Reporter's notebook: How health care issues are shaping the 2024 presidential primaries

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You may have noticed there are presidential primaries underway. It’s hard to miss – even if, like me, you’re sometimes tempted to cover your ears and stick your head in the sand when it comes to the posturing and sniping of politics.

Despite that, I’m paying close attention because the stakes are enormous. Early voting has begun here in Massachusetts. And health is playing a pretty interesting role in both parties’ contests. Many voters have questions about the age and mental acuity of the leading candidates. There are also the impacts of the post-Roe landscape and — most recently — the Alabama court decision about frozen embryos that’s already having a chilling effect on fertility treatment.

With just a week to go before Super Tuesday, I asked WBUR Senior Political Reporter Anthony Brooks for his insights on how health care issues are impacting the primaries.

Here’s a lightly edited and condensed version of his responses to my questions.

Elisabeth Harrison: You did a lot of coverage of the New Hampshire Republican primary, and you’ve been talking to folks in Massachusetts before Super Tuesday. How often is abortion an issue they bring up, and what types of comments do you hear most often?

Anthony Brooks: The Supreme Court’s decision in Dobbs to overturn Roe v. Wade and a national right to an abortion has helped galvanize Democrats in recent elections. For example, New Hampshire’s Democratic Sen. Maggie Hassan leaned into the issue in a big way in her 2022 reelection campaign, which helped her beat back a challenge by Republican Don Bolduc. The issue helped Democrats overall in the 2022 midterms, and was one of the reasons Republicans under-performed.

But the issue was less dominant in the lead-up to the New Hampshire primary, particularly on the Republican side in the race between Nikki Haley and former President Donald Trump. In that race, voters were most concerned with the economy, immigration and war in Gaza.

EH: What about the candidates? How do you see them and their parties honing their pitches to voters around this issue — including in states like Massachusetts, which has strong abortion protections? 

AB: In general, Democrats believe the abortion issue can help them in a big way in 2024.

“A vote for Joe Biden and Kamala Harris is a vote to restore Roe, and a vote for Donald Trump is a vote to ban abortion across the country,” Julie Chavez Rodrigquez, Biden’s campaign manager told me. “These are the stakes in 2024.”

But abortion is hardly the only issue motivating voters. The economy, foreign policy, immigration, as well as concern about President Biden’s age are also big factors in the race. That’s true in Massachusetts, where a recent poll from Suffolk University found the top issue for Bay State voters was the future of democracy (27%); followed by immigration and border and security (25%); and the economy (18%). Fewer than 5% of voters said abortion was their top concern.

EH: Which voters seem to be the most motivated by reproductive health-related issues?

AB: In general, it’s fair to say abortion access and reproductive health is a motivating issue among Democratic women, particularly younger women. According to a 2022 KFF health tracking poll, the issue is “motivating majorities of Democratic women, women of reproductive age, and Democratic and Democratic-leaning voters in states where abortion is currently illegal.” (This may help explain why the abortion issue is not a top issue among voters in Massachusetts, where abortion rights are protected by the state constitution.)

EH: Verbal gaffes by President Biden and former President Trump and a stinging special counsel report stating Biden has memory issues — which Biden vehemently denies — are adding to a chorus of concerns about the age of both these candidates. When you talk to voters, how concerned are they about the age of Biden and Trump? One more than the other?

AB: I’ve talked to plenty of voters in New Hampshire and Massachusetts who feel that both Biden and Trump are too old. It’s one of the reasons that Republican Nikki Haley is running as “a new generational leader.” It’s hard for voters to ignore the issue of Biden’s and Trump’s ages.

Biden, 81, is the oldest sitting president in U.S. history, and it’s easy to see that he’s aged a bit since he was elected in 2020 and is more prone to unscripted verbal gaffes. That said, plenty of people within the Biden administration say he remains sharp and in command of his administration. Trump is only three and a half years behind him, and is certainly prone to verbal gaffes as well. While many Democrats express concern about Biden’s age, Trump’s supporters seem less concerned about their candidate’s age. This could be because Trump appears more vigorous and continues to offer plenty of energetic bluster at his rallies, while Biden has become more soft-spoken.

EH: Are concerns about these candidates’ ages ageism, or a legitimate question for voters to ask?

AB: It’s probably both. Plenty of medical professionals will tell you that people can remain sharp and intellectually fit well into their late 80s and beyond. As I said earlier, people around Biden say he remains sharp. That said, according to a recent ABC News/IPSOS poll, 86% of Americans think Biden is too old to serve another term as president, while 62% think Trump is too old. So, whether it’s fair or not, whether it’s ageist or not, there’s a lot of concern about their age.

EH: In the past, the Affordable Care Act has played a role in elections. Do you see it playing much of a role today?

AB: I don’t. The Affordable Care Act is very popular — and its popularity has only grown since its passage in 2010. According to KFF polling released this month, more than three-quarters of Democratic voters (77%) want the next president to expand the law, while only 39% of Republicans want it to be repealed completely. 

Opposition to the ACA was once a central focus of Republicans, but after several failed attempts to repeal it, the party has moved on to other priorities. As a candidate, Trump continues to say that if re-elected he would repeal the ACA, also known as “Obamacare,” and replace it with “something much better.” But he has been unable to articulate what would be better. And any initiative to kill the ACA would be unpopular with voters and likely a poor choice politically for Republicans.

Many thanks to Anthony for sharing his thoughts on health and the presidential primaries! You can find more of his recent reporting on the run-up to Super Tuesday in Massachusetts here and here.

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