Despite concerns about ACA and reproductive rights, health care was not a voting issue: Experts

Americans who voted to elect Donald Trump the 47th president in Tuesday night's election expressed concerns about several major issues, including the state of democracy, the economy, immigration and foreign policy.

The state of democracy in particular was the most important issue to voters, with 35% saying as much according to an ABC News preliminary exit poll, followed by 31% who said the economy was the most important issue to them.

Health care, however, did not seem to be a major voting issue for many Americans. Though abortion, for example, was among the top five voting issues, only 14% said it was their most important issue, the exit poll showed.

Experts told ABC News that despite concerns about the repeal of the Affordable Care Act (ACA) and further restrictions on abortion rights, other issues were top of mind for Americans.

"Health care issues are always a concern to people, but certainly there were other issues that were more important to people at this time," Dr. Perry Halkitis, dean of the School of Public Health at Rutgers University in New Jersey, told ABC News. "It seemed like the economy and migration were the biggest issues, but especially the economy. People expressed very serious concerns about prices, very serious concerns about the affordability of things, very serious concerns about inflation."

"And those surpassed concerns about health care access and or reproductive rights, and many people voted based on their pocketbooks instead of their health care rights and access," Halkitis continued.

Affordable Care Act

During his first term, then-President Trump tried several times to repeal the ACA but was unsuccessful. He was promising as late November 2023 to replace it, saying Republicans "should never give up" trying.

However, throughout 2024, Trump said on several occasions, both on social media and during the presidential debate, that he wanted to make the ACA "better" rather than replace it.

Ultimately, worries about heath care and potential changes to the ACA didn't even crack the top five voting issues in ABC News exit polls.

Halkitis said he doesn't think there will be radical changes to the ACA during Trump's second term because it's "baked into people's lives." However, he does worry about legislation or policies that could limit the types of services that are available from health care providers, as opposed to a complete repeal or dismantling of the ACA.

"One example is that in the state of Texas, about a year ago, the district court decided that the pre-exposure prophylaxis, which is the use of one pill once a day to prevent HIV, did not have to be covered by insurance of a particular company," Halkitis said. "I think things like that that speak to people's beliefs, whether correct or incorrect, [that] may affect the kinds of health care services that are provided to people, if the president-elect is to make any changes to the Affordable Care Act."

Another example is the federal contraceptive coverage guarantee. Under a provision of the ACA, most private insurance plans must cover the full cost of most contraceptives, such as birth control, without making patients pay out-of-pocket costs.

If the incoming Trump administration allows employers and schools to use religious and moral exemptions to prevent coverage of contraceptives, as the White House did during Trump's first term, this may lead to out-of-pocket costs that make contraceptives unaffordable to some, some experts told ABC News.

Also at risk could be those with preexisting conditions. Under the ACA, insurers cannot charge more or deny coverage to someone or their child because of a preexisting health condition. However, Vice President-elect JD Vance has suggested placing people with chronic conditions into separate risk pools, which could raise premiums for those with preexisting conditions.

"I hope that doesn't happen because that would actually be disastrous for so many millions of Americans," Halkitis said. "What I think would happen is that, if they were to modify the preexisting conditions clause, and put the people in a different bracket, is that it may become unaffordable for people to have health insurance."

Dr. Stephen Patrick, professor and chair of the Department of Health Policy and Management at the Rollins School of Public Health at Emory University in Georgia, said he thinks voters in future elections will be motivated to go to the polls if they see modifications to the ACA.

For example, Patrick said public opinion is generally favorable for provisions such as parents being able to keep their children on their insurance plans until age 26, as a 2019 KFF Health Tracking Poll found, which may have inspired people to go to the polls in past elections.

"We know that as you start to make modifications to things like the Affordable Care Act, people do care as we start to modify things, or change things when it affects their health insurance," Patrick told ABC News. "If you say to someone, 'keeping your kid on your health insurance until they're 26,' people generally are in favor of those types of policies."

Reproductive rights

Some political strategists believed that the U.S. Supreme Court's 2022 decision overruling Roe v. Wade would drive voters who support abortion rights to the polls to vote for Kamala Harris. Trump himself took credit for the ruling, boasting that he "was able to kill Roe v. Wade."

While supporters of legal abortion still broke strongly for Harris, Trump's approach focusing on states' rights appeared to resonate with voters who didn't view abortion access as incompatible with a Trump presidency.

In Arizona, 23% who voted "yes" on the state's initiative enshrining abortion rights in the state constitution also voted for Trump. In Nevada, where another abortion-rights measure was approved, 25% of "yes" voters likewise went for Trump, according to the ABC News exit poll.

"I think what we're seeing [in] the exit polls is that abortion was a very important issue among many, many voters. However, those voters did not all vote for Kamala Harris," Dr. Leslie Kantor, professor and chair of the Department of Urban Global Public Health at the Rutgers School of Public Health, told ABC News. "I think that there was actually a certain amount of confusion, which was sown pretty deliberately by the Trump-Vance campaign in the final weeks, trying to convince people that, in fact, they don't oppose abortion, when the track record clearly shows that they do."

Kantor said this is evident in statements by Trump and Vance in which they said the president-elect would veto a national abortion ban if it came across his desk, or in comments by Trump in which he said he would not use the 150-year-old Comstock Act to ban mail delivery of abortion medication.

Kantor noted that, despite Trump expressing pride for appointing justices to the Supreme Court to overrule Roe v. Wade, he was less vocal about abortion rights on the campaign trail.

"In 2024, when people are seeing the devastating consequences of the overturn [sic] of Roe v. Wade, he really backed away from that position and was much less clear, and voters were clearly less clear," she said. "Because when you see somebody who says, 'I think abortion should be legal in most cases,' and then voting for somebody who clearly does not believe abortion should be legal, you know that people have been confused."

Preliminary exit poll results from ABC News show that abortion was an important voting issue for young women, with about 19% of all women voters saying it was their most important issue, rising to 42% among women younger than 30.

Kantor further noted that she thinks young women are scared after reading news reports about women pushed to the brink of death or dying after medical care was denied because physicians were hesitant to act due to restrictions to state abortion laws. She added that some abortion care providers are also leaving states where abortion care is restricted.

"Young women are terrified about what's happening all around the country," Kantor said. "The truth is it isn't even safe to have a wanted pregnancy in this country. …So, I think young women are staring at 30 years, possibly 25 years, of having to manage their sexual and reproductive health with very few providers and very few rights."

It may be difficult to access abortion services even in states where care is now legal. In Missouri, voters enshrined the right to reproductive freedom in the state's constitution, effectively ending the state's restrictive ban. However, abortion for now remains unavailable in the state.

"Access to services is incredibly restricted and, at some point, having a right is meaningless if you can't actually get the service," Kantor said.

ABC News' Gary Langer and Gibran Okar contributed to this report.