Don’t read too much into health care’s high poll rankings

An AP/NORC poll published late in December found that health care ranked number one on the list of the public's priorities for government. It's a well done and well reported poll, and as the head of a health policy and journalism organization, I suppose I should be happy that health ranked number one.

Yes, but: Having conducted and watched health care polling for decades, I'd caution readers not to over-interpret health care's first place finish, which may not mean very much for upcoming elections. They are unlikely to be about health care and are much more likely to be about the candidates and President Trump.

Between the lines: For one thing, health care has been in the news and hotly debated. So when given a list of issues to choose from on a poll, or asked to name issues on their mind in an open ended question, the public is more likely to pick health care.

The economy is doing well, and health care's other major competitor on a polling list of issues, the tax legislation, has not grabbed the public yet and may not until people begin paying their taxes.

The catch: When a topic like health care ranks high on a list of issues, it doesn't mean voters will vote on that issue. In many races, they are more likely to vote on the basis of how they feel about the candidate overall than on issues. These upcoming elections are also likely to become a referendum on President Trump, as the race in Virginia largely was.

We also cannot assume that when the public picks "health" or "health care" on a poll they always mean the Affordable Care Act, whether that's repealing it for Republicans or protecting it for Democrats.

• People will give you a typically partisan view of the ACA if you ask for it. But most Americans are not covered by the ACA, and our own polling at the Kaiser Family Foundation shows that the public is mostly concerned their own health care costs.
• Other health concerns also creep into the mix on various polls, such as CHIP funding and opioids.

What to watch: In the AP/NORC poll, Republicans placed a lower priority on health than Democrats and Independents did; they were about equally likely to pick immigration and taxes as health care. But we know from other polling that Democratic intensity about the ACA has increased, while Republican intensity is flat.

For that reason, Democrats are likely to put forward a variety of health care plans in 2018 and 2020, which will keep health care on the agenda. Health care could be for Democrats what it has been for Republicans in recent elections — a jump starter for the base. This could be the main way in which it plays a role in the election.

The bottom line: It's always good to remember that the top issues in polls are not often the top factors in elections, especially in a year when, one way or another, Donald Trump will be on every ballot.