KFF Health Tracking Poll May 2023: Health Care in the 2024 Election and in the Courts

Key Findings

• While the first 2024 presidential primary is nine months away, several Republican hopefuls and President Biden have begun their messaging to voters, including staking out positions on controversial health issues like abortion. Looking ahead to 2024, three in ten voters say they will only vote for a candidate who shares their views on abortion. This includes nearly half of Democratic voters (46%) and more than one-third of women voters (35%). Another half of voters (53%) say abortion is just one of many important factors they will be weighing in their decisions during the 2024 election and 16% say abortion is not an important factor in their vote.
• Six months after abortion access was one of the major issues in the 2022 midterm elections, Democrats have a strong edge over Republicans on which political party the public believes best represents their views on abortion, with four in ten (42%) saying the Democratic Party best represents their own views on abortion, compared to about one fourth (26%) who say the Republican Party best represents their own views on abortion. The Democratic Party also has the advantage among women ages 18 to 49. About half (45%) of women ages 18 to 49 say their views on abortion are best represented by the Democratic Party, nearly twice the share (24%) who say their views align most with the Republican Party. A substantial share (32%) of the public says “neither party” represents their views on abortion, including three in ten women ages 18 to 49.
• It’s been nearly a year since the Supreme Court issued a decision in Dobbs v. Jackson Women’s Health Organization and with many states passing laws either restricting or protecting abortion access, the KFF Health Tracking Poll finds large majorities of the public are now aware that Roe v. Wade has been overturned, though many Hispanic and Black women under age 50 remain unsure of the status of Roe (43% and 32%, respectively).
• Awareness of mifepristone, the abortion pill that has been the focus of several ongoing lawsuits, has doubled since January 2023, with about two-thirds of adults now saying they have heard of the drug compared to about three in ten in January. The share of women ages 18 to 49 who have heard of mifepristone has increased 15 percentage points to 61%, up from 46% in January.
• As the legal landscape surrounding abortion and mifepristone continues to change, there is widespread confusion about whether the use of mifepristone for abortion is legal. About half (45%) of the public say they are “unsure” whether medication abortion is available in their state, and more than half of women ages 18 to 49 living in states with a full abortion ban either incorrectly believe they can access medication abortion (15%) or say they are unsure (46%).
• Most adults in the U.S. are aware medication abortion pills are safe but views towards the medication are largely partisan, and some confusion remains. Nearly three-fourths of Democrats say medication abortion is safe (72%), as do six in ten (58%) of independents. Less than half of Republicans agree (40%). Republicans are also twice as likely as Democrats to say they are “not sure” about the safety of mifepristone (22% v. 45%). When it comes to abortion procedures, majorities across partisans are aware they are safe, and fewer are unsure about their safety.
• With the recent court case challenging the U.S. Food and Drug Administration’s approval of mifepristone, the latest KFF Health Tracking Poll finds confidence is relatively high for the government agency, with around two-thirds of adults expressing “a lot” or “some” confidence in the FDA to ensure that medications sold in the U.S. are safe and effective (65%). The public doesn’t have as much confidence in the U.S. Supreme Court, especially when it comes to making the right decisions on cases regarding reproductive and sexual health. A majority of the public, including about seven in ten women (69%) say they trust the Court either “not too much” or “not at all” to make the right decision on this issue. This includes majorities of women across age groups and race and ethnicity, as well as majorities of Democrats and independents. Nearly six in ten (56%) Republicans, on the other hand, say they trust the Court to make decisions about reproductive and sexual health.

The Role Abortion May Play In The 2024 Election

With abortion playing an important role in voters’ decisions to turn out and who to vote for during the 2022 election, the KFF Health Tracking Poll examines how abortion may motivate voters in the upcoming 2024 election, the first presidential election since the overturning of Roe v. Wade. Three in ten voters say they will only vote for a candidate who shares their view on abortion and about half (53%) of voters saying a candidate’s stance on abortion will be just one of many factors they will be weighing. A smaller share (16%) say abortion will not be an important factor in their voting decision.

Similar to the 2022 midterms, the issue of abortion access is most salient for women voters and Democratic voters. About one-third (35%) of women and nearly half of Democratic voters (46%) say they will only vote for a candidate that shares their view on abortion, more than twice the share of Republican voters (20%) who say the same.

