COVID-19 Just Latest Challenge for Health Care Polling

by Bradley Wascher April 27, 2020 · 11:45 AM EDT

We are in rarely charted territory, but not for the most obvious reason. With the COVID-19 pandemic having upended every facet of our society, regular public polling data is now being used as both a measure of public opinion and a lagging indicator of economic and epidemiological trends.

But amid the frenzied rush to make sense of the unknown, it’s important to remember that these are, after all, still polls. For this reason, it’s helpful to think of COVID-19 surveys as traditional health care surveys. They share two prominent similarities, together providing insight on November’s elections.

Mixed Messages
Initially, polls on health care and the pandemic both ask about a range of highly detailed policies, potentially muddying respondents’ intended answers.

In particular, the biggest hurdle for measuring opinions on health care is a classic conflict of values: people support expanding benefits, but oppose raising costs. Couple that with some answers dependent on question phrasing and inconsistent definitions of policy-dense terms (e.g. “Medicare for All”), and it’s a perfect storm for respondents to inadvertently contradict themselves on stated positions. High-quality polls exist, but this can be a tough issue to reliably track.

COVID-19 surveys likewise reveal the same catch-22; people are supportive of social distancing, but scared of the economic harms such measures may bring. Per an April 13 USA Today/Ipsos poll, although 69 percent favored a nationwide lockdown through the end of the month, 76 percent still believe the crisis poses a high threat to the global economy. Interestingly, the same survey found one percent who say the coronavirus is a “very low threat” to the United States (while there might be folks out there unfazed, the result could be chalked up to simple sampling error).

Other evidence displays similar dissonance. According to an April 15 Politico/Morning Consult survey, 81 percent supported social distancing lasting “as long as needed to curb the spread of coronavirus, even if it means continued damage to the economy.” Yet at the same time, governors in Georgia, Ohio, South Carolina, and Tennessee have already announced plans to soon begin re-opening non-essential businesses in their states. 

These conflicts aren’t the only pitfalls plaguing pandemic polls, unfortunately. In addition to having to process constantly evolving news, respondents are routinely asked their thoughts on unfamiliar policies and actors. Therefore, for reasons other than the vast uncertainty enveloping the entire world, public attitudes are changing very quickly on the pandemic itself, proposed solutions, and government response.

Breaking the Mold
Questions on government response, especially asking about leaders’ approvals, tend to poll predictably. Thanks partly to heightened partisanship, traditional health care surveys and new COVID-19 polls both follow closely to President Trump’s overall rating: a second similarity.

By some measures, the president’s scores on health care could be considered among the most elastic of any issue. In their polls tracking presidential approval, Gallup rotates over a dozen different items — ranging from the economy to foreign affairs to corruption in government — to gauge how President Trump is handling particular problems. Yet across 81 polls asking about 22 topics, only once has his approval rating for any issue dropped below 30 percent. Amid efforts to repeal and replace the Affordable Care Act throughout his first year, a June 2017 survey found 28 percent approval for President Trump’s handling of healthcare policy, opposed to 67 percent disapproval.

The counterpoint is that Gallup doesn’t include every topic in every survey. In fact, the organization has asked respondents their approval of President Trump’s healthcare policy only four times, all amid politicized debates — demonstrating a relative paucity of data on the subject.

Nonetheless, the apple doesn’t appear to fall far from the tree, as his health care ratings consistently resemble (if not lag a few points behind) his general approval and disapproval. Indeed, for other issues as well, President Trump’s specific scores parallel those overall; his approval has been remarkably, and historically, steady.  

COVID-19 put that to the test. At first, it appeared President Trump might benefit from a rally-around-the-flag effect, as his approval rating climbed to some of the highest peaks of his entire term. Yet, based on FiveThirtyEight aggregates, the present story is a tad different. 

Specifically in regards to his handling of the coronavirus, the president’s net rating (favorable–unfavorable) toes the line at –4 (46–50), made possible by a 70-point partisan gap. That’s still higher than his net overall job rating of –10 (43–53), though it appears any bumps from a brief rally-around-the-flag effect are all but gone. More importantly, just like other specific issues polled, his ratings here nearly match those generally. 

Contrarily, most governors’ approvals have skyrocketed because of their responses to the outbreak: state polls show many leaders with double-digit bounces, good for an average net rating of +42 (67–25). Some, such as Gavin Newsom of California, Andrew Cuomo of New York, and Mike DeWine of Ohio, now have approvals in the neighborhood of 80 percent.

These gains are so massive, an April 13 YouGov survey found Cuomo with higher nationwide support than President Trump. While gubernatorial mansion protests and early conspiratorial speculation portend potentially growing divides between Democrats and Republicans, this pandemic has undoubtedly “broken” partisan patterns in approval rating polling —  at least in the short term, and at least in some cases.

All that said, only a fraction of current governors are campaigning this year. So what does comparing traditional health care surveys to new COVID-19 surveys tell us about the upcoming election? Because attitudes change constantly as the situation develops, there’s a lot of uncertainty surrounding the end trajectory of public opinion. Thankfully, this lens for viewing coronavirus polls gives a few clues on what the physical and political environments will look like six months from now.

Top of Mind
First, the aforementioned catch-22 between health and economics is important. General sentiments will evolve — and leaders’ performances will be assessed — around that dichotomy of saving lives vs. opening shop. For another way of thinking about it, look at the variations in rally-around-the-flag effects: individual politicians’ responses can influence how they’re uniquely perceived.

Health care policy will also undoubtedly be an electoral flashpoint. The country was already on this path, as illustrated by CNN exit polling. When CNN asked voters in 2016 the most important issue facing the country, health care was absent from the list; for the 2018 midterms, it was not only the top response, but commanded a 41 percent plurality. Even among Americans who already thought health care was a deciding issue before the lockdowns, the Kaiser Family Foundation found in mid-February, 63 percent said it was “very important” in their decision for president. 

And considering 32 percent expect gatherings exceeding ten people to be unsafe until at least “later in 2020” (by way of an April 21 Washington Post/University of Maryland poll), it’s hard to imagine a future where COVID-19 doesn’t play a major role in the upcoming elections.