicians have long appealed to Americans who feel alienated or left behind and can be made to feel threatened by newcomers. In what social scientists call “limited empirical validation,” one anecdote or two can be used to validate a stereotype even if it is an outlier. We see that most sharply in the claim, based on a few incidents, that immigrants are widely committing murder.

As a KFF Health Misinformation Tracking Poll released today shows, the strategy is particularly effective with the Republican base. Republicans are much more likely than Democrats and substantially more likely than Independents to believe that immigrants are causing violent crime in the U.S. or that they are taking away jobs.

Most adults (80%) have heard the claim that immigrants cause violence. It’s the ultimate example of amplification of misinformation by political figures based on the intentional use of anecdotes. And it creates a dilemma for news coverage of this and similar examples of misinformation perpetrated by political figures: whether to cover it because it’s news and fact check it in the process, knowing that spreads it much further, including causing further rounds of social media attention; or ignore it knowing that then it will remain mostly in the echo chamber where it began.

There’s likely no choice when presidential candidates spread false information but to cover it and correct the lies in the process, but there are choices to be made about how it’s done. Giving free media to misinformation by broadcasting endless clips of candidates repeating falsehoods and misinformation may do more harm than good, even if they are followed by fact checking. Just ask the Haitians in Springfield, Ohio how they feel about it.

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Health misinformation is everywhere, now fueled by AI. But much of the public isn’t fully buying it. And like voting, there is a big group in the middle that is up for grabs.

Most Americans say they have heard various examples of health misinformation—about Covid vaccines, or reproductive health, or gun violence—but a much smaller share say they actually believe it.

Consider two examples:

• 65% of the public have heard false claims that Covid vaccines have caused thousands of deaths, but 10% believe this is definitely true.
• 49% have heard false claims that most gun homicides are gang related but just 9% say this is definitely true.

Most people are in a muddled middle, unsure whether these kinds of claims are true or not.
The believers tend to be less educated, rural, and Republican.

Misinformation is like American politics: There is a large group of “swing voters,” who at least in principle can be reached with reliable information. They say they trust doctors, local news and national news the most. They don’t trust social media much as a source of information but at the same time, many of them do say they regularly turn to social media for news.

Yes, but: Confusion can also lead to inaction. When people are unsure what is true, they may not take actions that health professionals would like them to take, such as getting the latest Covid booster. And misinformation is tricky terrain far more challenging than fact checking: One group’s outright falsehood can be another group’s strongly held belief even if they saw it on some fringe social media platform and it’s totally misguided. The misinformation case is always strongest when it’s built around claims that are clearly false.

At KFF, we’re looking at these issues and developing a new program area on Health Misinformation and Trust, which we’ll launch next year. It will be our fifth program area along with Policy Analysis, Polling and Survey Research, Social Impact Media, and KFF Health News, and the first program that we’ve added in over a decade. We plan to document what health misinformation is out there and where it is coming from in as close to real time as possible; publish regular updates to a new tracking poll to determine how misinformation is affecting the public, and especially vulnerable groups, in order to help those working to counter misinformation better target their efforts; and, investigate who is behind misinformation and why through a new investigative desk at our news service, among many other activities. We hope to work with partners.

One idea that jumps out to me from our pilot survey is pretty obvious: As is often the case, it’s one of those program ideas that is easier to conceptualize than execute. Our survey (and others) shows clearly that doctors and local TV news are among the most trusted sources of health information. So, it might make sense to mobilize local TV stations to feature their own local doctors trained in health misinformation to appear regularly, providing the facts on key health issues and countering mis and disinformation. We know that local audiences love health information almost as much as the weather. At scale, it would constitute a national network of locally based trusted messengers providing a counterweight to health misinformation.

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