More than a third of women voters 18 to 49 (36%), say they will only vote for a candidate who shares their views on abortion. Partisan voters within this age group are similar to partisan voters overall, with half (48%) of Democratic women voters ages 18 to 49 saying they would only vote for a candidate who shares their views on abortion, compared to three in ten independent women and about one-fourth (23%) of Republican women voters in this age group. However, few women voters in this age group across party say it is abortion is not an important issue to their vote (8% of Democrats,13% of independents, 13% of Republicans).

Voters living in states where abortion is fully banned (29%) or legal, but with gestational limits (28%) are no more likely to say they will only vote for a candidate who shares their opinion than voters in states where abortion is legal (32%). Similar shares of voters who say abortion should be legal in all or most cases (31%) and those who say it should be illegal in all or most cases (28%) will only vote for a candidate that shares their views.

For the public overall, the Democratic Party holds a strong edge over the Republican Party on the issue of abortion. About four in ten (42%) say the Democratic Party best represents their own views on abortion, compared to about one fourth (26%) who say the Republican Party best represents their own views on abortion. A substantial share (32%) of the public says “neither party” represents their views on abortion.

While most partisans select their own party as the one that best represents their views on abortion, about one in five Republicans say “neither party” best represents their views (21%), and an additional 6% say the Democratic Party best represents their views on abortion. Half of independents say neither party represents their views on abortion, while four in ten (36%) say they are best represented by the Democratic Party, and 13% say their views on abortion best align with the Republican Party. Nine in ten Democrats say their views on abortion are best represented by the Democratic Party.

Women ages 18 to 49, the group most directly impacted by the Supreme Court decision in Dobbs v. Jackson Women’s Health Organization, are nearly twice as likely to say their views on abortion are best represented by the Democratic Party compared to the Republican Party. About half (45%) of women ages 18 to 49 say they are best represented by the Democratic Party, while one-fourth (24%) say they feel their views align most with the Republican Party. About three in ten (31%) say “neither party” best represents their views. The Democratic Party also holds an advantage on abortion among Black, Hispanic, and White women ages 18 to 49. The Democratic Party also holds a similar advantage among women ages 18 to 49 in states where abortion is currently banned and in states where it is legal. Partisan women in this age group look similar to partisans overall, as about three-fourths of Republican women ages 18 to 49 say their views best align with the Republican party, 17% say neither party represents their views, and few (6%) say the Democratic Party represents them.

One Year Since The Dobbs Decision

Nearly one year after the U.S. Supreme Court overturned Roe, about seven in ten (71%) U.S. adults are aware of the decision and only a small share (5%) incorrectly say Roe is still the law of the land. Still, about one in four (24%) U.S. adults say they are “not sure” whether the 1973 ruling that established a woman’s constitutional right to an abortion is still the law of the land, including a substantial share of women ages 18-49, the group most directly affected by the ruling.

Nearly seven in ten women ages 18 to 49 (68%) are aware Roe has been overturned, while one-fourth say they are not sure, and 7% incorrectly say Roe is still in effect, relatively unchanged from June 2022. Within this group, Black and Hispanic women are less likely to be aware that Roe has been overturned than White women. Four in ten (43%) Hispanic women, ages 18 to 49, and about one-third (32%) of Black women, ages 18-49, say they are “not sure” about the status of Roe, compared to about one in seven (16%) White women. About a third of women ages 18 to 49 without a college degree are also unsure of the status of Roe in the U.S.

The survey findings indicate some women ages 18 to 49 are changing their approach to contraception and reproductive health following the Dobbs decision. More than half (55%) of women ages 18 to 49 say they or someone they know has taken at least one of several steps aimed at reducing the likelihood of getting pregnant due to concerns about not being able to access an abortion. This includes roughly three in ten women in this age group who say they or someone they know has started using long-acting birth control such as an IUD or implant (32%), gotten a new prescription for an oral contraceptive (28%), or bought Plan B or emergency contraception in case it was needed in the future (28%).

State Abortion Laws

Over the past year, the U.S. has seen various state-level actions on abortion access with many states making abortion illegal, some states solidifying access to abortions, and in some states legal challenges to abortion bans are still being considered in in the state courts. Three in four U.S. adults say they understand the abortion laws in their own state either “very well” (30%) or “somewhat well” (45%), while one in four feel they understand them “not too well” (20%) or “not at all well” (5%).

