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Illustration: Sarah Grillo/Axios

There's a big disconnect between the health care debates that dominate Washington, the campaigns and the politically active — where all of the talk is about sweeping changes like "Medicare for All" or health care block grants — and what the voters are actually thinking about.

The big picture: In our focus groups with independent, Republican and Democratic voters in several swing states and districts, the voters were only dimly aware of candidates’ and elected officials’ health proposals. They did not see them as relevant to their own struggles paying their medical bills or navigating the health system.

Details: We conducted six focus groups in three states (Texas, Florida and Pennsylvania), facilitated by Liz Hamel, the Kaiser Family Foundation’s director of Polling and Survey Research. Each one had 8–10 people who vote regularly and said health care will be important in their presidential vote in 2020.

The highlights:

  • These voters are not tuned into the details — or even the broad outlines — of the health policy debates going on in Washington and the campaign, even though they say health care will be at least somewhat important to their vote.
  • Many had never heard the term “Medicare for All,” and very few had heard about Medicare or Medicaid buy-in proposals, or Medicaid and Affordable Care Act state block grant plans like the one included in President Trump’s proposed budget.
  • When asked what they knew about Medicare for All, few offered any description beyond “everyone gets Medicare,” and almost no one associated the term with a single-payer system or national health plan.
  • When asked about ACA repeal, participants almost universally felt that Republicans did not have a plan to replace the law.
  • When voters in the groups were read even basic descriptions of some proposals to expand government coverage, many thought they sounded complicated and like a lot of red tape.
  • They also worried about how such plans might strain the current system and threaten their own ability to keep seeing providers they like and trust.

Between the lines: Most voters in these groups don’t seem to see the current health reform proposals on either side of the aisle as solutions to their top problems: paying for care or navigating the health insurance system and red tape.

  • That, combined with a general distrust of politicians, can make these voters wary of any plan that sounds just a little too good to be true to them.

The bottom line: For most voters, the debate will be more meaningful when they see stark differences on health between the Democratic nominee and President Trump in the general election. Then they may be able to focus more on what the differences on health reform mean for the country and their daily lives.

Go deeper

Updated 1 hour ago - World

German election: Social Democrats narrowly beat Angela Merkel's bloc

SPD leader Olaf Scholz. Photo: Alex Kraus/Bloomberg via Getty Images

BERLIN — The center-left Social Democratic Party (SDP) clinched a narrow victory in Germany's historic federal elections on Sunday, just four years after suffering its worst loss since World War II.

Why it matters: It's a stunning political comeback for the SPD, paving the way for its chancellor candidate Olaf Scholz to form a new governing coalition and lead Europe's largest economy into the post-Merkel era.

Updated 3 hours ago - Politics & Policy

Liz Cheney: Americans deserve better than choice of Biden or Trump

Rep. Liz Cheney talks with Lesley Stahl on CBS' "60 Minutes." Photo: CBS News

Rep. Liz Cheney (R-Wyo.) told CBS' "60 Minutes" in an interview broadcast Sunday that Americans "deserve better than having to choose between" President Biden's "disastrous" policies and former President Trump, "who violated his oath of office."

Why it matters: Cheney made the remarks after CBS' Lesley Stahl put it to her in the interview that Republicans feel that her joining the House select committee in charge of investigating the Jan. 6 U.S. Capitol riot helps "keep the focus on Trump instead of on the shortcomings of the Biden administration."

8 hours ago - Politics & Policy

First look: The LCV's $4M ad buy

A screenshot from a new League of Conservation Voters ad supporting Rep. Stephanie Murphy.

The League of Conservation Voters and Climate Power are aiming another $4 million worth of ads at centrist House Democrats, urging them to support the climate provisions in President Biden’s $3.5 trillion budget reconciliation package, Axios has learned.

Why it matters: Progressive groups are trying to counter the onslaught of conservative money pouring into swing districts. Both sides are trying to define Biden’s Build Back Better Agenda and pressure lawmakers to support — or oppose — the legislation scheduled for a vote in the House this week.