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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

America rebalances its post-Trump news diet

Illustration: Annelise Capossela/Axios

Nearly halfway through President Biden's first 100 days, data shows that Americans are learning to wean themselves off of news — and especially politics.

Why it matters: The departure of former President Trump's once-ubiquitous presence in the news cycle has reoriented the country's attention.

Why migrants are fleeing their homes for the U.S.

Illustration: Eniola Odetunde/Axios Photo: Herika Martinez /Getty Images 

Natural disasters in Central America, economic devastation, gang wars, political oppression, and a new administration are all driving the sharp rise in U.S.-Mexico border crossings — a budding crisis for President Biden.

Why it matters: Migration flows are complex and quickly politicized. Biden's policies are likely sending signals that are encouraging the surge — but that's only a small reason it's happening.

Cities' pandemic struggle to balance homelessness and public safety

Illustration: Sarah Grillo/Axios

Addressing homelessness has taken on new urgency in cities across the country over the past year, as officials grapple with a growing unhoused population and the need to preserve public safety during the coronavirus pandemic.

Why it matters: It’s led to tension when cities move in to clear encampments — often for health and safety reasons — causing some to rethink the role of law enforcement when interacting with people experiencing homelessness.