With many states passing bans on abortion, nearly three-fourths (73%) of adults say these bans make it more difficult for doctors to safely take care of pregnant people who experience major complications. In addition, two-thirds of the public are either “very concerned” (42%) or “somewhat concerned” (23%) that bans on abortion may lead to unnecessary health problems. This includes eight in ten (82%) Democrats and seven in ten independents and about half (47%) of Republicans who are concerned these bans could lead to unnecessary health problems. Four in ten Republicans say bans on abortion do not make it more difficult for doctors to treat pregnant patients.

Medication Abortion In The Courts

The availability of mifepristone, used for medication abortion, has been the subject of several court cases following the Supreme Court’s Dobbs ruling which overturned Roe v. Wade and eliminated the federal standard regarding abortion access. On April 21st, the US Supreme Court blocked a lower court order that would have stopped the distribution and availability of the medication abortion drug, mifepristone, across the country. The high court’s ruling allows the current FDA rules to remain in effect, keeping mifepristone available for medication abortion where and when abortion is legal as the case proceeds through the courts.

Awareness Of Medication Abortion On The Rise, But Some View It As Unsafe

Awareness of the abortion pill has doubled since January 2023, with about two-thirds (64%) of adults now saying they have heard of the drug compared to about three in ten (31%) in January. The share of women ages 18 to 49 who have heard of mifepristone has increased 15 percentage points to 61%, up from 46% in January.

Public confused aBOUT legality AND SAFETY Of medication abortion

There continues to be widespread confusion on whether medication abortion is legal in certain states with about half (45%) of all adults say they are “unsure” whether medication abortion is available in their state.

Those who live in states where abortion is legal and available are much more likely to be aware of the legality of medication abortion in their state, while a larger share of those in states where abortion is limited or banned say they are “unsure.”

In the 25 states and D.C. where abortion is legal beyond 22 weeks gestation six in ten correctly say medication abortion is legal in their state, while four in ten either incorrectly say medication abortion is illegal (6%) or say they are “not sure” (34%). In the 14 states where all abortion methods, including medication abortion is banned, one-third are aware of this while 13% incorrectly believe the medication is legal, and more than half (54%) say they are unsure. In states where abortion is banned beyond a certain number of weeks of gestation, medication abortion is a legal option for early intervention. Six in ten of adults living in these states are “not sure” about the status of medication abortion, 15% incorrectly say it is illegal, and one-fourth are aware it is legal in their state.

Similarly, there is confusion among women of reproductive age over what is available to them. Nearly half (46%) of women ages 18 to 49 living in states where abortion is banned are unsure about whether medication abortion is legal, and 15% incorrectly say it is legal. In states where abortion is legal up to a certain point, more than half (53%) of women ages 18 to 49 are unsure about the status of medication abortion, and an additional one-fifth (18%) incorrectly say it is illegal. Women in states where abortion is legal and available are more aware, with six in ten correctly saying medication abortion is legal in their state.

Most U.S. adults (55%) say medication abortion pills are “very safe” (30%) or “somewhat safe” (25%) for the person taking them when taken as directed by a doctor, but a substantial share (35%) say they are “not sure” about the pills’ safety. Few adults believe the pills to be either “very unsafe” (3%) or “somewhat unsafe” (6%).

Similar to most questions about abortion, perceptions of safety divide by partisanship. Nearly three-fourths of Democrats say medication abortion pills are safe (72%), as do six in ten (58%) independents. Less than half of Republicans agree (40%). Republicans are also twice as likely as Democrats to say they are “not sure” about the safety of mifepristone (22% v. 45%). Views on the safety of medication abortion also slightly differ by gender with larger shares of women than men saying medication abortion is safe, but at least three in ten men and women are unsure about the safety of the medication.

In addition, very few U.S. adults are correctly aware that mifepristone is safer, when taken as directed, than Viagra (16%), Penicillin (8%) and Tylenol (7%). About four in ten say they are not sure about how the safety of these medications compare to mifepristone (Viagra: 44%, Penicillin: 41%, Tylenol: 40%).

While many are uncertain about the safety of medication abortion, larger majorities (74%) are aware abortion procedures are “very” (44%) or “somewhat safe” (30%), with few saying they are “somewhat” (8%) or “very unsafe” (4%). An additional 14% say they are unsure about the safety of abortion procedures. Majorities across partisans and gender say that abortion procedures are at least somewhat safe, though women and Democrats are more likely to say this compared to men and Republicans.

Mifepristone For Miscarriage Treatment

Besides the use for medication abortions, mifepristone as well as misoprostol (the other drug used for medication abortion) can also be used to treat miscarriages and to induce labor. While abortion bans do not explicitly ban the use of mifepristone or misoprostol for miscarriage management, the exceptions to abortion bans are limited and vague. In states with abortion bans or restrictions, many clinicians have delayed providing miscarriage management until the pregnant person’s health worsens. A large majority of adults are not aware that mifepristone can be used to treat a miscarriage, though women (22%) and Democrats (27%) are most likely to be aware that it can be used for this purpose.

Views Of The Supreme Court And The FDA

On the heels of these key legal battles, the latest KFF Health Tracking Poll finds most U.S. adults disapprove of the Supreme Court of the United States (SCOTUS) and a strong majority say they don’t trust the Court to make decisions about reproductive and sexual health.

Six in ten adults (58%) say they disapprove of the way SCOTUS is handling its job including majorities of adults across age groups, race and ethnic groups, and gender. Views of the Court are largely partisan with three in four Democrats (78%) and six in ten independents (61%) disapproving of the way the Court is handling its job, while two in three Republicans (66%) approve. One year after the Dobbs decision, two-thirds of women ages 18 to 49 (65%) say they disapprove of the way the Supreme Court is handling its job.

About half of the public say they trust the Supreme Court to make the right decision about cases related to science and technology (55%), cases related to the role of the federal government (53%), and cases related to the future of the Affordable Care Act (ACA) (49%). Yet less than four in ten (37%) say they trust the Court to make the right decisions about cases related to reproductive and sexual health including about three in ten (28%) women ages 18 to 49.

Large majorities of Republicans say they trust SCOTUS “a lot” or “somewhat” to make the right decisions about cases related to each of the issues asked about while fewer than half of Democrats agree. At least six in ten Republicans say they trust the Court on issues related to science and technology (74%), the role of the federal government (66%), and the future of the ACA (65%). More than half of Republicans (56%) say they trust the Court to make decisions about reproductive and sexual health. Among Democrats, about four in ten say they trust SCOTUS at least somewhat on the role of the federal government (45%), science and technology (44%), and the future of the ACA (37%). A large majority of Democrats (79%) say they do not trust the Court to make the right decisions on cases related to reproductive and sexual health. Independents’ trust of the Supreme Court varies with about half of them saying they trust the Court at least “somewhat” on issues related to science and technology (50%), role of federal government (51%), and the future of the ACA (48%), but fewer (34%) say they trust the Court to make the right decision when it comes to reproductive and sexual health.

Nearly one year since the Dobbs decision, most women say they don’t trust the Supreme Court to make the right decision when it comes to cases related to reproductive and sexual health. About seven in ten women (69%) say they trust the Court either “not too much” or “not at all” to make the right decision on this issue, while three in ten say they trust the Court either “somewhat” or “a lot.” This includes at least half of Hispanic women (55%), and two-thirds of Black (64%) and White (64%) women  who say they do not trust the Court on these issues.

Nearly three-fourths (72%) of women ages 18-49, the group most directly impacted by the Dobbs decision, say they do not trust the Court to make the right decision on cases related to reproductive and sexual health. This includes a majority of women in this age group (ages 18 to 49) across party lines, including 56% of Republican women ages 18 to 49, and at least three-fourths of independent (75%) and Democratic (81%) women of reproductive age.

The U.S. Food And Drug Administration

In light of the legal debate around the U.S. Food and Drug Administration’s (FDA) approval of mifepristone, the latest KFF Health Tracking Poll finds six in ten adults say it is “inappropriate” for a court to overturn the FDA’s approval of a medication, while four in ten (39%) say they think it is “appropriate.” Three-fourths of Democrats (73%) say they think the court overturning the FDA’s approval of a medication is “inappropriate,” as do nearly six in ten (57%) independents. Republicans are divided with similar shares saying the court overturning the FDA’s approval of a medication is “appropriate” (50%) and “inappropriate” (49%).

Overall confidence in the FDA is relatively high, with around two-thirds of adults having “a lot” or “some” confidence in the FDA to ensure that medications sold in the U.S. are safe and effective (65%), including a quarter (23%) who say they have “a lot” of confidence. About one-third (35%) of adults say they either have “a little confidence” (21%) or “no confidence at all” (14%) in the FDA to ensure medications sold in the U.S. are safe and effective.

Majorities across demographic groups, including partisanship and age, report having confidence in the FDA to ensure the safety of medications. However, larger shares of adults 65 and older (31%) and Democrats (34%) report having “a lot of confidence” in the FDA’s certification of medications, with fewer of those ages 18 to 29 (15%) and Republicans (15%) who say the same.